EndoPAT – A Life Saver


Perhaps you noticed the recent events in sports. Gary Kubiak collapsed at halftime during the Texans recent game. Rocky, the Denver Nuggets mascot, passed out as he was being lowered to the court at the start of the game. These events certainly make me think of my own health. First and foremost, routine care with a primary care physician is vital. They will perform a health physical and routine lab work and EKG to check for metabolic and rhythm abnormalities. Advanced testing can also be performed, but will only be positive if structural abnormalities already exist.

If only a test existed to warn us of problems that may be looming. Well, here it is… it’s called EndoPAT. EndoPAT is a non-invasive diagnostic test that diagnoses endothelial dysfunction. Endothelial dysfunction is the EARLIEST marker of something going wrong with the vascular system. The endothelium is the largest organ in the body. It is the inner lining of all our arteries and veins. Long before a plaque forms that physically blocks or occludes the artery, functional abnormalities occur. With poor dietary and lifestyle choices, these functional abnormalities lead to stiffening of the blood vessels. This can now be tested for with EndoPAT in a non-invasive way! These changes are REVERSIBLE! So before you have a major event such as the ones seen over the weekend, get your functional test done and know your risk!

The test is offered at both our NJ and PA offices.

See this link to see a video on how the test works – www.itamar-medical.com/What_is_EndoPAT

Rage Against the Gluten Machine!


Certainly you have all heard about gluten-free diets by now. Why is this all the rage? Why is avoidance of gluten helping so many people battle various problems from digestive issues to allergic symptoms? Theoretically it comes down to the proteins gluten and gliadin. These are proteins found in wheat. So what’s the big deal with these proteins found in wheat you ask? Well, certain individuals form antibodies to these proteins which essentially attack the gut lining. This is called Celiac Disease. This is the most severe form of gluten intolerance and it literally represents an autoimmune process. Autoimmune issues are some of the most difficult problems to treat and often involve heavy duty drugs that basically suppress the immune system (not good for fighting infections and overall health). If these people eat gluten, they will have serious problems. The gut lining is only one cell layer thick! That means it is very sensitive to the many insults it faces daily. The standard American diet is already a nasty insult. Add an autoimmune process on top of that and you have chaos!

But what about people who test negative for Celiac Disease but still have intolerance to gluten? These individuals often exhibit the same symptoms as those people with Celiac Disease but they don’t form antibodies to these proteins. That means the body is not attacking itself like the autoimmune process of Celiac Disease, but harmful inflammation occurs which irritates the gut lining in much the same way. How do you know you have this intolerance? One way is simply to avoid gluten and see whether this eliminates your symptoms. A more sophisticated way is to come to our office and have this tested with a food sensitivity test. It’s a simple blood test and will show exactly what foods your individual body is intolerant to. Simple!

There are patients I have seen that have tested negative for Celiac Disease and negative for intolerance to gluten but they still say to me that their symptoms get better when avoiding gluten. Why would this be? Almost always it’s because of another intolerance. The beauty of the food sensitivity test is that we also test for various chemicals and food additives. I’ve seen many intolerances to glyphosate in these individuals. What the heck is glyphosate you ask? Well, it’s in most of the food you eat. It’s a chemical and you may even be familiar with it. You probably spray it on a lot of the weeds in your back yard. It’s called Round Up. That’s right. You are all ingesting Round Up when you eat many foods including most of the wheat that is available to us. This makes sense now, doesn’t it? These patients are not intolerant to the food, but rather they are now intolerant to the chemicals that are sprayed on the food as pesticides. It’s sprayed on so many things that sensitivities develop. Amazing and disturbing!

If you have any symptoms of gluten intolerance including gastrointestinal upset, gas, bloating, diarrhea, cramping, etc, please consider getting tested. Don’t stop with a simple Celiac panel. Get tested for food and chemical intolerances as well. We offer this testing and it’s covered by most insurances. Simply call to schedule an appointment to discuss your issues and get on a path to wellness today!

