Shepherd’s Pie

1 1/4 pounds small red-skinned potatoes
2 tablespoons extra-virgin olive oil
1 small onion, finely chopped
1 carrot, finely chopped
2 large tomatoes, chopped
1 1/2 tablespoons chili powder
Kosher salt
1/2 pound 93 percent lean ground turkey
1/2 pound 90 percent lean ground beef sirloin
1 1/2 cups frozen peas
1/2 cup low-fat milk, warmed
1/3 cup shredded low-fat cheddar cheese
Put the potatoes in a microwave-safe bowl and add 2 tablespoons water; cover and microwave until tender, 8 to 10 minutes. Let stand, covered, until ready to mash. Meanwhile, heat 1 tablespoon olive oil in a large skillet over medium-high heat. Add the onion, carrot, tomatoes, 3/4 teaspoon chili powder and 1/2 teaspoon salt; cover and cook, stirring occasionally, until the vegetables are tender, about 10 minutes. Transfer to a 2-quart baking dish.

Heat the remaining 1 tablespoon olive oil in the skillet over medium-high heat. Add the turkey, beef, the remaining 3/4 teaspoon chili powder and 1/2 teaspoon salt; cook, stirring and breaking up the meat with a wooden spoon, until browned, about 4 minutes. Stir in the peas and 1/4 cup water; simmer 2 minutes. Spread over the vegetables in the baking dish, then cover to keep warm.

Preheat the broiler. Add the milk and 1/4 teaspoon salt to the potatoes and mash well; mix in the cheese. Spread over the meat and broil until browned in spots, 1 to 2 minutes.

Per serving: Calories 448; Fat 19 g (Saturated 6 g); Cholesterol 77 mg; Sodium 847 mg; Carbohydrate 38 g; Fiber 6 g; Protein 32 g

Recipe courtesy of Food Network Magazine

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Snapping Hip Syndrome

Snapping Hip Syndrome, also known as coxa saltans or “dancer’s hip” is a vague term describing a snapping or popping sensation that occurs during hip movements. It is common in dancers, gymnasts, runners and soccer players, typically in the 15-40 year old age range, and is more prevalent in females than males.

There are two main categories and several subcategories for the presentation of snapping hip syndrome. The two main categories are intra-articular and extra-articular. Intra-articular snapping means that something is happening internally inside the joint. This occurs when a structure like the labrum or a bony fragment is pinched inside the hip joint; this type of snapping is uncommon. More frequently the sensation is caused by extra-articular sources. Extra-articular snapping is caused by a structure external or outside of the hip joint. This can happen when muscles/tendons snap across a prominent bony structure. The two most recognized extra-articular sources are: anterior snapping caused by the iliopsoas tendon, and lateral snapping caused by rolling of the iliotibial band.

Typically history and physical examination are used by a doctor to diagnosis snapping hip syndrome. MRIs and diagnostic ultrasound are imaging tools that can help differentiate between intra-articular and extra-articular sources. In a physical therapy exam, anterior snapping hip can present as snapping when the knee is flexed or while lowering a straight leg raise. Lateral snapping can sometimes be detected by side bending away from the affected hip and rotating the hip inward slightly.

Extra-articular snapping can typically be managed by conservative treatment. Often anti-inflammatory medications are prescribed by a doctor to alleviate pain. Physical therapy focuses on reducing inflammation, stretching tight structures, strengthening weak muscle groups, and correcting posture.

Surgeries are available if conservative management fails. This is rare for extra-articular snapping, but surgical approaches are available to lengthen snapping sources such as the iliopsoas and iliotibial band. Intra-articular snapping usually requires surgical intervention to remove or correct the cause of symptoms. Recovery from any of these surgeries typically takes 3-6 months before full return to pre-surgery activity level. Precautions include a period of non-weight bearing following surgery and a slow transition back into normal activity depending on the type of surgery.

