NPS and Pediatrics – Part 1


The world of Nail Patella Syndrome can be scary and intimidating at times for yourself, your child, and your family. While most of the time, NPS is genetic and passed down from a parent, there are also times when it presents spontaneously and your child may be the first one to have it in the family. In any of these cases, having a child with NPS may leave you questioning what to do? Diagnoses and treatments change every year and likely the healthcare world is vastly different from when you were a child.

First things first, find a healthcare professional who knows what you’re talking about. Nail Patella Syndrome is not common, it is a rare disease. More and more clinicians are becoming aware of rare diseases; however, it will continue to take time. And heck, even if your healthcare professional does know about it, that doesn’t necessarily mean they will know which direction to go in regards of treatment. They will likely use the best evidence out there (which is, again, lacking) to provide the most adequate treatment. My hope is that you can use this article (as well as the others) as a resource when it comes time to talk to your physician, PT, other clinicians!

As a physical therapist, we are taught about many developmental impairments that may delay or impair function in children. Of course, NPS is not one of the main syndromes we focus on; however, as a profession, we focus less on the medical diagnosis and more on the functional impairment based diagnosis. We consider the background of what is going on medically, make sure we are aware of any precautions or restrictions, and then treat each individual appropriately. As we are all different human beings, it is important to remember that no child with one syndrome will present identical to another child with the same syndrome. In fact, there may even be times when one child may present more similarly to a child who has a different medical diagnosis. It is important to consider this and then move onto our specialty and focus on functional movements.

Here are a few things to keep in mind when working with a child with Nail Patella Syndrome (Fong Disease):

Clubfoot or “Pseudo-clubfoot”: Pseudoclubfoot ? This may just have been made up by me just now – but I believe it is really a thing. Basically, it may appear similar to clubfoot, but by definition and presentation, it is actually anatomically different. You see, clubfoot (congenital talipes equinovarus) presents with foot deformities where the mid foot and forefoot are medially spun in regards to the hindfoot. Muscle contractures may be present in this, but it may also depend on how severe clubfoot is and whether it is a fixed deformity or flexible. A great link that provides some insight on clubfoot is seen here:

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Typical clubfoot is treated more with the Ponseti method. Other deformities (as I call “pseudoclubfoot”) may appear like clubfoot with abnormalities at the foot and ankle; however, the rotational component may be coming from higher up at the tibia or femur. This is important to recognize early as it can drastically change medical and physical treatment as well as improve the outcome for a child. Treatments here can range from very conservative- just letting the child grow up and hope the cartilage and bones naturally align (if it is not that severe), to casting, to other surgical repair or external fixation. Again, if the rotation is coming from somewhere other than the foot, it is important to recognize this early and perform appropriate clinical tests (tibial torsion test, femoral ante/retroversion test) to determine the best treatment. Check out this link for other rotational deformities you may see!

Toe walking – This may be present and may be for a variety of reasons. Whether it be due to a contracture (muscle shortening), neurological, or by choice, the best thing to do here is to talk your physician and physical therapist. Surgery may be an option, but likely conservative treatment will be chosen first pending the severity. Again, this is a very case-by-case basis.

Congenital Hip Dysplasia – Some children may be born with their hips already dislocated or just very unstable and on the verge of dislocating. Keep in mind, this may not be present initially at birth. It may take a few appointments to realize this – therefore, it is important to take precautions as necessary (proper swaddling and positioning, etc) to decrease the risk of any potential dislocations.

Learn more about the basic presentation of various hip dislocations and treatments at THIS website or also here.

Small or absent kneecaps – Alike to everything else, this should be looked upon on a case by case basis. With no kneecaps, this will generally make the legs, quads specifically, very weak as there is more force required to straighten the leg. Even with underdeveloped kneecaps, it may be difficult to build muscle mass in the quads due to the decreased amount of force able to be placed through the muscle and tendon which then attach to the kneecap. Just because your kneecap is missing/small does NOT mean you cannot walk. Please don’t think this! It may be difficult, sure, but everyone is different! Talk to your physician and PT about this!


One of the biggest takeaways from these numerous lower body deformities .. Does it affect their FUNCTION? This is something specifically that you will discuss with a physical therapist, as again, our goal is to look at the overall functional mobility. One impairment doesn’t mean someone can’t do something. It simply means that we need to find a way to make it work. Our bodies are amazing things and are able to adapt and create patterns without us understanding why/how.. Don’t give up hope!