Spring-time Running Tips; by Jason Green, DC


It took long enough, but it finally appears as though Spring is on its way.  With this winter dragging on the way it did, I personally cannot wait for the temps to rise and the sun to shine.  And now that the time has come, it’s time to lace up the shoes and start training for your big race.

For some of us, this may mean hitting the pavement for the first time since 2013.  Others may be polishing up the finishing touches on Boston Marathon.  And the rest are getting going with a 5k, 10k, or half marathon in mind.  No matter your running goals, experience or savvy; here are several tips to hit the ground running as we spring in the warm weather.

  1. Pick a race and sign up!
    Plain and simple, when there’s an end-all goal in mind, getting out the door and running is that much easier.  Although this can be a little intimidating to those who have never done it before, it can also be very rewarding.  It doesn’t matter whether it’s a 5k, 10k, 15k, half or full marathon.  Put it on the calendar and make the commitment.  You won’t be upset with yourself that you did!
  2. Commit to a training plan.
    Regardless if you are simply running for physical fitness or for competition, a little bit of structure can go a long way.  Don’t wing it, especially if you’re in a bit of a rut.  And if a little extra help is needed, sign up for training services or get a coach.
  3. Change up your stretching routine.
    Current literature suggests that static stretching (ex. stretching a single muscle group for 30 seconds) is effective only following an athletic activity.  Before beginning any run, warm up with dynamic stretching (actively stretching multiple muscle groups through constant controlled motion).  Dynamic stretching is designed to increase blood flow, increase range of motion, increase awareness of joint position, and increase athletic performance.  Not only that, but it’s also a lot more fun than laying on a floor for 30 minutes in a hurdler’s stretch.
  4. Treat yourself to a new pair of training shoes.
    You would think that this is a no-brainer, but you would be surprised how many experience runners limp into my office in their muddy, beaten-down running shoes with 10 months of wear on them.  The rule-of-thumb is every 400-500 miles, or 6 month maximum, to replace your trainers and prevent over-use injury.  They may not cosmetically look bad, but remember that the mid-sole, or cushioned part, will wear out before the harder out-sole.  So pick up some new running shoes, and do this by getting fitted for the proper set while at a reputable running store.

So mark the calendar, layout the training program, and get out there and train with a new found sense of intensity in that new pair of running kicks!

Anterior Snapping Hip Syndrome


If you are frequently experiencing a snapping sensation in the front of your hip, you may have a condition called snapping hip syndrome. The snapping sensation is felt in the front of the hip when you walk, run, or even rise from a chair. This condition is especially common when training uphill runs and stair climbing. Snapping hip syndrome is caused by repetitive use of the hip flexor muscle called the iliopsoas which lies along the front of the hip. This muscle may become tight and inflamed from rubbing over the hip bone during bending and extending motions of the hip.  In rare cases, hip cartilage may tear and cause the hip to lock.  Pain will accompany this condition and increase in intensity as the condition progresses without medical interventions or a change in activity programs.  Decreased active hip range of motion will result as the individual’s pain increases and movement patterns change such as limping.

Treatment for snapping hip syndrome consists of reducing or avoiding the activity that aggravates the pain.  For instance, one could perform other cardio workouts such as swimming or the individual can stop running uphill.  Applying ice to the irritated hip and taking over the counter anti-inflammatories (advil, aleve, ibuprofen, etc.) will help decrease the inflammation in the hip.  If the pain is impacting your daily life, physical therapy is highly recommended. Physical therapy will focus on stretching the quadriceps and iliopsoas muscles, strengthening surrounding hip and core muscles, and realignment of the pelvis girdle. In severe cases, treatment such as a corticosteroid injection to the front of the hip can decrease inflammation and provide pain relief.  If these symptoms sound familiar to you, please consult a medical professional to diagnose your symptoms and seek the appropriate treatment.

