Dr. Brittany Krake

Dr. Brittany Krake Regenerative and Functional Medicine for Pain, Performance & Hormones.

There is a name to what is happening to your joints in perimenopause and many doctors in specialties outside of women’s ...
04/09/2026

There is a name to what is happening to your joints in perimenopause and many doctors in specialties outside of women’s health haven’t heard the term yet.

In 2024, researchers formally named the Musculoskeletal Syndrome of Menopause, which is a collective term for the bone, joint, muscle, and connective tissue changes that accompany the drop in estrogen during the menopausal transition.

This isn’t new and the correlation between menopause and MSK degeneration has been acknowledged for decades. What’s new is the language and the recognition that these symptoms deserve to be treated as a coherent syndrome, not a scattered list of complaints.

Typical symptoms include:
— Joint pain that moves around or fluctuates
— Stiffness that appeared without an obvious cause
— Tendons that suddenly don’t tolerate what they used to
— Accelerating bone loss
— Muscle mass that’s harder to maintain

Estrogen receptors are found throughout the musculoskeletal system(joint cartilage, tendons, ligaments, and bone). When estrogen fluctuates and eventually drops, it becomes a systemic issue.

An estimated 70% of women in perimenopause will experience MSK symptoms. 25% will be significantly disabled by them through the transition.

Joint pain during this transition is not just aging and there is SO much we can do together to prevent and treat early decline.

Pain is such an undertreated and misunderstood signal in medicine, and the distinction between what’s structural and wha...
04/09/2026

Pain is such an undertreated and misunderstood signal in medicine, and the distinction between what’s structural and what’s inflammatory can be tricky to understand as a patient.

📣 Inflammatory pain tends to be worse in the morning and improve as you move through the day. It fluctuates, responds to rest and anti-inflammatories, and sometimes just a better week of sleep (or during a different part of your cycle). It often has systemic drivers (hormones, diet, stress, immune activity) that extend well beyond the joint itself.

📣 Structural pain tends to be more predictable. The same movement reproduces it and loading the problematic tissue makes it worse. It reflects a mechanical problem in the tissue itself. For example, a tendon that hasn’t remodeled properly, a ligament that’s lost tensile strength, a joint that’s lost the structural support around it.

📣📣 These two patterns overlap fairly often, which is part of why chronic pain is so difficult to treat when you’re only addressing one piece.

A common first line treatment, cortisone, is an anti-inflammatory. It can provide meaningful relief and can have appropriate clinical applications. What it doesn’t do is rebuild tissue or make the injury or degeneration go away. For someone whose pain is primarily structural, it may provide some pain relief, but the documented longterm negative tissue changes make risk-benefits conversations absolutely essential.

Prolotherapy and PRP work through a different mechanism: stimulating the body’s repair response in tissue that has stopped or slowed healing on its own. Over the last 8 years, I have found that they work best when the inflammatory environment is also being addressed, because a structurally compromised tendon inside a systemically inflamed body is a compounded problem.

The most useful question to bring to any orthopedic and/pain management appointment is simply this: is what I’m feeling coming from a structure that needs repair or a system that needs to calm down, or both? The answer should drive the treatment.

04/07/2026

Athletic identity doesn’t have a size, an age, or a required output level.

Life happens, and with it body composition and capacity may change too. Life phases might even change what movement looks like for you. None of that erases who you are underneath.

I’m a regenerative medicine and naturopathic physician. My job is to work with the body you have, at the stage you’re in, so you can keep moving in ways that are meaningful to you.

That’s it. That’s the whole thing.

04/03/2026

Perimenopause wants your muscle mass. I’m not giving mine up.

Real talk, I got lucky these last 6 years while raising littles. Chasing them around and picking them up every 3.5 minutes kept my muscle and cardio fairly resilient. I also developed biceps tendinopathy… which I unfortunately/fortunately know can often precede osteoarthritis, frozen shoulder, and rotator cuff tears. This means these pushups aren’t just a workout, they’re part of my own treatment and prevention plan.