Another huge takeaway is checking to see if your child is hitting the normal developmental milestones. This is important to discuss with your physician.

Of course having a child who is in braces, casts, etc. for part of their childhood or undergoing another specific treatment may be delayed in crawling, walking, or other milestones. The good news is that generally there is no cognitive delay or impairment associated with NPS, meaning many of those milestones may be delayed due to physical impairments, but likely the child will catch up. And, of course, they won’t be “behind” in cognition due to NPS. Check out more about milestones HERE.

I hope this gives a little insight into what to think about when having a child and/or raising a child with NPS. Remember – everything should be a case by case basis. Nobody with NPS presents the same, and some may have very mild deformities that don’t limit a child at all! Don’t define yourself or your child based on a syndrome!

Be sure to check out a few of my other posts on NPS and stay tuned for more in regards to pediatrics! And, as always, if you have any questions, suggestions, or comments – feel free to message or email me! 🙂

Other NPS posts: NPS Overview, Your Knees and NPS, NPS and Pregnancy.

Until next time,

Jen 🙂

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My Basic Workout Schedule

Since I’ve head a few people ask me about what I do for exercise, I thought I’d write up a post for you all here!

Okay, so this is basically what I do for exercise. Each are not exactly in this order, but I generally follow a similar guideline each day, especially for leg day…

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Day 1 – Arms & Abs Pt 1: This day I focus mainly on biceps/triceps.

  • Start off with 10 minutes of cardio warm up (I usually do the elliptical just so I can get my arms in with the workout).
  • Optional: Row machine for 2-3 minutes for more cardio and to warm up the arms
  • Lat pull down: 3 x 10 reps (if you go heavier, you may only be able to do 6-8 reps)
  • Dumbbell bicep curls SUPERSETTED with tricep kickbacks/extensions: 3 x 10. Supersetting helps improve cardio PLUS you get your workout done faster 😉
  • Dumbbell Lateral raises (for deltoid muscle) SUPERSETTED with standing lateral external rotation. 3 sets of 10 Lat raises, 2 sets of 15 external rotation
  • AB WORK: I usually go to the assisted dip/chin up machine and perform a few of the following:
    • Hanging pike raises (however many you can do)
    • Hanging tucks side to side
    • Hanging tucks straight forward
    • Supported on dips handles – flutter kicks
    • Supported on dips handles – tucks
    • Supported on dips handles – tucks side to side

Day 2 – Leg Day Pt 1: I will usually do one heavy lift on this day, the other on the next. Let’s make this one squats.

  • Start with 10 minutes of cardio. I usually get on the bike or stair stepper for leg days.
  • HEAVY LIFT – Squats. I do a “ladder” technique
    • 10 reps bodyweight squats – check my form
    • 10 reps with the bar
    • 8 reps with some added weight (pending what you can do)
    • 3-6 reps x 3 sets of the maximum weight
    • 8 reps with added weight
    • 10 reps with the bar
  • Here’s the kicker – in between each of those sets when I rest, I also do 10 reps of lunges on each side, so yes, I superset that as well:
    • Forward lunges
    • Backward lunges
    • Side lunges
    • Skiier lunges (crossover)
  • Next I move onto the smaller muscles and more isolated machines
    • Leg extension machine 3×10
    • Prone hamstring curl 3×10
    • Hip abduction/adduction machine 3×10
    • Hip thrusters (as long as I can find a non-awkward-space) 3×10

Day 3 – Yoga + Run: I also do yoga throughout the week, and I’ll be honest – I don’t always run. BUT it’s a good idea to do some cross training in the middle of the week! Whether that be yoga, running, hiking, whatever! Yoga has helped me SO much when it comes to arm strength!


Day 4 – Arms & Abs Pt 2: This day I focus mainly on my upper/lower back.