 Submitted by Rachel Wilson, DPT

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Fish Tacos with Tomatillo Sauce


  • 12 ounces whitefish, such as cod or tilapia
  • Salt and pepper to taste (optional)
  • 1/4 head Napa cabbage (1 1/2 cups)
  • 1 teaspoon cumin
  • 2 teaspoons paprika
  • 1/2 teaspoon chili powder
  • 1/2 small yellow onion, diced (1/4 cup)
  • 2 tablespoons minced cilantro
  • 2 red Fresno peppers, diced
  • Zest and juice of 1 lime (1/2 teaspoon zest, 1 tablespoon juice)
  • 4 wheat tortillas (8-inch diameter), lightly grilled or toasted
  • 1/4 cup (4 tablespoons) green tomatillo sauce


Season fish with salt and pepper if you like. Then bake fish at 375 F for about 20 minutes until internal temperature reaches 145 F. Or grill fish if you prefer.

Place remaining ingredients except tortillas and green tomatillo sauce in a mixing bowl and toss to combine. Flake and place fish on tortillas. Top with cabbage mixture and a tablespoon of green tomatillo sauce, and enjoy.


Nutritional analysis per serving

Serving size :1 filled tortilla

  • Total carbohydrate 19 g
  • Dietary fiber 3.5 g
  • Sodium 512 mg
  • Saturated fat trace
  • Total fat 5 g
  • Trans fat trace
  • Cholesterol 48 mg
  • Protein 19.5 g
  • Monounsaturated fat 1.5 g
  • Calories 201
  • Sugars 0 g
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Roasted Corn, Pepper, and Tomato Chowder

There is nothing like a bowl of warm, hearty soup for these cold winter days.  And what makes it even better is when it is low in calories.  Try this recipe for something different.


3 red bell peppers, halved and seeded

3 ears shucked corn

1 1/2 pounds tomatoes, halved, seeded, and peeled (about 4)

2 tablespoons extra-virgin olive oil

4 cups chopped onion (about 2 medium)

3 (14-ounce) cans fat-free, less-sodium chicken broth

1/4 teaspoon salt

1/4 teaspoon freshly ground black pepper

1/4 cup (1 ounce) crumbled blue cheese

2 tablespoons chopped fresh chives


  1. Prepare grill to medium-high heat.
  2. Arrange bell peppers, skin side down, and corn in a single layer on a grill rack; grill 5 minutes, turning corn occasionally. Add tomatoes; grill an additional 5 minutes or until vegetables are slightly charred. Remove from heat; cool 10 minutes. Coarsely chop tomatoes and bell peppers; place in a medium bowl. Cut kernels from ears of corn; add to tomato mixture.
  3. Heat oil in a large Dutch oven over medium heat. Add onion; cook 7 minutes or until tender, stirring occasionally. Stir in tomato mixture; cook 3 minutes, stirring occasionally. Increase heat to high, and stir in broth. Bring to a boil. Reduce heat, and simmer 30 minutes or until vegetables are tender. Cool 20 minutes.
  4. Place one-third of tomato mixture in a blender; process until smooth. Place pureed mixture in a large bowl. Repeat procedure twice with remaining tomato mixture. Wipe pan clean with paper towels. Press tomato mixture through a sieve into pan; discard solids. Place pan over medium heat; cook until thoroughly heated. Stir in salt and black pepper. Ladle about 1 1/2 cups soup into each of 6 bowls; top each serving with 2 teaspoons cheese and 1 teaspoon chives.

Nutritional Information

Calories 155

Fat 7.2 g

Satfat 1.7 g

Monofat 3.9 g

Polyfat 1.2 g

Protein 5.4 g

Carbohydrate 21 g

Fiber 4.4 g

Cholesterol 4 mg

Iron 1.1 mg

Sodium 620 mg

Calcium 45 mg

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My Back Needs To Pop

Most of us have experienced the popping of a knuckle or a joint in the spine. However, few people understand what is actually occurring in the joint. Most of the joints in our body are filled with a fluid called synovial fluid. This fluid acts a lubricant to the joint surfaces and provides nutrition to the cartilage. One of the many components of the synovial fluid is nitrogen. Nitrogen is capable of being present in either a gas or a liquid state. When a joint is stretched a cavitation, or pop, can occur causing the nitrogen gas bubbles to form in the synovial fluid. When a joint cavitates many people experience a sense of relief. This is due to the fact that a cavitation triggers the release of endorphins, which are the body’s natural pain killer.

