Sciatica_Therapy_Portsmouth_NH_2

3 Reasons You Need PT After Minimally Invasive Spine Surgery

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Minimally invasive spine surgery (MISS) started to take off in the 1990’s. It has since become far more common for spinal conditions. Some being degenerative disc disease, herniated discs, spinal stenosis, scoliosis, spinal infections, spondylolisthesis, compression fractures, and spinal tumors.

Minimally Invasive Spine Surgery is a far better alternative to open-spine surgery.

You can expect less anesthesia and less blood loss during surgery. Along with a reduced risk of infection, less pain after surgery, less pain medication needed, smaller scars, shorter hospital stays, faster recovery time, and quicker return to daily activities and work.

But don’t confuse the term “minimally invasive” with minimal risk.

With MISS – you’re still at risk for many of the same consequences of open-spine surgery should things go wrong. Therefore, you want to make sure you really need spine surgery before you go “under the knife” – even if it’s a tiny one.

There are some risks of MISS:

  • Bad reactions to anesthesia
  • Pneumonia after surgery
  • Blood clots in your legs that could travel to your lungs
  • Infection (although this is significantly minimized with MISS)
  • Blood loss during surgery requiring a transfusion
  • Injury to the nerves of your spinal cord

While rare, these are very real risks and they do happen. Risks like this don’t occur with conservative treatment – such as specialized physical therapy.

It’s why I’m a huge advocate of folks not undergoing surgery until all conservative approaches have been exhausted. Or if you’ve got what we call a progressive neurological deficit occurring. Such as quick deterioration in your muscle strength, ability to walk, or ability to control your bowel/bladder.

All that being said – assuming you really do need surgery and will benefit from MISS – you still need physical therapy.

I’m amazed at how many surgeons no longer prescribe rehab after a minimally invasive procedure. Just because recovery time is reduced – doesn’t mean you don’t need a specialist to help you recover properly.

Here are 3 reasons you need PT after minimally invasive spine surgery:

1. Proper scar management

Minimally invasive procedures already do a great job of reducing scar formation. The incisions are smaller and less invasive, but there is still an incision. And the incision with MISS is deep because you have to get to the layers of the spinal nerves, vertebrae, and discs. Because the scars are small, people mistakenly assume they will heal without issue. The truth is they might. But the odds of your scar healing properly are much better with professional scar management. Scar mobilization should begin about 2 wks after MISS.

A specially trained physical therapist will not only help you manage your scar healing, but teach you how to do it on your own. You’ll improve blood flow to the area of the incision (which promotes healing), increase soft tissue mobility, and help reduce any swelling that formed in the area.

2. Restore pre-existing impairments

Odds are pretty good you didn’t end up with spontaneous MISS. You likely had a long road leading to your surgery. It’s critical you go back and address all of the problems that occurred prior to your procedure.

This includes everything from muscle weakness, to poor compensatory movement strategies your body adapted to deal with pain, immobility that occurred either because of pain or to protect you from pain, and residual numbness and/or radiating pain that is still in your legs. MISS might do a great job of quickly getting rid of your back pain, but something led to that pain to begin with.

The absence of pain does not equal the absence of a problem. Now is the perfect time to work with a specialist who will help you not only optimize your recovery from MISS – but make sure the problems/impairments that led you to the operating table to begin with don’t come back.

3. Restore deep core strength

Chronic pain tends to inhibit the ability for muscles to work properly. If you’ve been suffering from back pain for awhile – odds are pretty good your deep core strength is not where it needs to be.

Plus, good core strength is critical for the prevention of future back problems (yes – you can still get back pain after back surgery). Ideally, now that your minimally invasive procedure has either eliminated or significantly reduced your back pain, it’s more critical than ever to work with a specialist who can help you restore your deep core strength. They’ll know how to do it safely and effectively – to not only help you recover from your MISS faster – but keep the original problem from coming back – because it can.

If you’re considering any type of surgery – but especially back surgery – I always advocate getting a second opinion first – even if the procedure is minimally invasive. Eighty percent of the time – back problems can be resolved without surgical procedures.

