2 large eggs
2 TBSP skim milk
1oz low-fat cheddar cheese
1 TBSP olive oil
2 TBSP black beans (low sodium)
1 cup raw spinach
8” multigrain tortilla
1/8 tsp cumin
1/8 tsp chili powder
1/8 tsp onion powder
1/8 tsp garlic powder
Pinch of cayenne
1 tsp fresh cilantro (optional)

Prep time: 5 mins
Cook time: 7 mins

Heat the olive oil in a large nonstick skillet or cast

iron pan of your choice. Cook the spinach until fully

wilted. Remove from the heat and put spinach in a bowl.

In a separate bowl whisk together 2 eggs, 2 TBSP skim milk, cumin, chili powder, onion powder, garlic powder, and cayenne.

Reheat the skillet or pan used for the spinach, set to

medium. Reduce heat to low and add egg mixture as

well as cheese. Scramble until cooked through about

3 minutes.

Place tortilla on a plate with spinach in the center, then

add eggs, and blk beans on top. Cilantro if desired.

Pair with a glass of skim milk or calcium fortified

orange juice.

Nutrition Facts:


Nutritional benefits:

Skim milk provides a great source of lean protein, calcium, magnesium, phosphorus, zinc, and potassium. It is also rich in vitamins A, B2, B3, B6, B12, D, thiamin and folate. It is low in calories, fat and cholesterol.

Black beans are a great source of protein and fiber, rich in iron, phosphorus, calcium, magnesium, manganese, copper and zinc.

Spinach is high in insoluble fiber, vitamins A, K, C, folic acid, iron and calcium. 

What is Mechanical Low Back Pain?
There are many different diagnoses for someone experiencing low back pain, some more severe than others. The most prevalent cause of back pain is mechanical low back pain. This type of back pain is one of the less severe diagnosis, if caught in a reasonable amount of time. Mechanical low back pain refers to pelvic angles and muscle balance as related to the lumbar spine (low back). People of all age groups are developing a forward leaning body position and in the lumbar spine forward leaning is called an anterior pelvic tilt. 

Forward Leaning Pelvis (The Anterior Pelvic Tilt)
Abdominal muscles and back muscles are stabilizing postural muscles. When standing in a neutral position (normal posture) the gravitational line passes slightly behind our hips. The low back has a natural curve. When that curve increases it becomes abnormal and affects our pelvis creating an anterior pelvic tilt. Prolonged sitting in an office, car, or in general is a known cause for this issue. In an anterior pelvic tilt, muscles on each side of the pelvis become weak abdominals and glutes. Two other muscle groups hip flexors and erector spinae (back muscles) on each side of the pelvis become tight. This tilt causes stress on the lumbar spine. Think about a rubber band that has lost its elasticity; it is too weak and overstretched to do its job. In contrast, using a very tight rubber band to cover a large object. This instability and postural abnormality leaves people the potential to cause injury and is what causes most people back pain.  All these muscle groups should have the same strength and stability to hold the pelvis in a neutral position in relation to the lumbar spine. 

How To Alleviate the Problem
Correcting an anterior pelvic tilt:  decrease time spent sitting throughout the day as in an office or car. Sitting causes muscles to tighten in the shortened position and causes muscles to become weak in the lengthened position. Strength training of abdominals and glutes, stretching of back and hip flexors.  

Make stretching and exercise a part of your daily routine, make it a lifestyle choice. Postural health is just as important as your oral health. Anyone who has suffered from back pain knows it hurts just as much or worse than having a tooth issue. We spend at least 8 minutes a day taking care of our oral health with flossing, using mouthwash and brushing at least 2-3 times a day. Taking care of our postural health only takes 8-10 minutes a day with proper stretching and exercise. Exercises and stretching can be done all at once or spread throughout the day. 

Petty, N. J. 2006 Neuromusculoskeletal Examination and Assessment. New York, NY: Elsevier.



