Back_Pain_Specialists_Portsmouth_NH

Failed Back Surgery Syndrome? You’re not alone.

Back pain impacts approximately 80% of the population. The response to that has been more and more back surgeries being performed each year. However, despite more surgeries being performed, people aren’t having any less back pain. In fact, those that do get back surgery only have success rates of 50%. After a few years, their results are no less successful than those who chose to have conservative interventions. Such as physical therapy and exercise, for the same problem. If you’re experiencing failed back surgery syndrome, you’re not alone.

The American Society of Anesthesiologists estimates that 20-40% of all back surgeries fail. That statistic gets worse for patients who have a second surgery. Estimating that only 30% of second back surgeries are successful. Should you have a 3rd or 4th surgery your success rate plummets. Only 5-15% of 3rd and 4th back surgeries have successful outcomes. Despite these statistics, approximately 500,000 Americans are still undergoing back surgery every year to relieve their pain. The Agency for Healthcare Research and Quality estimates that back surgery costs us $11 billion annually. That’s a lot of money to spend on something that isn’t even guaranteed to work. 

So why are we spending so much money on back surgery when for almost half of these people (and in some cases more), it’s not even successful?

Problem number one is if you’re dealing with debilitating back pain that is impacting your life and happiness. Surgery is often going to be a very attractive option. If you’re told surgery will take away your back pain, why wouldn’t you want to choose this approach?

The second major problem is with the way back pain is typically diagnosed. Nowadays, doctor’s rely on imaging (X-rays or MRI’s) to decide what’s wrong with you and to formulate a treatment plan. They rarely take the time to talk to you about the events that led to your back pain, examine the way you move, or make certain that what shows up in your images is actually responsible for your pain.

For example, if they see a bulging disc and you’ve got coinciding leg pain – they assume that’s the source of your problem and recommend you cut it out. If you’ve got severe degenerative changes or stenosis in your spine, they recommend fusion.

What’s the problem with this approach?

Things like bulging discs and degenerative changes show up in MRI’s and X-rays, and are quite normal. They occur naturally as you age. It’s no coincidence that before the invention of MRI’s – there were far less surgeries being performed. What we do know is that 50% of the time, back surgery fails. Could it be because we are going in and tampering with structures that have nothing to do with the source of our back problem?

Let me explain.

We now know from research that 70-80% of all back pain is considered “mechanical” in nature. Meaning, the root cause or your pain is due to restrictions in your joints. Or restrictions in soft tissue that impact the way you move. This, in turn, can make surrounding structures very angry and lead to pain. Findings such as bulging discs, disc degeneration, and stenosis are all a normal part of aging and there are plenty of people out there who have these exact same findings on their images – yet have no pain at all. That’s because for some, their joints move fully and freely, and these (normal) abnormalities don’t give them any trouble. But for those whose joints do not move well, that bulging disc has a better chance of getting irritated or causing something else (like a nerve) to get irritated.

Removing the disc, or fusing your spine, won’t take away your underlying mechanical movement problem. It will put a temporary band aid over it until the problem either re-occurs – or shows up in another section of your spine – often years later.

Does this help you to understand why so many back surgeries are unsuccessful? 

It’s such a common occurrence they even have a name for it – “Failed Back Surgery Syndrome”.

When your back pain is due to a mechanical problem – such as an underlying movement or mobility issue – surgery will not fix this. Additionally, MRI’s and X-rays can’t accurately diagnose it. When you do have surgery, you end up prolonging your problem further. Because you think that just because your back pain is gone, your problem is gone.

It’s only a matter of time before your pain returns, and it’s usually worse. Plus, your mechanical problem becomes more challenging to address once you’ve had surgery. But the good news is that it’s still possible to address it without a second back surgery. And it’s possible to address debilitating back pain without a first surgery altogether.

So if you’ve got back pain and are considering surgery, definitely think twice and be sure you’ve been fully examined by a mechanical back pain expert first. And if you’ve already had back surgery and it failed, still talk to a mechanical back pain expert. 

Remember that the odds of success for second and third back surgeries are very low. Even after a failed back surgery, it’s still possible to learn how to address back pain on your own and get back to doing everything you love. 

Did you know that we specialize in back pain – and have helped thousands of folks learn how to treat back pain completely on their own?