CLICK HERE to get a second opinion from one of my specialists.

If you truly want to avoid surgery – and we think we can help you do that – we’ll let you know and get you scheduled with us as quickly as possible.

However, if you’ve recently undergone MISS, ask your doctor to refer you to physical therapy. Many surgeons won’t. It’s going to help you recover optimally and faster – and will set you up for the best possible future success when it comes to back problems.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or request a free copy of her guide to back pain, email her at [email protected] or call 603-605-0402

syringe

Shoulder Still Hurting After Your Covid-19 Booster?

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Shoulder pain is quite normal after any vaccine.

But prolonged shoulder pain isn’t.

Shoulder injuries related to vaccine administration (otherwise known as “SIRVA”) is a rare, but possible occurrence when you get a vaccine or booster shot. Shoulder injections should enter the deltoid muscle. But SIRVA occurs when a healthcare professional administers the vaccine too high, or too deep into your shoulder.

When not properly administered, your next booster shot could graze your bone or nerve, or even puncture your bursa (a fluid-filled sac that protects your shoulder tendons).

Pain from SIRVA can be really difficult to distinguish from the normal pain that occurs after a shot in your arm. But it’s critical you know what to look for. Because if left untreated, SIRVA can cause prolonged problems in your shoulder over time.

I’ve seen folks end up with entirely preventable rotator cuff tears, bursitis, and tendonitis – all because someone didn’t take their complaints of shoulder pain after getting a Covid shot in their arm seriously enough.

Normal shoulder pain after a Covid vaccine or booster shot:

Mild skin sensitivity and localized shoulder pain is quite normal after a Covid vaccine or booster shot. Some people experience what is now known as “Covid arm” – a mild rash and skin sensitivity that can occur anywhere from a few days to even a week after receiving your shot. You’ll experience skin sensitivity and/or swelling that might look similar to cellulitis.

While annoying, Covid arm is not considered dangerous or threatening.

The symptoms will typically go away after a week or two and in the meantime, talk to your doctor or pharmacist about over the counter or prescription remedies that can address the symptoms of itchiness or swelling.

Localized shoulder pain at the site of your vaccine or booster shot is also normal. The pain you feel is from the mild trauma caused by the needle being inserted into the soft tissue (muscle) of your arm. It often feels like a bruise, and you may experience a little bit of swelling. It will typically go away after 2-3 days. Even though your arm can be quite sore, the important distinction here is that you’ll still have full, normal function of your arm. In other words, despite the soreness, you can still move your arm freely up and down if you had to without restriction.

Your arm soreness will go away with time, but gently massaging the area of pain, and even some easy movement or exercise can help the soreness go away faster.

Abnormal shoulder pain after a Covid vaccine or booster shot:

The symptoms of SIRVA are different, and typically more severe than what I’ve just described above. If not addressed, some of these symptoms could lead to long lasting shoulder problems or compensatory problems elsewhere.

As I’ve already alluded to, one of the main distinctions between “normal” shoulder pain after a vaccination shot and SIRVA is how well your arm functions. If the needle was accidentally inserted into your joint capsule, for example, you will notice limited mobility and possibly limited strength. If unaddressed, symptoms like this can manifest into more serious shoulder problems down the line such as adhesive capsulitis or frozen shoulder.

If the needle was inserted too high or too deeply, and beyond your muscular layer, it could have injured your bursa. This could cause it to become inflamed, turning into shoulder bursitis. Your mobility may or may not be impacted when this happens, but you’ll notice prolonged shoulder pain that doesn’t subside after 2-3 days like it should. Bursitis is actually a really simple injury to treat. But with SIRVA, it’s often dismissed as normal pain after the shot.

When ignored – shoulder bursitis can lead to compensatory movements due to pain – and cause problems later on in places like your neck, shoulder blade or even elbow.

One last common problem we see as a result of SIRVA is rotator cuff tendonitis. Much like bursitis, you may have normal motion in your shoulder, but what you’ll notice with this is again, the pain will persist longer than it should. But unlike bursitis, you’ll also have pain and weakness when you exert force through that tendon – particularly with overhead movements or lifting something with an outstretched arm.