  • 10 minute cardio warm-up (elliptical)
  • Optional 2-3 minute row machine
  • Lat pulldown 3×10
  • Low Rows 3×10
  • Overhead press 3 x 10 (or however many I can do)
  • Pull-ups, assisted or not – however many you can do
  • Pull-ups/rows at an angle 3×10
  • AB WORK: I usually go to the assisted dip/chin up machine and perform a few of the following:
    • Hanging pike raises (however many you can do)
    • Hanging tucks side to side
    • Hanging tucks straight forward
    • Supported on dips handles – flutter kicks
    • Supported on dips handles – tucks
    • Supported on dips handles – tucks side to side

Day 5 – Leg Day Pt 2: Other heavy lift (deadlifts):

  • Deadlift with similar ladder technique as squats
    • Bar only – to check form
    • Add weight as able and complete a set of 10, 1-2 sets of 6-8, a set of 10 (or just however many you can do) – KEEP GOOD FORM ESPECIALLY FOR DEADLIFTS! Lighter weights are totally fine.
    • Superset with lunges in between
      • Forward, Backward, Side, Crossover/Skiier Lunges
    • Leg extension machine 3×10
    • Prone leg curl 3×10
    • Sidesteps with theraband (for hip abduction and more booty work!)


  • Kettlebell workout!! I do this when all the leg day equipment is taken..because usually the kettlebells aren’t 😉
    • Kettlebell Swings: 2-3 sets of 20 reps
    • Kettlebell Sumo Squats: 3 sets of 10
    • Single leg deadlift (try these first without kettlebell.. you will likely need a lower weight. Really focus on stabilizing core here prior to adding weight! It’s a good balance activity)
  • Personal PT workout for hips (I do this because I’ve had knee injuries and I want to prevent further injuries!)
    • Clamshells: 2 sets of 20 (both sides)
    • Bridges: 2 sets of 20
    • Single leg bridges: 2 sets of 15 (squeeze your booty first here-not your hamstring! People have a tendency to cramp up easily because of that)
      • On ground
      • On bosu ball for extra strength/balance requirement
    • Personal PT workout for arms
      • “Sahrmann Slides” – to help improve the movement of your scapula and help balance out your arm/shoulder muscles
      • Push-up plus – can do the push-up part, or just protract your shoulders and push into the ground to help activate your serratus muscle (again helps to improve scapular mobility and control)

After each workout, I try to either drink a protein shake (plant-based for me, but whatever you choose!) or eat a protein bar/cookie (highly recommend Lenny&Larry cookies, plus they always have a sale..) within 30 minutes. If it’s not that early, it’s okay, that just tends to be the most optimal time for GAINZ 😉

I will do my best to post pictures and videos soon. But in the meantime, hope this helps! Feel free to message/email me if you have any questions 🙂

Instagram: @jennpalmer19

Until next time,



BBQ Tempeh and Basic Buddha Bowl

Hi all!

In honor of Vegweek – I wanted to provide 2 more vegan recipes for anyone to try (they are easy, I swear).

I’m pretty bad at taking pictures of my food both as I’m making it and before I eat it… Mainly because I’m hungry and impatient… but I managed to snap a few pictures of two recipes Scott and I have been using pretty frequently lately.


First is … BBQ Tempeh! Um – WOW – have you ever tried tempeh?? The texture is amazing and we love it way more than tofu. It has more of a “meat” kind of consistency too, so for the people missing it – this might be a good option for you!

We buy our tempeh from Trader Joe’s. You do have to be careful as tempeh is a fermented product – make sure it’s still okay to eat! Some mold is actually okay, but when it starts getting too black, ya better throw it away.

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I’m also not super great at following recipes with exact measurements.. but here’s the best I can do (cooking is supposed to be fun and half winging it anyways, right?)

  1. Cut the tempeh into slices.
  2. Grab a ziplock bag and throw them in there.
  3. Pour whatever seasoning you want – I simply use BBQ sauce that I have (vegan), throw a little pepper in the bag as well, and a tiny bit of apple cider vinegar. ** You can use whatever you want – if you want to let it marinate in some sort of oil with spices or a dry rub – go for it!**
  4. Place bag in the fridge for about 30-45 minutes. The longer you let it marinate, the better it will taste 😉
  5. Preheat the oven while you’re at it — like right when you put the bag in the fridge or so. I set mine at 350 for this!
  6. Once you’re all ready, place your tempeh on your baking sheet (I put aluminum foil on top of mine). Drizzle a little extra sauce or seasoning on there, too!
  7. Bake for 10-12 minutes, then flip to the other side for another 10-12 minutes.
  8. Ta -daaaaa, you’re done! Let it cool!

We tend to serve this over rice or quinoa, with a side of veggies and maybe some fruit for dessert 🙂 I end up getting the rice or quinoa prepped while the tempeh is still marinating in the fridge, but you can do as you please!