CLICK HERE to talk to someone from my team – especially if you’re considering back surgery and want to make sure you’ve explored ALL possible alternatives first.

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 guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Three Ways You’re Getting Back Pain Treatment Wrong

If you’re over the age of 40 and reading this, odds are pretty good that you’ve experienced back pain at least once in your life. In fact, four out of five people are impacted by back pain, and for many, it’s a constant back-and-forth year after year. Keep reading to learn three ways you could be getting back pain treatment wrong.

The first thing you need to understand is that back pain is normal. It’s hard to combat the everyday stressors our modern-day lifestyles impose on our spine. We simply weren’t meant to sit for hours each day or be crouched over electronic devices. Rather than have unrealistic expectations about pain-free lifestyles, we should instead be focusing on ways to naturally manage our own back pain.

Now keep in mind, I make a living off helping people recover from debilitating back pain. But that doesn’t mean I want you to suffer. Here are three ways we’re getting back pain treatment wrong.

1. Quick fixes and passive modalities.

Reliance on quick fixes or passive modalities is how most people attempt to treat their back pain. It’s also the number one reason why back pain returns. A passive modality is something that is done to you vs something you actively do on your own. It’s where you walk in somewhere, lie on a table, and receive some kind of treatment. This could be chiropractic care, massage, acupuncture, or even injections and surgery. You have no active role in the process – it’s completely passive.

Now, I’m not saying there is anything wrong with these treatments. They are great for easing symptoms related to back pain – especially tight, spasmatic muscles. (I have back pain myself and get a massage once per month.) But they shouldn’t be used in isolation. They need to be part of a more comprehensive, movement-based approach to addressing back pain at its source. Plus – you’ll find the relief you get from passive modalities is almost always temporary. And when your pain keeps coming back – it’s a sure sign you’re missing something. Don’t get back pain treatment wrong by relying on passive modalities.

2. Letting MRI’s make the decision.

Traditionally, the medical community diagnoses your back pain with images. If you’ve had back pain for a while, and especially if you’ve already tried some physical therapy, doctors will prescribe an MRI to “see what’s going on” inside your spine. The problem is that what shows up in your MRI doesn’t always correlate with what’s causing your back pain. In fact, 60% of the time, what you see on your MRI has nothing to do with the root source of your problem.

For example, your MRI might show a bulging disc in your spine. Well, did you know that bulging discs are normal and occur naturally as you age? You could have two people with the same bulging disc on their MRI and one will have zero back pain.

Why? Because the root cause of back pain is more complicated than your anatomy. Evidence from research tells us that 70-80% of all back pain is primarily caused by restrictions in your mobility – which is influenced by your habits and the way you move – not by what’s going on structurally in your spine.

So if your doctor lets your MRI make the decision, and recommends surgery to cut out a bulging disc that isn’t even the source of your real back problem, you’ve not only wasted a surgery, but wasted even more time not addressing the real cause of your pain. Letting MRI’s dictate your treatment plan is one of the most overlooked ways we’re getting back pain treatment wrong.

3. The wrong exercises.

One of the biggest problems I see when it comes to treating back pain is non-specific, non-prescriptive, generalized exercises that are designed to make you strong and perhaps even target your core – but it’s before the real problem gets addressed.

Almost 90% of the time, back pain is due to immobility in your spinal joints (vertebrae) that causes irritation of surrounding structures in your spine – such as discs, nerves and ligaments. What we know to be true is that these mobility restrictions can be freed up with very specific movements, in very specific directions, using a very specific frequency during the day.

Once the restriction in your spine is free and you’re moving normally, you can do any exercise of your choosing. It’s at this point that strengthening your core, for example, is beneficial. Because a strong core helps prevent future back pain episodes (but it doesn’t cure a current back pain episode).

To figure out which specific move you need to address your back pain will require help from an expert. But the good news is once you know what movement gets rid of your back pain, you can use it time and again to manage it on your own. But generalized exercises, when done too soon, is another big way we’re getting back pain treatment wrong.

If you’ve been suffering from back pain longer than you should, I hope this information helps you figure out where you might have been steered wrong.

It’s worth getting help from a back pain specialist who emphasizes corrective, prescriptive movement as a means to recovery – vs quick fixes, MRI’s, and generalized exercises.

Want help from one of our specialists? Request a Free Discovery Call HERE to see if you’re a good fit for what we do.