Controlled loading of the biceps tendon and surrounding shoulder girdle is one of the most evidence-backed ways to drive tendon remodeling and reduce pain over time. Rest alone doesn’t cut it - tendons actually need progressive mechanical stress to heal.

And for the bigger picture that nobody talks about enough: women in perimenopause are at higher risk for rotator cuff and labral injuries. Declining estrogen affects collagen turnover, muscle recruitment, joint stability, inflammation, and bone remodeling… all the things that protect your shoulder from the kind of degeneration that ends up on an x-ray or MRI. Strength training builds muscle AND it protects the architecture around your joints.

So yes, I’m a regenerative + functional medicine physician who also does her pushups. Because the best injection I can offer is still second to what your body can do when you give it the right stimulus.

If your shoulder has been nagging you and you keep getting told to just rest it, let’s talk. That’s not always the answer.

📍Portland, OR | Regenerative injections + functional medicine

“Good news! Your labs came back normal.”It is one of the most frustrating things to hear when you are dealing with chron...
04/01/2026

“Good news! Your labs came back normal.”

It is one of the most frustrating things to hear when you are dealing with chronic joint stiffness, brain fog, insomnia, or the shifting landscape of peri-/menopause.

There is currently a lot of debate in both public and medical circles about whether or not to run certain labs during perimenopause. While it is true that hormone snapshots can be unpredictable and sometimes “inaccurate” due to daily fluctuations, I find that these data points are incredibly useful when viewed in the context of your specific story and symptoms.

My job isn’t to gatekeep your health data based on an algorithm. It is to look at your internal terrain: your metabolic health, your fuel levels, and your hormonal signaling to understand why you don’t feel like yourself.

Swipe for the list of labs I typically run to get a more informed picture.

If you are ready to look past “normal” and start finding answers, the link in my bio has more info on how we can work together.

03/16/2026

No Sunday Scaries when your Monday looks like this.

02/19/2026

I woke up this morning and my heart is happy.

Clinicians across the country are posting about the framework I presented on last night, hosted by Clinicians are asking about “terrain” when it comes to PRP injections. They’re talking about hormone receptors in MSK tissue.

THIS IS SUCH AN IMPORTANT CONVERSATION IN PAIN AND MSK INTERVENTIONS.

We don’t have all the answers yet. But here’s what we DO know:
1) Estrogen, progesterone and testosterone receptors exist in bones, tendons, ligaments, cartilage
2) Growth factor signaling (TGF-beta, IGF-1) is hormone-dependent
3) 70% of menopausal women report joint pain and 40% have NO structural findings on imaging
4) 99% of preclinical aging studies ignore menopause (Nature Aging, 2024), including those looking at PRP

So why WOULDN’T we question or consider hormonal terrain before—or alongside—PRP?

The terrain model isn’t just a metaphor. It’s a call to revolutionize how we approach regenerative medicine for women (and men with changing hormones, too).

To every clinician interested in these questions: THANK YOU. Keep going. Our patients need us to think differently. I am so excited to see where this conversation takes us.

What questions do you have about hormonal terrain and regenerative medicine? Drop them below. 👇

One of the most frustrating parts of treating frozen shoulder is how many women tell me:“I didn’t know…… this was a thin...
02/05/2026

One of the most frustrating parts of treating frozen shoulder is how many women tell me:

“I didn’t know…

… this was a thing.”
… I was at higher risk.”
… who I should go see first.”
… that early treatment was important.”
… there were other options.”

Frozen shoulder is more common in women, particularly during perimenopause and menopause. Yet musculoskeletal symptoms are rarely discussed as a major player in this hormonal transition. So women often navigate stiffness, pain, and loss of function without a framework, bouncing between providers or being told to “wait it out.”