A few pics of the product (literally a few, my bad…)

And up next – something we eat frequently.. your “Basic Buddha Bowl”

Truly, we have found that eating vegan tends to be eating a lot of things out of a bowl. There are so many different combinations you can create and throw into a bowl. This is one example of ours!


Ingredients (use what you want): Sweet potatoes, quinoa, vegetable broth, red and green bell peppers, onion, garlic salt, black pepper, coconut oil, mushrooms, garbanzo beans (use any type of bean if you’d like), spinach, avocado.

  1. First of course preheat your oven. We set ours to 450 degrees.
  2. Prep those sweet potatoes of yours. I just rinse mine and then stick a bunch of holes in it with a fork. We usually put about 4-6 on our baking sheet depending on the size (on top of aluminum foil as well).
  3. Cook those bad boys for 35 minutes – but start checking them around 30. They should be easy to cut into with a fork. Again, this varies on the size.
  4. While those are cooking, get your quinoa going! This usually takes about 15 minutes to cook. We use red and white quinoa and it is always a 2:1 ratio of liquid:quinoa. We like to use 1 cup of vegetable broth and 1 cup of water with our 1 cup of quinoa (hopefully that makes sense). The veggie broth just gives it a little extra flavor, but it’s definitely not necessary.
  5. AND while that’s going – quinoa doesn’t take a ton of effort, really – you want to start sautéing your other veggies in a pan! So throw in those peppers, onions, and mushrooms first. Add a little coconut oil and some spices (garlic salt and pepper for me) and get to cookin’ !
  6. I usually have the pan on medium-high here, let it start simmering a little – maybe 5-6 minutes or so. Then I’ll add in the spinach and a tiny bit more coconut oil. Keep cooking but keep an eye on this – and remember your spinach will shrivel up to tiny little pieces (so ya might want to add more)
  7. Everything should be finishing up around the same time.. Go ahead and add your beans (I use canned because I’m lazy and it’s easy) to the sautéed veggies and heat them up for a little!
  8. Once everything is done, let it cool a little. Cut up an avocado if you want- we just had one ready to eat so I said YOLO and did it.
  9. Take your sweet potato and place it at the bottom of your bowl. Cut/smash it up a little. Pour your quinoa over top of it. Throw the veggies on top of those. Top it off with your little avocado if you desire.. and voila!
  10. This should make a few meals – I usually put some in Tupperware for the next night 😉

**I’ve also added salsa, tomatoes, and just other random veggies to this. Try whatever you like!! There’s no “real” way to make these**

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Here’s a few pictures of the masterpiece (lol):


Anyways, happy veg week and I hope you all enjoy some plant-based foods! If you want to check out some other recipes that I have followed or made items from (again-easy and quick), check out these links here: Going Vegan in Japan and What Eating Vegan Did for Me

Stay tuned for some other vegan blogs- including a shopping trip with us and some other ways to save money (in addition to these)!

Until next time,



What We Say Vs. What They Hear

“Did you fall on your elbows?” The nurse practitioner asked me as she did a quick visual scan of my appearance at my employee occupational health visit.

Did she mean any harm by saying this? No, of course not. Does it make me feel a little awkward? Yes, definitely.

“No, it’s actually from a rare disease I have,” I explained back.

Her pause and stare made it clear she didn’t know how to respond after.


“Oh, okay, well then I can mark you down as having something congenital. But you’re still doing really well in this screen.”

Well that’s a relief, because for a moment there it seemed maybe the appearance of my odd-looking elbows could have made the functional health screen head in a different direction. Or maybe not. But what am I to think now?

As both a physical therapist and a human who has a rare disease, I experience both sides of this awkward situation. Ya know, when you say something that you didn’t mean to be harmful but maybe it came off that way…

How could we have worded this better: “Did you fall on your elbows?” –? To some this may make the conversation get ugly – “Well why did you point that out?” Or others, it may make them feel embarrassed and not want to confide or give you all of their health information anymore…

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First off – is it even important in this functional occupational health screen? It wasn’t noticed until after I already performed an upper body gross screen with manual muscle testing – all with flying colors. It wasn’t until after as we were chatting some more that this was noticed. Do we need more training in these functional screens? More education? It’s possible.

Maybe she felt really comfortable with me, I always think I’m fairly easy to get along with and talk to. Maybe she thought I left out an injury on my form. Maybe she was just curious.

I’m not sure – but again, the muscle strength was already there AND the (minimal) decreases in my range of motion were not noticed until I pointed them out.