This is also not a complicated injury to rehabilitate, but if not addressed, could turn into a more serious problem such as a rotator cuff tear or chronic tendonosis – conditions that are more difficult to treat.

To recap – your shoulder will hurt after getting a vaccine.

It’s normal. And you may even experience Covid arm. But these symptoms should go away and not remain.

And you should still have normal function of your shoulder, despite the pain.

If you have shoulder pain that persists, and especially if you’re noticing limited mobility, it’s something worth getting checked out. The last thing you want is for these symptoms to go on longer than needed, or turn into compensatory, more complicated problems.

The good news is that even with SIRVA, your shoulder pain can be successfully treated naturally, and without medications or procedures. Don’t let a healthcare professional brush off your concerns and blame your prolonged shoulder pain on your booster shot.

Talk to a musculoskeletal expert who understands this sort of thing and get some help!

CLICK HERE to request a Free Discovery Call with our Client Success Team.

They’ll let you know if we can help – and if you’re a good fit for our services – get you scheduled as soon as possible.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

How to Prevent Knee Pain When Hiking

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Hiking is a popular way to stay active during the summer months – but it can also wreak havoc on your knees.

Personally, I love to hike. My pup (Bodie) and I are currently in the process of conquering the 48 4K footers of the White Mountains – and the very last thing I want is for knee pain to get in the way of that journey.

The good news is that there is quite a bit you can do to prevent knee pain when hiking. So when one of my readers asked this week – “How do I prevent knee pain when hiking?” – I couldn’t wait to answer it.

Here are 4 of my top tips to help you prevent knee pain when hiking.

 

1. Strengthen your hips and core

Your hips and core provide much needed support for your knee joint to function properly. The large bone in your thigh, called your femur, makes up your knee joint on the bottom, and your hip joint on the top. Your hip joint is connected to your pelvis, which houses major core muscles groups like your glutes.

Let’s say your glutes (part of your core) and hip muscles aren’t as strong as they could be. When you’re trying to climb up a large rock or steep trail, for example, your glutes and hip muscles are supposed to stabilize your pelvis so that your femur can easily extend your hip. When not strong enough, your pelvis will tilt to compensate – which impacts the alignment of your femur – and ultimately the alignment of your knee.

When I hike a 4k footer – I get in approximately 27,000 steps. If your knee is compensating for every one of those steps – it’s eventually going to hurt. If hiking is something you love to do, it’s critical that you strengthen your hips and core.

2. Keep your knees mobile

One of the biggest mistakes I see when it comes to knee problems is a lack of full mobility. Your knee shouldn’t just straighten, it should be able to hyperextend a little bit. When you bend your knee, you should be able to tolerate a full deep squat without any pain. These full end range movements are pretty essential to have when it comes to hiking. Your knee needs to be able to squat, pivot, and tolerate stress on those uneven trails. When you lack full mobility, it impacts your knee’s ability to tolerate these micro-stresses and over time – your knees will ache.

If you’ve got pain or stiffness in your knee in either direction of movement – it’s important to try and push that movement and work through it rather than avoid it – even if your knee seems painful at first. More often than not, the more you move your knee joint, the better it will feel. If that doesn’t happen – then you know it’s time to talk to an expert about it and have them take a closer look at your knee.

3. Work on your balance

Hiking can involve everything from uneven terrain, water crossings, and rock hopping. Good balance is essential for these activities and without it – your knees will suffer.

So how do you work on your balance?

Aside from the obvious (practicing balance exercises), it’s also important to look at a few other things – namely – the mobility of your toes, foot and ankle joints as well as the strength of your arch (plantar fascia). These structures all play a role in how well you’re going to be able to balance. You can do all the balancing exercises in the world, but if you’ve got faulty mobility in your ankle, for example, or a flat, weakened arch – balance is always going to be really difficult for you.

Perform regular stretching of your ankle and calf muscles, Be sure to move those toes – can you lift your big toe up by itself when you’re standing? And use a small ball to regularly massage the arch of your foot to keep it flexible. These small activities can play a huge role in helping you to be able to balance with more ease – especially on the trials.

