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Squatting in Gym

Knee Pain When Squatting?

Knee Pain When Squatting? 1200 799 ResilientRx

“My knee hurts when I lift weights or run- what’s going on?”

It’s incredibly common for people who engage in fitness activities, like weightlifting and/or running, to experience anterior knee pain. This is pain in the front of the knee in the area around the knee cap (the patella). In fact, as much as 85% of the population may experience some type of anterior knee pain! The onset can come on both slowly over time or acutely. And as the title of this blog implies, it is a nagging issue because there is up to a 90% recurrence rate in affected people (Willy, et al., 2019). Both acute and chronic anterior knee pain can be quite debilitating when in a flared state, making simple daily activities such as standing up from a chair or climbing stairs daunting.

Common diagnostic labels you may have seen (or even have been told you have) are:

  • Patellofemoral Pain Syndrome
  • Chondromalacia
  • Jumper’s Knee
  • Runner’s Knee

The good news is, that despite the different diagnoses listed above, they tend to have similar qualities and contributing factors and therefore are treated similarly.

Individuals often will experience pain with activities that involve loaded, impactful, or repetitive movements that involve knee flexion such as running or squatting. The pain felt in the knee is often anywhere along the borders of the patella, referred to as the peripatellar region, or felt behind it, referred to as the retropatellar surface. Anterior knee pain is often poorly defined, meaning that it may jump around and change locations and severity at any given point.

What is the cause of knee pain?

According to the research, there is no single definitive cause of anterior knee pain. Multiple factors are thought to play a role and can be divided into physical and nonphysical influences.

Physical factors may include:

  • Hip and quadricep strength
  • Hamstring flexibility
  • Ankle/foot stability
  • The capacity of the knee’s tendons to handle external load.

These physical factors can increase or alter how the patellofemoral is mechanically loaded.

Non-physical influences include:

  • Stress
  • Psychological state

These affect the nervous system and can sensitize the body’s tissues and keep them in a persistent painful state

How to treat knee pain

Studies show that the most effective treatments for anterior knee pain include exercises that strengthen the muscles of the hip and quadriceps. Typically, the exercises start out by gently working the muscles without placing too much stress on the knee joint or increasing symptoms. Then gradual loading and progressive strengthening exercises over time are utilized to improve the mechanics of the entire leg. Other interventions such as patellar taping and foot orthoses along with exercise can improve pain, but should only be used for a short period of time early-on.

Make a plan

For the majority of patients, the “educate and wait” approach of simply avoiding pain-provoking activities has been shown to be ineffective in improving pain and function in the short, medium, or long term. This is what leads to recurrence of pain/symptoms and keeps people sidelined longer than they should be. Early physical therapy intervention, along with proper guidance on modifications to activity and exercise, can speed up the recovery process and get you back to a pain-free lifestyle.

Struggling with knee pain?

Written by Nick DiSarro, PT, DPT, OCS


Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., … & Torburn, L. (2019). Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1-CPG95.


The content in this post is intended for educational purposes only. No information in this post is to be taken as medical or health advice. See a healthcare professional if you have any questions about your individual needs.

PH Scale

Why do I keep getting yeast infections?

Why do I keep getting yeast infections? 1024 540 ResilientRx

Chronic UTIs, bacterial vaginosis and yeast infections can occur for a variety of reasons.

In order to understand why chronic vaginal infections occur, we need to review the pH scale.

The scale goes from 0-14:

  • 0 being acidic
  • 7 is neutral
  • 14 being alkaline (or basic)

In its natural state, the vagina is more acidic, with a pH of about 4. Changing the pH of the vagina can have a direct effect on the vaginal environment which can cause a variety of symptoms.

Here are a few things that can change the vaginal pH:

  • Sperm: This is more basic, ~7 pH. Some may think they are allergic to sperm, but in reality that their vaginal pH is off which is causing a reaction to the sperm.
  • Stress: Increased blood sugar
  • Soap
  • Detergent
  • Lube
  • Diet: Foods high in sugar
  • Douching
  • Wet clothing
  • Tight clothing: Clothing that traps moisture
  • Medications: Like antibiotics
  • String from the IUD
  • Decreased estrogen: Menopause, breast feeding and taking oral contraceptives decrease estrogen, which decreases acidity (Harvard Health Publishing, 2019)

Decreased acidity in the vagina can cause:

  • Dryness
  • Yeast infections
  • Recurrent UTIs
  • Bacterial vaginosis
  • Pelvic pain

Maintaining healthy bacteria in the vagina is important in reducing risk of infections.