You see, with a rare disease, deformity, illness – anything that isn’t super common, the patient generally has to do more of the explaining to the practitioner. I pointed out that I did not fall on my elbows, but since I have Nail Patella Syndrome, I did indeed have large radial heads which also limit full elbow extension and forearm supination. Again, was this noticed during the upper body screen? Nope. It never has been. Or if it has been, nobody has ever said anything.

So where is that fine line? How do you politely and appropriately ask someone about something that seems peculiar/abnormal without offending them and without asking about more than you need to know.

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I don’t have answers here, this is more just a reminder to watch what you say and process what you are saying to patients before you do. Luckily for me, I am not offended easily and am open to conversation, but I can’t say the same for all the others with rare genetic deformities.

And with that being said, of course there are clinicians and people in general out there who are still not as mindful of these things. Those who think that one way is the only way and that in order to perform at your optimal level – you must be “perfect” – with that “perfect” range of motion, “perfect” form. Newsflash y’all – everyone and every body is different. Our bodies are made to perform the best they can with what we have.

Yes, certain improper forms may predispose people to injuries, especially when awkward repetitive actions or techniques are performed. But in your “abnormal” person with a deformity – how do you treat that? You make sure they are functional, right? Help them improve themselves to the best of their ability.

Someone asking me if I fell on my elbows does not upset me now, but as a child – whether it was people asking about my elbows, accusing me of being anorexic, making fun of my thumbnails, or heck – even pointing out my giant calf muscles (I know, who gets embarrassed about that..but I was a kid) – these things can hurt. And they can linger through life.

I’m not saying that I’m perfect with this. I know I still have patients where I try not to offend them but then something comes out and I realize I said it the wrong way. Just thinking of different ways to ask questions, getting to a patient’s eye level, speaking with the proper tone of voice, and showing caring gestures and welcoming body language can help – and I can’t stress the importance of it enough. Building relationships between patients and clinicians is a huge part and foundation in helping everyone thrive in this crazy healthcare world we have now.

Be compassionate, think before you speak. Don’t end that relationship before it even gets started. And hey, do yourself a favor and keep educating yourself, keep practicing, and don’t forget to forgive yourself if you make a mistake. 😉


If you’re interested in any other PT thoughts that I have, be sure to check out a few of my other blogs: The Generalist PT, Becoming an Acute Care PT, tips with Productivity in Acute Care, and the Struggles of being a Small PT. Or if you want to learn a little more about the rare disease I have – check out NPS and Knee Pain and NPS and Pregnancy.

And of course, be sure to join in with the GlobalPTConnect fun on Instagram to join PTs sharing their days around the world! Or just check out my time visiting an Outpatient Japanese Clinic and a Singapore Physical Therapy School. 😉

Until next time,


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What Eating Vegan Did For Me

Watch the video if you don’t feel like reading- — or read if you don’t feel like listening (the best of both worlds!)

Hey guys!!

Some of you may have recently seen my Instagram story about my blood work levels – but if not, that’s also why I’m writing about it here 😉 (duh)

If you’ve been following along, you may have seen that my husband and I transitioned to a vegan diet and lifestyle when we were back in Japan a few months ago. Click HERE if you want to read a little more about that first.

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So anywho… what sparked me to write this blog? Well I am beginning a new job over here in California and I had some blood work drawn up. Just a simple “wellness check” that a lot of companies do nowadays. I had happened to have my yearly blood work ran back in October, just 2 months before we decided to start eating vegan.

At this point in time, we were both eating pretty healthy – mainly chicken and vegetables and the occasional night out to eat sushi or some other Japanese cuisine. And yes, a few beers or Chu-his (Japanese alcoholic drink) here and there. We worked out a lot, we drank protein shakes, ate lots of fruits and vegetables, and we had even already been drinking almond milk to cut down on the dairy intake. We were eating “healthy” according to the typical workout/gym stereotype. My body looked the same as it always has (I don’t think I’ve grown since 7th grade, seriously) and I thought we were doing the right thing.

Here are my few blood work results from then:

Cholesterol: 166 mg/dL
Triglyceride: 63 mg/dL
HDL Cholesterol: 51 mg.dL
LDL Cholesterol: 102 mg/dL
VLDL Cholesterol: 13 mg/dL
Cholesterol/HDL Cholesterol: 3.25

For the most part, everything looks okay. My LDL cholesterol and Cholesterol/HDL Cholesterol are right on the border of being low risk to moderate risk. Everything else isn’t too bad at all.. fairly healthy for a 26 year old!