Photo by Clarisa Guerra on Unsplash

Osteoporosis Defined      
Osteoporosis is a musculoskeletal disorder that affects approximately ten million men and women in the United States annually. Osteoporosis is a condition in which a person’s bone mineral density lessens and bone mass decreases, therefore weakening bones and increasing the chance of fractures. This diagnosis can affect both genders, however, the occurrence in women is four times that of men. There are two types of osteoporosis known as primary and secondary. In primary osteoporosis, there are two subcategories.  Type 1 bone loss is associated with menopause due to decreased estrogen levels and type II bone loss is typically due to the aging process. In secondary osteoporosis, there can be multiple causes such as; prolonged immobility, careers involving space travel due to lack of gravitational forces, diet, eating disorders, drastic hormone fluctuations, and metabolic issues.  Osteoporosis can cause fractures in any skeletal structure with the most common sites being the hips, spine, and forearms.

Role of Nutrition and Exercise in Prevention and Management of Osteoporosis
Nutrition and daily physical activity play a key role in lowering the risk of developing osteoporosis. Daily intake of calcium is vital to bone strength and health.  The recommended daily amount is 1000-1200 mg. A well-balanced diet is always recommended as the best way to obtain calcium is through food sources, however, supplements can be utilized when needed.  Another important nutrition component for bone health is Vitamin D. Vitamin D can be obtained through food sources, supplements, and sun exposure. The recommended daily amount is 400-600 IU.

Physical Activity 
Another Important variable for optimal bone health is weight-bearing exercise and physical activity. When a person performs a weighted form of physical activity this places stress on the bone that in turn increases bone mineral density. The stress applied on the bone allows it to become thicker and stronger, lowering the risk of fracture. Research supports daily weight bearing activity to prevent or reduce the risk of osteopenia, the precursor of osteoporosis. Time interval recommendations for adults performing physical activity is at least 30 minutes and for children at least 60 minutes daily. Examples of weight-bearing physical activity include but are not limited to; walking, running, jogging, weight training, high intensity interval training, dance, gymnastics, and basketball.

 For adults, the importance of daily activity is to help maintain as much bone mass as possible. For children, the importance of daily activity is to build as much bone mass as possible. Ages nine through twenty have been shown to be the optimal time to increase bone density.  Therefore, it is crucial for our kids to be running and playing outside versus inside with television, video games, tablets, and smartphones. Being sedentary and not participating in daily activity for all age groups decreases bone mass and increases the risk of fractures.

Our evolving lifestyles and advances in technology are causing more people to be sedentary in nature. Whether you are sitting at home or at work, and not being physically active, this has the potential for causing injuries and conditions. Osteoporosis is one of the more serious conditions that people of all age groups can develop. This condition can be prevented with proper daily nutrition and daily exercise throughout one’s lifespan. If followed this will allow people to gain muscular and skeletal strength and enhance their lifestyles. 

Nieman, D. C. 2011 Exercise Testing
and Prescription, A Health-Related Approach, Seventh Edition. New York, NY: McGraw Hill.


Calcium Packed Breakfast Wrap

Recipe by: Brooke Rao, MS, RD, LDN

August 30, 2018

Osteoporosis and the Importance of Daily Activity in Children and Adults

By Dr. Jerome A. Rao, DPT

August 30, 2018


Photo by Olenka Kotykon Unsplash

Photo by Josh Feiber on Unsplash


Forward Head, Forward Shoulder Positioning Problem Defined

By Dr. Jerome A. Rao, DPT 

August 23, 2018 

A Type of Mechanical Low Back Pain: Anterior Pelvic Tilt 

By Dr. Jerome A. Rao, DPT   

August 25, 2018

Effect Of Forward Leaning Body Position
Forward head, forward shoulder positioning (lousy posture) leads to muscle weakness injury and pain. Forward head positioning lengthens the muscles on the cervical spine, forward shoulders lengthens the muscles of our shoulders and thoracic spine. This creates an imbalance of the front of our bodies with the back and causes muscle weakness. Most people would think if I have pain as a result of weak muscles, it is simple; lift weights in the gym to correct this.  However, to understand this problem specifically one needs to know the different types of muscles and fibers that compose them. 

Different Muscles Serve Different Purposes
Our musculature is made up of striated muscles and smooth muscles. Smooth muscles are the ones that line some of our internal organs such as those that perform tasks to aid in digestion. Striated muscles make up our musculoskeletal system, think the recent mainstream obsession to attain abs and glutes.   A critical difference between the two types of muscles has to do with strength in a lengthened position. Smooth muscle stays strong as opposed to striated muscle, which loses strength in a lengthened position.  