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 guide to back pain CLICK HERE or visit her website at cjphysicaltherapy.com.

tight hips

Two Reasons People Avoid Exercise Over Age 50

Should you truly “avoid exercise” once you’re over 50?

Over the course of my career, I’ve worked with many folks over the age of 50 who are enjoying the same activities they did in their 40’s – including surfing, playing tennis, hockey, running, hiking, etc. – so the short answer is “No”. None of these activities are considered “easy on the joints” – and yes, you might have to make some modifications to continue enjoying them – but you certainly don’t have to avoid exercise if you don’t want to.

So why is it that some folks see age as just a number, whereas others see age as a time to slow down and stop doing certain things? 

Once you’re over 50, the two most common reasons I see people avoiding activities they love is because

1) they fear pain could be causing damage to their body and

2) they were simply told to by a medical professional. 

  1. Fear that pain could be causing damage 

When it comes to musculoskeletal pain, the pain itself is typically not the biggest concern for most. People are willing and able to tolerate a certain amount of pain at the expense of doing what they truly love. We do it all the time in our 20’s or 30’s. But as we age, fear starts to set in when we’re in pain. We naturally become more cautious with activity and begin to question what the pain could be doing to our bodies. Plus, as you get older, it becomes harder to recover from injuries, leading some to rationalize for themselves that it’s better to just avoid certain activities altogether because it’s “safer” than getting injured.

So does pain mean we’re doing damage? Not necessarily. Pain is simply a signal from your brain that it wants you to pay attention to something. You shouldn’t ignore it, but you don’t have to fear it either. Oftentimes, pain just means you might have to adjust or modify something. Once you understand what your pain is telling you – you can take appropriate action. This is one of the secrets to being able to continue your favorite activities well beyond your 50’s. Learn how to “talk” to your pain.

  2. A medical professional told you to avoid exercise 

When we’re younger, we’re more likely to address pain with a wait-and-see approach. But as we age, pain becomes a bigger concern and we’re more likely to seek professional medical help sooner. While this would seem prudent, the problem is there are a lot of well-meaning medical professionals out there who aren’t always up to date with the latest research. The consequence? Mixed messages and “old school” advice for many of their patients. 

For example, many doctors have come to rely on images (X-rays and MRI’s) to base their diagnosis of musculoskeletal pain and subsequent treatment plan/recommendations. If your X-ray shows “bone on bone” arthritis, they start talking about joint replacements – and/or tell you to stop doing any activity that could “damage” your joint further. But the current research disputes this line of thinking, and says 70-80% of all musculoskeletal problems (even when you’re over 50) can be solved without a procedure or surgery. How your pain behaves is what matters most. Not your age, arthritis, or images.

Here’s a real life case study that illustrates what I’m talking about.

Not too long ago, I met a 55-year-old woman (we’ll call her Kate). She was having knee pain that interfered with her hiking and running. She was told by her orthopedic surgeon that knee replacement was her only option. This was because of the “bone-on-bone” in her knee. Kate questioned the knee replacement and asked if she could wait. Her doctor’s response was to scale back on activity and stop running and hiking altogether. But just because Kate’s X-ray showed osteoarthritis in her knee, it doesn’t mean it’s the cause of her knee pain. Research tells us this. It’s entirely possible that Kate’s knee pain is due to something other than her “bone on bone” arthritis.

Did she really need surgery? And did she really need to stop running and hiking?  If she underwent a knee replacement without being sure if arthritis is truly the main cause of her knee pain, she not only risks unnecessary surgery, but would also be set back several months for recovery.

First, inactivity is one of the worst things you can do for arthritis.

People who stay active with weight-bearing activities are shown to have less arthritis than those who avoid doing things that compress their joints. Second, during Kate’s movement exam, we were able to quickly turn her knee pain “off” and then “on” again. That means her knee pain could not be solely due to the arthritis in her knee – because you can’t reverse “bone on bone” arthritis with movement and certainly not that quickly.

You can, however, successfully address a mechanical joint problem with movement – which is exactly what was happening. Mechanical problems in your spine or joints won’t show up on X-ray. So you don’t want to rely on images alone to make decisions about your pain – and certainly don’t rely on images alone to decide if you should have surgery or not. 