Lactobacillus is the most dominant bacteria in the vagina (over 70% in asymptomatic reproductive age women). It also produces lactic acid which causes the acidity in the vagina and this is what keeps the vaginal environment in equilibrium. Loss of lactobacillus is linked to chronic bacterial vaginosis (Tachedjian, et al., 2017).

In addition, bacterial vaginosis (BV) can cause issues with fertility.
“Bacterial Vaginosis is three times more common in infertile women than fertile women” (American Pregnancy Association, 2020). BV, and other infections in general, can decrease fertility in a number of ways:
  • Increasing inflammation and immune system activity, making a toxic environment for reproduction
  • Causing damage to sperm and vaginal cells
  • Interfering with the production of healthy cervical mucus during ovulation
  • Blocking the fallopian tubes through scar tissue damage from infections, so that sperm and egg can’t meet” (American Pregnancy Association, 2020).
If you are experiencing chronic pelvic infections, you may want to consider looking at some of the suggestions above to see if restoring your normal vaginal pH can help reduce your chronic infections.

Tips to reduce chronic pelvic infections:

  • Only wash your vulva and vagina with water
  • Try to use unscented detergents without harsh chemicals
  • Try a low sugar/carbohydrate diet
  • Reduce your stress levels
  • Air out your vagina: Try going without underwear to reduce bacterial growth from excessive moisture
  • Avoid tight or wet clothing for long periods of time
  • Talk to a pharmacist or your physician about a vaginal probiotic, especially if you are taking an antibiotic
  • Change out your tampons regularly.
  • Don’t douche

As always, you should consult with your physician first.

Written by: Mary Grimberg PT, DPT, OCS

Sources: Harvard Health Publishing. (2019, March). Vaginal yeast infection. Retrieved February 3, 2021, from https://www.health.harvard.edu/a_to_z/vaginal-yeast-infection-a-to-z

Tachedjian, G., Aldunate, M., Bradshaw, C., & Cone, R. (2017, April 20). The role of lactic acid production by probiotic lactobacillus species in vaginal health. Retrieved February 3, 2021, from https://www.sciencedirect.com/science/article/pii/S0923250817300839#bib18

American Pregnancy Association (2020, October). Bacterial vaginosis and fertility. Retrieved February 3, 2021, from https://americanpregnancy.org/getting-pregnant/bacterial-vaginosis-and-fertility-68826/

Back Pain

Lumbar MRI: Do I need one?

Lumbar MRI: Do I need one? 1200 799 ResilientRx

Many people with low back pain (LBP) have asked this question and wondered if an MRI will help guide them down the right path to recovery. Up to 80% of us will experience some form of LBP at some point in our lives. The great news is that the majority of low back pain cases are not serious.

What should I do if I have a new onset of low back pain?


While you may have to temporarily refrain from more intense activities such as running or weightlifting, avoid complete bed rest and try to maintain gentle movement and activity within your tolerance.

Consult your healthcare provider.

Preferably, consult one who will manage your case conservatively first, like a physical therapist (PT). PTs are trained to do a thorough subjective interview, medical history intake and physical assessment to rule out red flags. From there they will either proceed with treatment or make the appropriate referral to a specialist.

Degenerative disc disease and bulging discs are common.

In 2015, researchers took MRIs of the low backs of over 3000 people who did not report back pain and found some interesting results- of the subjects in their 30s, 50% had “disc degeneration” and 40% had “disc bulges” although they were asymptomatic. The study noted that these percentages increase across decades of life. For example, 60% of people in their 50s had these findings, 70% of people in their 60s, and so on (Brinjikji, et al, 2015).

What we know is that LBP has multiple contributing factors that extend beyond structural changes alone. In the study mentioned above, we can conclude that the “disc degeneration” described should be considered a normal part of human aging- like “wrinkles on the inside.”