Get Ready for Winter Running! By: Katie Palmer, DPT


Winter running is a whole other beast compared to running outside in other seasons. In my opinion, winter running is for the strong and truly dedicated. While I choose to take my running indoors during the winter, I can appreciate all that goes into running in cold weather. The air and the surface are different, and it may lead to more injuries if you are not following a set of guidelines. If you choose to brave the cold, here is a set of guidelines I give to my patients who are winter runners to prevent injury:

1)      Layering and proper fabric with running clothes is first and foremost. Active.com recommends polypropelene fabrics when layering as opposed to cotton fabrics which do not wick away moisture. Make sure to be properly layered and keep from having too much skin exposed. Wearing a hat always helps me when I am playing tennis in the cold because it helps to trap the heat in.

2)      Warming up is more important than ever. Pre and post running stretches are still imperative! The research is still out on which is better, but in my opinion, you should be stretching before and after a run. Of course, you do not want to stretch cold muscles, so make sure to do a short warm up like jumping jacks or jumping rope indoors before doing your pre running stretching. It is important to maintain flexibility to prevent injury

3)      Diet and hydration are important. Make sure to eat a carb heavy diet the night before the race and avoid fried foods while training. Potassium rich foods such as bananas and leafy greens throughout training will help in preventing muscle cramps. Water intake is highly important during training and of course on race day.  It is usually recommended that you intake 4 to 6 ounces of water for every 20-30 minutes of running. For longer runs, an electrolyte based drink is necessary to replace lost electrolytes.

4)      If the road is slick or icy, I would work on the treadmill that day. While some websites say jogging in light snow is OK, it is hard to tell where there may be icy spots. Be safe and run indoors. If you slip and fall, you may be out of commission for a lot longer than you would like.

5)      Safety first! Wear protective and reflective clothing. Know when the sun is going to set (since it is a lot earlier than we always think) and make sure to be prepared. Bring a cell phone in case of an emergency and limit usage of music when near major highways.


Enjoy the weather safely!

The Functional Movement Screen By: Chris Cush, DPT


What is it? How does it relate to an athlete’s return to sport?

More and more of today’s individuals are working harder to become stronger and healthier. These individuals are constantly working to improve their activities by increasing their flexibility, strength, endurance, and power. A large number of athletes and individuals are performing high-level activities even though they are inefficient in their fundamental movements. Without knowing it, these individuals are putting fitness on dysfunction. This dysfunction is a physical or functional limitation. In order to isolate this dysfunction, the body’s fundamental movement patterns should be considered. The Functional Movement Screen attempts to pinpoint this dysfunction and alleviate it.

The FMS is comprised of seven movement tests that require a balance of mobility and stability. The patterns used in this screen place individuals in positions where weaknesses, imbalances, asymmetries and limitations become noticeable by a trained healthcare professional. The FMS focuses on correcting mobility first because quality stability is driven by quality proprioception (your body’s ability to sense where you are in space). Once these corrections are made the health care professional will then turn their focus on improving stability to maintain the individuals newly improved mobility.

The Functional movement Screen is also a good diagnostic tool for predicting re-injury in athletes and the weekend warrior trying to increase their fitness level. One study performed to assess FMS accuracy in determining re-injury stated that if the FMS score ? 14 then probability of suffering a time loss injury increased from 15% to just over 50%. Another study indicated that a significant amount of injuries were noted in athletes with right to left sided strength and flexibility imbalances (asymmetries). The seven movement patterns performed during the FMS are the Deep Squat, Hurdle Step, Inline Lunge, Shoulder Mobility, Active Straight-Leg Raise, Trunk Stability Pushup, and Rotary Stability. Our physical therapists perform the functional movement screen so if you are an athlete with an injury or a weekend warrior looking to increase your fitness level we would love for you to come in and see us!

How much Vitamin D should you take? By: Mike Dougherty, DC


With any over the counter supplement, there is sure to be various recommendations for what constitutes enough.  Vitamin D is an often recommended supplement that falls under this category as well.  The Institute of Medicine’s Food and Nutrition recommends 600 IU (standard for International Units) while the Endocrine society recommends 2000IU.   Sometimes there is too much information in society and sometimes, not quite enough to make the right decision.