If you’re getting older, know that age related changes like arthritis are normal and nothing to be afraid of. Pain is also normal. It’s an important signal that alerts us to take action. It doesn’t always equal damage. Be sure to educate yourself about these topics and ask more questions if you’re told to stop an activity “just because”, or that surgery is your only option because of an image.

Do you avoid exercise because of back, knee, hip, shoulder, or ankle pain?

 Let us help you get back to it! Request a FREE Discovery Call with my team. It’s a no obligation call to figure out 1) if we can help you and 2) are you a good fit for what we do.

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] .

Avoid Pills. Use Movement as Medicine Instead

Avoid Pills. Use Movement as Medicine Instead

In the 1990’s, it started becoming widely accepted to prescribe opioids for people recovering from surgery or injury. As well as those suffering with moderate-to-severe musculoskeletal pain (such as back pain and osteoarthritis). Although effective for managing pain, we would soon find out how highly addictive these drugs are. Statistics show that one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. And once addicted, it’s very hard to stop. Keep reading to lear why movement as medicine is a better option.

The Centers for Disease Control and Prevention (CDC) found in their 2018 Annual Survey Report of Drug-Related Risks and Outcomes that in 2016, more than 11.5 million Americans reported misusing prescription opioids. And despite efforts to curb these statistics, this number started to creep up again during the pandemic.

In response, the medical community established more strict control around the prescription of opioids. Many are avoiding prescribing them all together. For patients with severe back pain and arthritis, for example, injections and minor procedures have become far more common and recommended.

While this approach prevents you from becoming addicted to opioids, there are still inherent risks any time you have an injection or undergo a procedure.

So what’s the alternative?

Prescriptive movement strategies are the alternative. Specialized, custom-fit “exercises” that are designed to have a very specific (and noticeable) effect on your pain.

But what’s the difference between generalized exercises that make you feel good vs prescriptive movements that also make you feel good?

Well, the distinguishing factor is both in:

1) how your pain responds to the movement while you’re doing it, and more importantly

2) how it behaves afterward. Lots of exercises feel good while doing them, but not all exercises give you the long-lasting effect you’re truly looking for.

For example, let’s say you’ve got back pain. Perhaps stretching your back a certain way makes you feel good and temporarily eases your pain. But an hour or two later, or the moment you perform an activity that typically aggravates your back, your pain comes right back. The stretch makes you feel better, but it doesn’t do a good enough job to make you stay better.

Over time, you might find that your back pain comes and goes often. Although this stretch always helps, nothing really takes away your problem completely. Instead, you get stuck in that vicious cycle of stopping all activities every time you hurt your back. Or worse – start avoiding certain activities altogether for fear of hurting your back. This is no way to live and it’s not an example of a good prescriptive movement strategy.

So what would a prescriptive movement as medicine strategy look like?

Let’s take the same example above. But this time – you find that a particular stretch not only makes your back pain go away in the moment, but it stays gone the more you do it. Whenever your back pain returns, you can reliably use this stretch to take your back pain away every time. This is an example of a prescriptive movement strategy. You know exactly what to do, how often to do it, when to do it. And it works without fail every time. Plus, once you know what your prescriptive movement is, you can use it to prevent pain as well.

The good news is that 70-80% of all musculoskeletal pain responds to a prescriptive movement strategy. It works in all joints and muscles. You just have to work with someone who knows how to help you find it and then use it over the course of time. I can’t tell you how often I meet people who have the right movement, they just weren’t applying it correctly to get the long-term relief they were looking for.

Too good to be true?

It’s not – I promise. The problem is there’s a lot of mis-information out there and not every health care or fitness professional is trained in discovering the prescriptive movement that you need – or teaching you how to use it properly. The second problem – to be frank – is that hospitals make a lot of money from procedures and surgeries. There’s no real incentive for them to support conservative, natural treatments that you can do on your own at home.

With procedures and surgery, the results are faster, which makes for happier patients (in the short term). But studies show that 2-3 years out from surgery your results are no better or worse than if you were properly prescribed movement as your treatment. And after 10 years, those who’ve managed to avoid surgery for the same problem, actually have much better outcomes than those who went under the knife.

The greatest benefit of taking the time to go slow at first, and find a prescriptive movement strategy that works, is that you’ll have this movement “medicine” at your disposal at all times. It’s always in your “medicine cabinet” and you never need a prescription or pharmacy to refill it.