When appropriate, comprehensive care can include physical therapy AND hormone support, AND regenerative, volume-based injections — earlier, not as a last resort.

I love treating shoulders. Truly.
And little is as satisfying as knowing that early, effective intervention may have saved someone months to years of pain, prolonged PT, and loss of function.

This is about reducing suffering and expanding what good care looks like for women.

If this resonates, share it with a woman who’s been told to “just stretch it out.”


This week my heart is heavy. Like so many, I’ve been following the news of those killed during encounters with federal i...
01/27/2026

This week my heart is heavy. Like so many, I’ve been following the news of those killed during encounters with federal immigration enforcement — people who posed no imminent threat, whose deaths have shaken communities and raised urgent questions about accountability.

As a physician, my first commitment is to do no harm. In the Naturopathic Physician’s Oath, we pledge to care for individuals without discrimination, to protect human dignity, and to serve not only our patients, but the health of our communities. That responsibility does not end in the exam room…

We are trained and called to be helpers. To run toward suffering. To protect life.

What has stayed with me most in the public accounts of Alex Pretti is this: even in his final moments, we watched him help. Care was present. Humanity was present. And it was met with violence.

What is happening in the world affects me deeply, too. Fear and injustice live in bodies, nervous systems, and families. Medicine is inseparable from humanity. Public health is inseparable from safety, trust, and justice.

Silence is not neutrality. And care demands courage.

I will continue showing up for you, as a physician, as a helper, and as a human, committed to compassion, advocacy, and doing no harm regardless of race, ethnicity, immigration status, s*x, gender, age, abilities, religion, political beliefs, and so on. You get to be human and I will see you as such.

The only way out of this mess is through shared humanity.

I hear it from so many of my patients, and -absolutely, yes- i’m deep in it too. If it feels harder to regulate your ner...
01/23/2026

I hear it from so many of my patients, and -absolutely, yes- i’m deep in it too. If it feels harder to regulate your nervous system right now… it makes sense.

We’re living in a moment where distressing news is always available, stress is constant, and your body is actually just trying to keep you safe with the input.

And during perimenopause + menopause, nervous system regulation really matters. Stress physiology amplifies:
• inflammation + pain
• sleep disruption
• cravings + blood sugar swings
• fatigue + slower recovery
Symptoms that already show up with a changing hormonal landscape.

So let me give you a little peace of mind… you don’t need perfect calm at every moment.

But you do need moments of safety—small, repeatable practices that help your body come back online… so you can keep showing up for yourself, your health, and the social endurance this season demands.

Save this + try one tool today:
humming or singing
tapping (EFT)
dancing for 60 seconds
feet on the ground outside
hand on heart + long exhale

Let’s do each other a favor… can you share just one regulation practice that you find most helpful right now?

01/22/2026

Perimenopause doesn’t just change your cycle.
It changes how you recover.
How you build muscle.
How your joints handle load.
How inflammation shows up.

You’re not weak and you’re definitely not broken.
You’re in a new physiology — and you deserve care that understands that.

Strength isn’t punishment. It’s protection.

Follow for hormone-informed strength + joint support.
📍Local? Book through my Linktree.

Perimenopause doesn’t just change your cycle.It can change your joints. Your recovery. Your strength. Your responsivenes...
01/19/2026

Perimenopause doesn’t just change your cycle.
It can change your joints. Your recovery. Your strength. Your responsiveness.

It’s not usually what brings perimenopausal patients in (thanks irritability, insomnia, heavy periods), but is often mentioned as a side note:
“I’ve never had knee pain before.”
“Why do my shoulders feel stiff?”
“Why am I suddenly getting pain in the bottom of my feet?”
“Why does exercise feel harder than it used to?”

You’re not imagining it. This is one of the most overlooked parts of perimenopause:
muscle + connective tissue + inflammation + recovery shift. And there are evidence-based ways to support this!

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Portland, OR
97086-97299

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