In order to set their limits, the Vitamin D Council first looked at a study that determined what the level of serum vitamin D, or what’s present in the blood, was in those living at or near the equator.  From this study, they were able to determine that the people in this study were close to 46ng/ml.  Then, they determined from another study that serum vitamin D levels are partially genetic but closely related to body weight as well.  They presented a few goals when formulating their dose.

They wanted something that would help get most people to about 30-50ng/ml, would be easily to obtain at any drugstore or pharmacy, and would not cause toxicity.  From this they determined that for a normal bodyweight adult, 5000IU/daily is sufficient at getting serum D levels to at least 40ng/ml.  For those who want a bit more accurate calculation, they determined that roughly 35IU/per day/per pound of body weight was sufficient.

Vitamin D is often overlooked when it comes to blood testing, so don’t be afraid to ask your doctor.  There is more evidence emerging in regards to vitamin D supplementation.  The current literature sites vitamin D as immune-modulating, with anti-cancer and cardiovascular disease properties.  Preliminary evidence also seems to suggest that low serum vitamin D has a link with autoimmune disease.  So, when determining what you need in regards to supplementation, 5000IU seems to be a good place to start, especially with this winter thus far.

Understanding neck pain: A non-surgical approach to diagnosis and management By: Mike Dougherty, DC


Pain that originates in the shoulder, arm, or upper back can arise from the neck.  Differentiating between them can be tricky and should be managed by a licensed healthcare practitioner.  In this article we will look at information to help understand the process of identifying the pain.

What your MRI says:

One study looked at the MRIs of individuals without pain.  In this case, cervical intervertebral discs of 497 asymptomatic subjects by were assessed.  In each subject, ?ve disc levels from C2-C3 to C6-C7 were evaluated.  What they found was the frequency of all degenerative ?ndings increased linearly with age. Disc degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age.  The take home message here is that MRIs are a tool to help us make a clinical decision.  People without pain can have abnormalities in the spine as well.  We should never use MRI to help us solely make our decision.

Pain generators in the cervical spine:

We typically think of four different pain generators; nerve root, disc, facet joint, or muscle.  Let’s take a look at each one.

Nerve root lesions occur when there is compression of the nerves that exit the neural canal.  Usually, there is a pain distribution that corresponds with the irritated nerve or nerves specifically.  The irritation can be from a bone, disc, chemical irritation, or all of the above.   When there is compression due to a multitude of factors, sometimes the word “stenosis” is used.  This is a Latin word that simply means “narrowing.”  It’s descriptive rather than diagnostic.  It’s the same as saying the word “sciatica,” which is Latin for “leg pain.”  We know you have leg pain or that there is spinal narrowing, but why or from what should be the real question.

Now, we know the disc is involved in nerve compression but what about just disc pain.  A disc derangement is typically one sided, with or without radiation, usually to the shoulder blade, trapezius muscle, or deltoid muscle.  There tends to be an absence of neural tension signs with limitations in specific ranges of motion.  Patient’s will often say, “I felt like I slept wrong,” and have pain and stiffness first thing in the morning.

The facet joints are the joints that make up either side of the spine.  These are typically where the clicking and popping sounds heard in the spine come from.  They sometimes take a little more detective work to find but there usually is clinical history with imaging findings.  The patient may have pain with extension (tilting the head back), and pain with provocative testing to the facets .  There is typically restriction in range of motion with similar referral patterns as discogenic pain.  Patients will often complain of cervicogenic headaches, or those arising from the back of the head into the top of the head face, and sometimes even the eye.

Muscular pain alone is rarely a clinical condition in and of itself.  It tends to be contributory in nature and related to an underlying spinal problem.  We do see some muscular spasms with postural faults or syndromes.  For instance, Kapandji, Physiology of the Joints, Volume 3 wrote:  “For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.”

Understanding where your pain is coming from can sometimes ease worrying.  It’s also important to realize that what an old MRI says doesn’t have to define you.

Benefits of Coconut Oil By: Susie Clothier, DC


Over the past couple years I’m sure you’ve started hearing more and more about coconut oil. Coconut oil is made up of antioxidants, Medium-chain triglycerides (MCT), Lauric acid, Carprlic acid, and Capric acid. Below I’ve listed some of the benefits of coconut oil and why you should be using it as soon as possible to benefit your health.