Hopefully I’ve got you thinking. And encouraged you, at the very least, to explore whether or not movement really can be your medicine. If you’re already tried and failed at this, it’s quite possible you just didn’t have the right approach.

Consider talking to someone from my team if you’re serious about getting help.

We’re trained to help you find YOUR prescriptive movement as medicine strategy and are up to date on the latest research.

CLICK HERE to request a Free Discovery Call with my team to see if you’re a good fit for what we do.

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 guide to back pain CLICK HERE or to get in touch, email her at [email protected].

When You Can’t Feel Your Abs

I’ve been a physical therapist for 20 years, a Pilates instructor for 11, and have been specializing in back pain for the past 10 years of my career. When it comes to core strength and preventing back pain, I am an expert in my field. Yet for some reason this morning, during my Pilates workout, I just couldn’t feel my abs. I teach people how to do this every single day yet this morning, I couldn’t seem to access my own.

What was happening?

And more importantly – if it can happen to someone like me – it can certainly happen to someone with less training than I have. I started to think about all the reasons this could be happening to me. Had I gotten enough sleep? What had I eaten the day before? Could it be stress?

And then it hit me.

I had just come back from a 2-day course where I’d been sitting far more than usual. I sat for 8 hours straight. Two days in a row. Not to mention all the very cramped sitting I did on the plane to and from this course. When one of my clients is about to have a few days like this, this is what I recommend. Get up from your chair and stretch backwards as frequently as possible every few hours.

But guess what – I didn’t follow any of my own advice. The result? A stiff back and sleepy abs upon my return.

Our bodies are highly intelligent and have every capacity to heal themselves when given the right environment. Conversely, when in the wrong environment, our bodies will also do what it takes to naturally protect from harm and injury. In my case, I came home from this course with a stiff lower back.

Back stiffness is the first sign that your back is not happy. This means your chances of tweaking it or exacerbating an old back injury are higher. When any joint is stiff and not moving well the muscles surrounding that joint will become naturally inhibited or weakened. This occurs on purpose as a protection mechanism. Your body doesn’t want a fully contracted muscle compressing an unhappy joint. In the case of your lower back, the muscles that can get inhibited when your back is not happy include your abdominals as well as back muscles.

So what can you do when you feel less core strength?

The good news is I’ve already helped you with step one: awareness. Inhibited muscles are not the same as weak muscles. In my case, I do have strong abdominals. My weekly routine consists of a regular Pilates practice, lifting weights, and I perform activities like hiking and running that engage my core. Yet despite all this, my abs were simply not having it this particular morning. They were not set up for a successful workout.

The combination of my stiff back and having sat for several days just meant that I needed to do something different to prepare my lower back and abdominals for this workout – so that I wouldn’t injure myself. My sleepy abs and stiff back were, in effect, trying to tell me just that.

All I needed to do was have the awareness this was happening so I could take appropriate action.

It’s no different than when you go on vacation and you get off your routine by eating more than usual. You might return a bit bloated and not feeling your best self. This kind of feeling we are accustomed to. And might respond by getting a bit strict with our diets until feeling back on track. Our joints can react similarly to a change in routine – we’re just not as accustomed to the signs and symptoms that let us know. But once you are – you can easily manage this and avoid injury. Had I pushed through my Pilates routine as normal this morning despite sensing that my back and abdominal function was off – there’s a good chance I’d be sitting here writing to you with full on back pain instead of just some lingering stiffness.

If you’re reading this, and you’re over the age of 40, odds are pretty good that you’ve experienced back pain at some point in your life. The odds are also pretty good that you’ve experienced back pain more than once.

If this is a recurring pattern for you, your abdominals and deep core may not be functioning at their best.

You could be caught in a vicious cycle of trying to improve your core strength only to keep hurting your back.

The missing solution for you might be that nobody has fully examined your back in a way to ensure that it’s moving fully and freely like it should. Once your back moves well, you can usually start to strengthen your abdominals without a problem.

If you’re confused right now – I don’t blame you.

The take home point here is that if you keep experiencing weakness in a particular area despite trying to strengthen it consistently, it’s possible you could have a problem in your joints that is keeping your muscles from fully activating like they should.

Talk to one of my specialists about it.

Someone from my client success team will call you right away and see if you are a good fit for what we do. At the end of the day – we’re here to help.

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 guide to back pain CLICK HERE or to get in touch, email her at [email protected].