Many of our patients with unstable spines have been chronic “self manipulators” that constantly pop their own back or neck. This urge to self manipulate can actually be a type of chemical dependence due to the endorphin rush. The risk of continually doing so is that when the nitrogen gas forms in the joint it causes the joint to swell. If the joint is stiff, this can be beneficial to aide in stretching. However, if done over and over again this can lead to too much mobility and eventually instability at the spinal segment. Many people will state “my back needs to pop.” While they may be feeling tight, self manipulation lacks the ability to isolate a tight segment. If this person forcefully twists their spine the most likely segment to cavitate will not be the tight one, but one that is already very mobile. Over time this becomes the weak link in the chain and pops easier and easier. When a joint in the back is too mobile it forces the muscles in the area to work much harder to provide support. When these muscles get overworked, the back gets sore, and the person feels once again that they need to pop their back. The temporary relief provided by the endorphins makes the person think that they have successfully fixed the problem when in fact they have merely restarted the cycle.

While joint manipulation can be a useful tool in the hands of a skilled therapist, self manipulation lacks the ability to diagnose and treat the correct joint. Once an instability develops the proper course of treatment is a stabilization program to the affected region. While this can have a good outcome, the much easier solution is to avoid self manipulation to prevent the problem from developing in the first place.


Submitted by Joe Schmersahl, PT

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Bunion (Hallux Valgus)

A bunion is a bump on the medial side of the foot at the base of the big toe. This is a condition often characterized by spreading of the metatarsals and drifting of the big toe toward the other toes. Bunions are more common in women, with the most common causes being hereditary and poor footwear. Symptoms include pain along the medial side of the foot over the bunion, most notably when there is pressure on the bump due to tight shoes. Some individuals develop a callus on the ball of the foot as a result of the weight being transferred to the second toe.

Non-surgical treatment options include medication, altering footwear, and physical therapy. It is recommended to choose wider footwear to alleviate the pressure on the bunion that could further increase the angle at the first MTP joint. Toe spacers may help with mild deformities to decrease the angulation of the toes or the progression of the bunion. Your physician may prescribe NSAIDs to decrease inflammation. Physical therapy interventions include stretches to maintain flexibility of the great toe and foot, strengthening of the great toe, and gait activities to maintain the proper mechanics of the foot.

When non-surgical options have been exhausted, surgery may be indicated to correct the alignment of the first metatarsal and big toe. Depending on the severity of the bunion, your surgeon will choose the proper technique to correct the deformity. Post- operatively, it is important to return to wearing properly fitting footwear. Physical therapy may be prescribed post-surgically to restore range of motion and flexibility of the great toe and foot.

Caitlin Niemeier, MPT

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Balance Rehabilitation

Balance dysfunction is a common cause of falls in an aging population, which makes physical therapy intervention vital to prevent injury. Understanding the true cause of disequilibrium, or imbalance, is important for treatment.

There are three different systems that control balance: vision, proprioception, and the vestibular system. Visual feedback provides an image of one’s environment; decreased visual feedback can disrupt balance due to a lack of awareness of the environment. Proprioception is the perception of spacial orientation, or where one’s body is in space. A decrease in proprioceptive feedback can distort an individual’s ability to negotiate changing surfaces. The vestibular system provides a perception of motion and orientation in relation to gravity, as well as controls eye movement to permit a clear visual image of surroundings (Walter). Vestibular dysfunction from various causes can elicit a variety of symptoms including vertigo (dizziness), nausea, headache, imbalance, tinnitus (ringing in the ears), and visual disturbances.

The good news: physical therapy can help! Depending on the cause of symptoms, a general balance / strengthening program may be permitted for essential fall prevention. If symptoms are more vestibular / vertiginous in nature, vestibular rehabilitation may be warranted. Vestibular rehabilitation typically incorporates balance training and adaptation or habituation of activities that are symptom producing or magnifying. Balance and vestibular rehabilitation can be valuable and provide a substantial impact on one’s life with regard to fall prevention.