Treat the Human, Not the Image.

Scans have their place and they are also just one snapshot in time. They don’t always tell us the entire story of the person that stands before us. It’s been found that early & unnecessary imaging for LBP is expensive and actually leads to poorer patient outcomes (Jacobs, et al, 2020). Not to mention that the average cost of care when getting an MRI first is $6,664, compared to $1,871 when physical therapy is sought first (Fritz, et al 2015).


  • MRIs have their place and are useful in detecting more serious conditions such as tumors, fractures, and infection.
  • Other findings such as degenerative changes and bulging discs, although commonly seen, offer very little information on a person’s overall condition and correlate poorly with a person’s pain and function.
  • Premature imaging of the lumbar spine in an episode of LBP is costly and in most cases, can do more harm than good.
  • We never disregard someone’s MRI findings or their concerns, but instead place more emphasis on looking at the individual from a holistic perspective.
Struggling with lower back pain? Have some questions?

Written by Nick DiSarro, PT, DPT, OCS


Fritz, J. M., Brennan, G. P., & Hunter, S. J. (2015). Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges. Health services research, 50(6), 1927-1940.

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

Jacobs, J. C., Jarvik, J. G., Chou, R., Boothroyd, D., Lo, J., Nevedal, A., & Barnett, P. G. (2020). Observational Study of the Downstream Consequences of Inappropriate MRI of the Lumbar Spine. Journal of general internal medicine, 35(12), 3605-3612.


The content in this post is intended for educational purposes only. No information in this post is to be taken as medical or health advice. See a healthcare professional if you have any questions about your individual needs

Running on Track 2

Postpartum Running: When Can I start?

Postpartum Running: When Can I start? 1200 629 ResilientRx

After delivering a baby, you might be wondering when can I start running again? This is a very common question clients ask at the clinic. It’s important to consider a more gradual return to pre-pregnancy fitness levels, especially when it comes to running.

According to a group of physical therapists’ research on returning to running postnatal, they recommend that “returning to running is not advisable prior to 3 months postpartum or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running” (Goom et al 2019).

Why wait 3 months?

For many, this may be hard to follow. However, consider that women require adequate time to heal and regain strength after giving birth. Pregnancy and birth (whether vaginal or cesarean) have a huge impact on the abdominal and pelvic floor muscles, often leading to muscle weakness, incoordination, and dysfunction.

During pregnancy and early postpartum, increased body weight has allowed for a forward shift in your center of gravity causing your body awareness in space to be totally thrown off and your body learns to compensate. During this 3 month period, you’ll likely notice that doing certain activities you did before now feel completely different. In addition, you may be experiencing pain, discomfort or urinary leakage with those activities.*

Low Impact Exercises Postpartum:

During your three month healing period, the following can be generally helpful:

  • Basic core activation
  • Walking
  • Squats
  • Lunges
  • Lifting
  • Swimming
  • Cycling

What’s next?

Prior to getting back to running, your physical therapist will help you achieve adequate strength and control of your pelvic floor and hip musculature and help you manage impact and load on the body.

Once cleared by your physical therapist, a “graded return to running” plan (e.g. starting with short distances to longer distances) can be implemented. During this period, you should continue to monitor for signs and symptoms while building training volume.

At ResilientRx, we offer 1:1 care and work with you to meet your individual needs. If you are experiencing symptoms of urinary incontinence, pain, pelvic organ prolapse, or any other musculoskeletal issues, and want to get back into running again, seek help from us to guide you in the right direction.

Written by Michelle Andoy, PT, DPT

*Remember to reach out to your healthcare providers, including a pelvic health physical therapist, to figure out the root causes and address these symptoms. Although not traditionally routine after every birth, there is always an option to receive a comprehensive pelvic health assessment from a pelvic floor physical therapist.

Sources: Goom, T, Donnelly G, Brockwell E (2019). Returning to running postnatal–guidelines for medical, health and fitness professionals managing this population. Retrieved from: https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population

Running Outside

Quarantine Workout Plan

Quarantine Workout Plan 1500 998 ResilientRx

Have you felt disconnected from your body since COVID-19 hit? Have you been experiencing increased stress affecting your mental health? Judgement around your body?