Handmade bracelets made by women in Nepal!

Fast forward to when we transitioned to Vegan – the first few days were rough, not gonna lie. We felt groggy, out of it, just kind of “bleh” while we detoxed ourselves. After about 2 days, we started feeling normal again. BUT one thing you have to keep in mind when you switch to all plant-based food.. You’re increasing your fiber intake. And what does that mean? Increased fiber means increased farts (someone had to say it – it’s the truth). But let me tell ya, nothing makes a relationship stronger than an apartment smelling like straight fart all the time (haha!). Luckily for us, this only lasted about 2 weeks while our stomachs adjusted. There are different tips for this – some say eat more cooked veggies to help your body digest it easier, but some say go full on with the raw so it can adapt better and quicker.. Try what you want!! We just kind of ate food, because food>farts. Scott also started having a TON of energy after about a week- me, I like naps, so I’m not really sure hehe.

It was tough being in Japan (again check out the post for our first simple recipes that we used — we didn’t have an oven and we didn’t speak Japanese soooo) to start – but we kept at it. Once we got to the states, we had access to many more options and it has been WAY easier.


Okay, so here we are – April of 2018. Vegan for about 3-4 months with some occasional slip ups (this happens sometimes when eating with family and friends — sometimes there’s a little melted cheese on something or there just are only vegetarian options and you’re starving.. YOU’RE HUMAN, DON’T FORGET THAT).

My recent blood work results (wasn’t a full workup so it’s limited, but CHECK the difference):

Total Cholesterol: 111
HDL Cholesterol: 49
Cholesterol/HDL Cholesterol Ratio: 2.3
Blood Sugar: 84

Trust me, I wish I had more values to look at for both – I’m so MINDBLOWN by the difference. It’s insane. Literally this is what has changed in these last few months: worked out the same (possibly less since we just moved and such), cut out the other dairy, egg, and meat and their products, replaced those with beans and more veggies/quinoa/tofu/tempeh/whatever we could find, was super stressed out in life because of moving from Japan>MD>California with a cat (LOL – video/post coming soon), also stressed about not having a job, again..MOVING.

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My bodyweight and figure has stayed the same – this was never intended to be a weight loss thing for me (HeLlOoOO VeGaN iCe CreaM), just a health thing. So again, side by side – check this out:

Cholesterol Oct 2017 to April 2018: 166->111
HDL Cholesterol: 51->49 (this is the good cholesterol)
Cholesterol/HDL Cholesterol Ratio: 3.25 (almost moderate risk)->2.3

Still healthy, just HEALTHIER!

These results don’t lie you guys, I’m in shock too. I will be posting some additional recipes that we’ve been doing (now that we have an oven..and more ingredient options..) AND a trip to the grocery store with us so you can see what we buy to stay healthy, on a budget, but also treat ourselves. If you’re looking for other ways to save money – check out my other post I wrote!

As I’ve said before — I’m not here to preach. Eat whatever you want. I’m just here to objectively show my results. I’m so amazed and I hope this opens your eyes up! Message me (@jennpalmer19 on instagram) or comment if you have any other questions or requests!!

Until next time,


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Japanese Outpatient Clinic Experience

As I approached my last few days in Japan, I was honored that one of my students who I was helping to teach English to wanted me to visit his very own physical therapy clinic!

I had been working with Masahiro for a few months on conversational English, grammar, some medical terminology, and a few general patient-therapist conversations. It was an awesome experience not only helping him learn English, but also seeing that lightbulb go off when there was a connection made, especially during some of the medical terminology.


Masahiro had his own outpatient clinic in Odawara, Japan. He told me that while he went to school in Tokyo and many of his colleagues stayed there, he moved a little south to open his own clinic. He also loves to surf, so moving closer to the beach is a no-brainer!

“Groundwork” (the name of his clinic) was on the 4th floor of the building we walked to, in a single office room. There was a desk, a mirror, a set of parallel bars, a plinth, some weights, and a bunch of other typical outpatient goodies. Now, I know Japan has different health insurance, a different framework, etc… But clearly his clinic is for one-on-one treatment.

For one last English session, Masahiro “treated” me as a patient, using as much English vocabulary as possible to help improve my “glut med issue” – which wasn’t supposed to be an issue, but my balance was a little off, ha! He performed a few manual techniques, analyzed my gait, performed a few manual muscle tests, and gave me a few exercises to do. All with the English we had worked on together! It was so rewarding to see that!