Skin Care

The MCT in coconut oil act as a natural skin conditioner. Deeply penetrating and moisturizing, they protect against environmental and free radical damage, it also helps with anti-aging, eczema and even provides some sun protection.

Hair Care

Coconut oil is one of the best ways to provide nutrients to your hair. The fatty acids condition deeply from the insides of the strands out. Providing protein, eliminating dandruff, and aiding in re-growth. Many people use it as a conditioner as well.

Stress Relief

Coconut oil is very soothing. The natural aroma of coconut is also very soothing. You can apply the oil to your hands and gently massage to help remove mental fatigue.

Weight Loss

The fatty acids in coconut oil destroy candida (yeast overgrowth), which triggers weight gain, carbohydrate cravings, and fatigue. They’re easily digested and converted into energy, which helps to speed up metabolism and help burn stored fat.


The unique saturated fates of coconut oil contain antibacterial, anti-viral, anti-fungal, and anti-parasitic properties that help to strengthen the immune system. Consuming coconut oil regularly will reduce incidence of sickness.


Lauric Acid (found only in breast milk and coconut oil) is converted into monolaurinin the body. This may destroy bacterial and viral infections like measles, influenza, hepatitis C and even HIV. Monolaurin may also eliminate Athlete’s foot.


MCT molecules in coconut oil are small so they are easily digested with less strain on the pancreas and digestive system. People suffering from diabetes, obesity, gallbladder disease, or Crohn’s disease may benefit greatly from coconut oil.


Coconut oil may improve insulin sensitivity and glucose tolerance over time. It helps regulate blood sugar levels and protects against insulin resistance. It can even prevent type 2 diabetes.

Heart Health

The fat in coconut oil does not have a negative effect on cholesterol. In fact, it helps improve your cholesterol profile. It helps prevent heart attacks and stroke and may even cure heart disease.

The key is to buy organic, unrefined, cold-pressed, extra-virgin coconut oil.

Optogait’s contribution to Rehab and Performance By: Jake Caulfield, ATC


We, at Performance Spine and Sports Medicine, like utilize every possible option we have available when diagnosing, prescribing and treating our patients.  We like to look at the every piece of the puzzle that is getting our patients better.  One of the puzzle pieces we like to use is the OptoGait/OptoJump systems.

The OptoGait is a system we use for gait analysis and sports performance analysis.  The OptoGait consists of 192 LED sensors that can be positioned on a treadmill or floor.  The data is collected when there are interruptions between the two bars, and is accurate within one thousandths of a second. When placed on the treadmill we are able to gain quantitative data that correlates to all phases of gait.  The system collects real time data that can be analyzed by your provider immediately after performing the test.  When looking at the gait analysis we look at a few major components of the gait pattern, step length and the load response (force exerted into the ground when propelling yourself to your next step).  With the data that we collect, we look for any asymmetries between your right and left leg.  With the use of this data, along with a video recording of your gait pattern, the rehab team is able to determine faults in your gait, if you have any.  They will also be able to piece together whether a fault in your gait is the cause or result of any pain that your may be experiencing, or could experience in the future.  With this data, the rehab team is able to create a personalized corrective exercise program that will help correct any faults in your gait and posture and get rid of your pain.  We retest your gait after a set number of rehab visits to show data on any improvements that have been made.

For our sports performance analysis we look at important factors that directly correlate to competitive athletics.  We are able to test like jumping, leg strength compared left to right, reaction time and quickness.  A baseline test for sports performance is the first thing we will do, then after analyzing the data we will be able to create a program that is personally fit for the athlete to strengthen and weaknesses present.  With the use of cameras and computer technology, we are able to show an athlete exactly what they are doing and what we want of them during any exercise that they may be performing.  After a set amount of sports performance sessions, we will retest you on the OptoGait to show any improvements.

Although the OptoGait is just one factor that goes into your rehab, it is a very valuable piece to the puzzle that is getting you better.