You are not alone!

We all remember in March of 2020 when COVID-19, something that previously felt so far away, truly hit us at home. We were told to shelter in place, removing us from our regular ways of self care and joy.

Gyms shut down, the demand for at home exercise equipment skyrocketed and then effectively sold out (some still not available today!) and we were left wondering what we’d be doing at home for coming months.

Mental Health, Fitness + Self-Care

When expenses and mental health are challenged many people lose their ability to find an outlet in fitness affecting not only their strength, but their motivation and mental health.

We’ve heard this time and time again- when there are disruptions like COVID-19, “our normal capacities to regulate stress” are undermined. Unfortunately, social connection and physical wellness through movement are protective factors when it comes to our well-being (Katella, 2020) and they took a big hit. It is important to be kind to yourself and continuously remind yourself that you are not alone and you have the ability to return to where you were prior to the pandemic or find a new space of contentment or even joy as you explore new ways of moving and being.

Here at ResilientRX, we are seeing an influx of clients who are significantly distressed about their exercise performance. Many people are sharing that they are the weakest they have ever been in their lives. This has caused not only physical distress, like exacerbating old injuries, but also mental stress as judgment and worry creeps in- “Can I get back to where I was?” or “How can I find calm when my body feels out of alignment or pain and I can’t use my regular emotional outlet?”

Give Yourself Mental Space + Grace

One way to ease yourself back in is to be gentle and give yourself grace. Trying to go back to where you were in February or March may set you up for a future injury and disappointment. This could further exacerbate not only your physical inability to move your body but also your mental fortitude to commit to it.

Yes, many of us have experienced changes in our bodies. Know that it doesn’t change your value as a human. Whether your goal is getting strong, moving your body safely or getting back to your pre-pandemic way of movement and joy, it can happen.

How to safely return to exercising:

  • Start with walk-jog intervals.
  • This allows your body to slowly adapt to the impact.
    • For example, if you used to run 3 miles a day, try walking for 2 minutes and jogging for 1 minute. Try this for about a mile or so. Give yourself a day to recover, and see how you feel.
  • Are you sore? Maybe try just walking or riding a bike to allow your body to actively recover.
  • Are you experiencing joint pain? Try decreasing your distance or decreasing your jogging time and try again.
  • Try to wean back into your workouts with higher repetitions and lower weight. This allows your body to slowly adapt to the weight changes. Try out a few different things:
    • For example, if you were lifting 100 lbs prior to COVID-19, try ¼ of the weight first to see how you feel. Try doing higher repetitions of the 25lbs and see how you feel the following few days.
  • If you feel no difference, then increase your weight
  • If you feel pain in your joints, try to decrease the weight
  • If you feel just sore, try to stay at that weight for a week or so and slowly increase the weight.
HIIT training:
  • Before adding impact or high intensity interval training, make sure you have a base level of strength.
  • If you can perform a push up, a full body plank and a squat with proper form and without pain, you likely can start pushing yourself with interval training or impact.
  • If you cannot do these yet, try slowly working up to these exercises.
  • If you cannot do a push up or a plank, over a couple of weeks, try a push up or plank on a wall first, then on a counter, then on a chair then on your knees.

Always check in with yourself and ask:

  • Am I sore in the muscles that I am targeting?
  • Is this pain in my joints? If so, decrease your weight and/or correct your form

If you have any specific questions about your exercise routine, we would be happy to do a telehealth or in person visit. Our goal is to help you meet your goals and to empower you to understand your body so you stay active, pain free and stress free.

We are here for you and you are never alone! ResilientRx is your team and we are here to help you overcome this crazy time! Click HERE to book an appointment.

Have some questions? You can book a phone consultation HERE.

Written by: Mary Grimberg PT, DPT, OCS & Francesca Budesheim, MSSW, E-RYT


Katella, K. (2020, August 05). Taking Your ‘Mental Health’ Temperature During COVID-19. Retrieved January 07, 2021, from https://www.yalemedicine.org/news/mental-health-covid-19