When I asked Masahiro about his normal schedule of patients, he said he sometimes has patients as late as 10 PM. Crazy, right!? While that is late, it’s not all too surprising if you understand the nature and culture of Japanese people – they’re always working. I’m talking 60 hours a week as the norm sometimes. This obviously can be an issue with work-life balance, and it is something the Japanese people are trying to work on, but again, a 10 PM appointment is fairly normal to them.

Masahiro also stated that physical therapists in Japan are not looked upon as highly/paid as much as those in the USA. Granted, they also are still at the Bachelor’s level as compared to the Doctorate in the US, so I’m sure that in itself is a big difference. Not to mention there are varying levels of autonomy and they still require a referral from a physician at all times.

Handmade items from Nepal

Overall, the outpatient clinic was quaint, tiny, but effective. Masahiro told me that most of his friends have similar clinics if they are in private practice. Of course, there are bigger gyms and rehabs as well. Again, it was a great experience and so rewarding to not only network with another physical therapist on the other side of the world, but help him out with his English while learning a little about different treatment techniques from one another.


If you’re interested in checking out my other experiences abroad – be sure to read my other blogs: A Day at a Japanese Day Rehab and Visiting a Singapore Physio School. Or if you just want to check out other real-talk-PT blogs, check out The Generalist PT, what it’s like to be an Acute Care Therapist, and The Struggles of Being a Small Physical Therapist.


Hope you enjoyed reading! Be sure to message me if you have any questions 🙂

Until next time,


NPS and Pregnancy


Everyone knows that changes occur when you’re pregnant. Hormones change, you might feel nauseous, you might feel exhausted, or you might even start to feel some increased pain in your joints. Your stomach is growing and pulling your spine into more of a lordosis than it is used to, and it might even be throwing you off balance a little.

How could this be different with NPS?

Well, in regard to the medical aspect of NPS, you must consider a few things. Having NPS puts you at a risk of having issues with your kidneys. It is very important to monitor for any proteinuria that may signify some sort of nephropathy (fancy word for kidney issues). As in any pregnancy, proteins in the urine will increase, but with NPS, there is a chance of already having an elevated number prior to the pregnancy.

While in many cases the proteinuria is benign, keeping an eye on this can help physicians to notice if there are any other symptoms that may suggest some sort of pre-existing kidney condition. If you do feel uncertain about your symptoms in any way, please contact your physician to determine the best treatment.


So why am I talking about kidneys so much? I’m a physical therapist, not a nephrologist after all. Well, you see, sometimes when people have an infection in their kidneys, they may have a specific referral pattern for their pain.

This referral pattern can be in your low back region, maybe even a little in the abdominals and sides of your body, or even into your groin area and the front of your legs potentially. Crazy, right? All of these referral spots are similar to places that a pregnant woman may feel pain due to loosening ligaments. So which one is it? Back and hip pain from the increased laxity of your ligaments or kidney pain? This is very important to discuss with your physician before continuing on with physical therapy and exercises.

Now, besides the loosening of the ligaments, the major cause for back pain is due to your growing stomach pulling your back into a more curved position. The larger area in front of your body pulls your center of gravity more forward and can throw you off balance a little. If you remember reading the general clinical presentation of NPS, you may remember that many people already face hyperlordosis in the lumbar region. Pulling you even further forward can increase this and place someone with NPS at a higher risk for low back pain, or even further injury such as a spondylolisthesis (a break in your vertebra). This is very important to consider when participating in exercises and other activities as some activities may be contraindicated.

Here’s a video to understand the general background about back pain, pregnancy, and nail patella syndrome.. and how they all come together.

This being said, if it truly is just back and hip pain (very common and very likely), I have a few exercises for you here! Again, these are very general and each exercise program truly should be better adapted to your body and your pregnancy. But this can be a good place to start.



Beginner Exercises for Core Strength

As always, remember to get checked out to better adapt and enhance your exercise program if you feel you need more assistance. This is very general and it is best to have someone view your functional impairments in person so that you can have the best treatment program for you!

Hope this helps!

Stay tuned for the next blog… and be sure to check out my blog on NPS and Knee Pain , NPS – General Presentation, and NPS and Pediatrics (Part 1) if you haven’t already!

Until next time,