Lori Hooker, DPT

References: Jeff Walter, PT, DPT, NCS (Vestibular Rehabilitation Therapy: Practical Management of the Patient with Dizziness and Balance Dysfunction)

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Baked Parmesan Zucchini

Crisp, tender zucchini sticks oven-roasted to absolute perfection. It’s healthy, nutritious and completely addictive!


4 zucchini, quartered lengthwise

1/2 cup grated Parmesan

8 1/2 teaspoon dried thyme

1/2 teaspoon dried oregano

1/2 teaspoon dried basil

1/4 teaspoon garlic powder

Himalayan salt and freshly ground black pepper, to taste

2 tablespoons virgin olive oil

2 tablespoon chopped fresh parsley leaves

Instructions Preheat oven to 350 degrees F. Coat a cooling rack with nonstick spray and place on a baking sheet; set aside. In a small bowl, combine Parmesan, thyme, oregano, basil, garlic powder, salt and pepper, to taste. Place zucchini onto prepared baking sheet. Drizzle with olive oil and sprinkle with Parmesan mixture. Place into oven and bake until tender, about 15 minutes. Then broil for 2-3 minutes, or until crisp and golden brown. Serve immediately, garnished with parsley, if desired.

Total per serving: Calories 74, Carbs 4, Fat 5, Protein 3, Sodium 165, sugar 2


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Peroneal Tendonitis

Peroneal tendonitis is an inflammation of the tendons crossing the lateral side of the ankle. This can develop for several reasons including ankle sprains, fracture of the fibula, overuse from running, or from somebody with a high arch.

Symptoms include sharp pain along the lateral aspect of the ankle and foot with pushing off of the toes. Swelling and general soreness usually come along following activity.

Physical examination will show point tenderness along the peroneal tendons as the follow behind the ankle and insert into the foot. Resistance to turning your ankle outward (eversion) may also be weak and reproduce pain. A physician may order x-rays, an MRI, or ultrasound to find an underlying condition and to determine if there is a tear in the tendons or if it is simply inflammation.

Treatment for this condition includes rest for which a walking boot may be ordered. The physician may choose to prescribe an anti-inflammatory to reduce pain and swelling. Physical therapy is usually a necessity to restore normal range of motion and strength and to further determine the underlying imbalances associated with this condition.

Surgical treatment of peroneal tendonitis is a last resort and includes repairing the tear in the involved tendon or tendon sheath. Recovery is length at 3-4 months, but patients are often able to resume their normal activities.

Submitted by Brian Manning, MPT, CSCS

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Ingredients – original recipe makes 6 servings
6 skinless, boneless chicken breast halves 1 tsp. garlic salt
Ground black pepper to taste 2 T. olive oil
1 onion, thinly sliced 1 (4.5 oz) can diced tomatoes
½ c. balsamic vinegar 1 tsp. dried basil
1 tsp. dried oregano 1 tsp dried rosemary
½ tsp dried thyme

PREP, 10 min; COOK 25 mins; READY IN 35 mins

• Season both sides of chicken breasts with garlic salt and pepper.
• Heat olive oil in a skillet over medium heat; cook seasoned chicken breasts until chicken is browned, 3 to 4 minutes per side. Add onion; cook and stir until onion is browned, 3 to 4 minutes.
• Pour diced tomatoes and balsamic vinegar over chicken; season with basil, oregano, rosemary and thyme. Simmer until chicken is no longer pink and the juices run clear, about 15 minutes. An instant-read thermometer inserted into the center should read at least 165 degrees F (74 degrees C).

Calories, 196 kcal (10%); Carbohydrates, 7.6 g (2%); Cholesterol, 61 mg (20%); Fat, 7 g, (11%), Fiber, 1.2 g, (5%); Protein, 23.8 g (48%), Sodium, 511 mg, (20%), * Percent Daily Values are based on a 2,000 calorie diet.

Hint: For lower sodium, use sea salt and fresh garlic instead of garlic salt. There are recipes on the web to make your own low sodium vinaigrette dressing. Check out this article on low sodium in vinegar:

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