Postural muscles are stabilizing striated muscles, not known for power, like our quadriceps or hamstrings. They are known for sustaining symmetrical weight for long periods of time (endurance) and require a different muscle fiber for training.  There are two types of muscle fibers, which can be explained by thinking about one of my favorite activities, running. The first type is type 1, slow twitch; this is your long distance runner (aerobic activity). The second is type II fibers, fast twitch.  Type II can be further broken down into II-a moderately fast such as your short distance runner and type II-b fast such as your sprinter (anaerobic activity). 

How Does All Of This Relate To Posture? 
With our evolving lifestyles and advances in technology, we slouch (forward) at a desk, slouch watching TV, slouch on a phone or tablet.  This slouched position (forward head forward shoulder) causes asymmetry in our striated musculature that comprises the musculoskeletal system. The muscles on the back of our neck, shoulders, and back itself become stretched.  The muscles on the front of our neck, chest, and abdomen become tight leaving us prone to injuries.  These injuries can include herniated discs in the back or neck, muscle tears in the shoulder, inflammation of the cartilage in our chest, lack of inspiratory capacity (breathing), digestive issue and balance issues decreasing one’s quality of life.  How do we fix this problem facing modern society? It comes down to strengthening the elongated muscles and stretching the shortened muscles to create the symmetry our body needs to function optimally. Postural muscle exercises need to be performed utilizing type 1 fibers and training daily for endurance over time.

Stretching and exercise needs to be included in our daily lives which in turn will enhance our lifestyles. The solution is harder than the current trend of simply bracing oneself into the correct position which has been shown by research to atrophy or weaken musculature. Another trend is using technology to remind someone to stand up straight through a visual or vibratory cue, again this approach does not provide muscle training. To improve our posture, we must fix this asymmetry over time through exercise; one must stretch the anterior structures (chest and thorax) and strengthen the posterior structures (neck and back).  

Petty, N. J. 2006 Neuromusculoskeletal Examination and Assessment. New York, NY: Elsevier.




Shoulder Impingement

By Dr. Jerome A. Rao, DPT

October 11, 2018

Photo by Jesper Aggergaard on Unsplash

Have you ever felt pain or numbness while lifting your arm, carrying something, or simply laying in bed. If so you may have a shoulder impingement. 

To understand shoulder impingement here is a little background on the muscles involved, primarily shoulder stabilizers and scapula stabilizers. 

Shoulder Stabilizers
The Rotator Cuff is a set of muscles that provide strength and stability to keep the shoulder joint firmly together during movement of the arm. There are four muscles that make up your rotator  cuff; these include supraspinatus, infraspinatus, teres minor, and subscapularis. 

Scapular Stabilizers
For proper movement of the shoulder to occur, the scapula has to be positioned  appropriately in relation to the thorax.  The primary scapular stabilizers are the rhomboids, serratus anterior, trapezius, and levator scapula. 

Shoulder Impingement causing discomfort, pain, and a decrease in quality of life. 
Shoulder impingement can affect people of all age groups regardless of activity level. You can be an athlete or a sedentary individual and develop an impingement of your shoulder. This diagnosis occurs because of a mechanical abnormality affecting tendons that control shoulder movement. The tendons of the rotator cuff are squeezed between a bone when the arm is lifted up. 

Why does this painful issue occur?

There are several reasons that this occurs, some are preventable and some are anatomic.
     1. Bony structural abnormalities, simply stated a jagged bone that can cut your tendon.
     2. Repetitive loaded motion (lifting) especially overhead. For example the constant motion of lifting and               rotating a drill overhead.
     3. Postural and alignment issues, such as sitting lazily and slouched in a chair.
     4. Muscle weakness of the scapula stabilizers and shoulder stabilizers.  Causing these muscles to not have           the strength that is needed to function properly.

Creating perfect symmetrical movements of our shoulders relies upon scapular movement and stability with relation to the thorax. 

Poor posture (forward flexed positioning) interrupts this symmetrical movement and causes or contributes to shoulder impingement. 

Nieman, D. C. 2011 Exercise Testingand Prescription, A Health-Related Approach, Seventh Edition. New York, NY: McGraw Hill.