4. Use Trekking Poles

Even if you implement every single tip I mentioned above, depending on your overall level of fitness, and the condition of your knees prior to when you decided to get into hiking, you could still have some knee pain despite doing “everything right”.

Trekking poles can be a real life saver – or should I say knee-saver.

They help take away some of the stress from your knees and lower legs – especially on really long hikes and technically challenging trails. Plus, if you’re carrying a backpack, trekking poles help to disperse that extra weight away from your knees and into your arms. And added bonus – hiking with poles gives your arms a little extra workout at the same time and keeps your hands and fingers from getting puffy on those extra hot and humid days.

If you love hiking as much as Bodie and I do – then I know the last thing you want is for knee pain to keep you from hiking. I hope these tips help you to ease any knee pain you might currently have as well as prevent future knee pain on the trails.

Do you love to hike but knee pain is currently getting in the way? CLICK HERE to talk to one of our specialists. 

They’ll let you know if we can help – and if you’re a good fit for what we do – they’ll get you on our schedule right away.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

Plantar Fasciitis

Are Flip flops Aggravating Your Plantar Fasciitis?

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Now that summer is here – it’s flip flop and sandal season for many. Unfortunately, this also typically results in a rise in foot pain and plantar fasciitis cases. One of my readers recently wrote to me and asked about this.

Here’s what Jennifer wanted to know:

“Now that I’m wearing flip flops again, I noticed that my plantar fasciitis is acting up. Is there anything I can do? Do I need to stop wearing flip flops?”

This is a great question Jennifer. In order to answer your question, let’s look at a few reasons why plantar fasciitis occurs in the first place. Ideally, if you can stay on top of your plantar fasciitis and/or prevent it all together, flip flops won’t even be an issue.

First – what is plantar fasciitis? 

It’s inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot. Your plantar fascial runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you land on your foot your arch falls or flattens – this is called pronation. The response to this action is that your foot then stiffens or supinates – this is where your foot gets the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked – leading to inflammation/plantar fasciitis.

What causes your plantar fascia to become overworked?

Basically anything that impacts or disrupts the natural mechanics of your foot to pronate and supinate. Most commonly, poor mobility in either your ankle or 1st toe is the culprit – but even tight hips and weak glutes can cause problems all the way down to your foot. Anything that impacts the way your foot hits the ground has an opportunity to influence the level of force and energy transmitted through your foot and arch when you walk, which in turn impacts the natural pronation/supination mechanism. When disrupted, your plantar fascia will attempt to compensate for the pronation/supination mechanism. If this continues to happen, your plantar fascia eventually becomes angry and irritated – resulting in plantar fasciitis. 

Flip flops, or any other shoe for that matter, can either “protect” your arch, or cause it to overwork. Technically speaking, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. Sadly, this is rarely the case for many people. Because of how much we sit, and how little we walk around barefoot, the bottoms of our feet are simply not as conditioned as they could be. This is really the problem – not so much what you put on your feet. If you’re accustomed to wearing supportive and cushioned shoes all the time, and then suddenly switch to flatter, less supportive flip flops in the summer, it’s going to be a shock to your foot. And if you’re prone to plantar fasciitis, it’s going to flare up during flip flop season.

The best thing you can do to prevent and treat plantar fasciitis is to not neglect your feet.

Performing consistent mobility exercises for your toes and ankles is key, as well as conditioning for the strength and stability of your arch. Balance exercises, toe exercises, and plyometric (jumping) exercises are all important, as well as making it a point to walk around without shoes as often as you can. If you’ve already got an ongoing problem with your foot, then I wouldn’t recommend haphazardly incorporating these exercises into your routine without guidance. Talk to an expert who can help you. Plantar fasciitis, when addressed correctly, is very treatable, and you could be back to enjoying flip flops in no time.

Are you local to Portsmouth, NH and looking for help with foot pan?

CLICK HERE to request a discovery call with our Client Success Team to see if we would be a good fit for you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or request a free copy of one of her guides to back, neck, knee, or shoulder pain, email her at [email protected].