January 2023 - CJ Physical Therapy & Pilates

How to Know if You’re Getting Quality Physical Therapy

January 30, 2023/in Physical Therapy/by Carrie Jose

How to Know if You’re Getting Quality Physical Therapy

I’ve been a Physical Therapist for just over 20 years and I’ve seen a lot of changes in my field over the course of my career. One of the biggest (and saddest) changes I’ve seen is the overcrowding of physical therapy clinics. This has ultimately impacted the quality of care you receive. Reimbursements from insurance companies have gone down. In turn, traditional physical therapy clinics have been forced to increase their volume of patients.

That means you rarely get to spend time with your therapist anymore. And your treatment sessions may consist of repetitive exercise sets that you typically can do at the gym or on your own, and that aren’t all that prescriptive or effective. If you do manage to get some one-on-one time with your therapist – whether it be for hands-on-care or actual consultation about what’s going on with you – it’s often just a quick 20 min.

The rest of the time, your well-meaning therapist is often held hostage to a computer because of all the documentation requirements placed on them (just to get paid and keep their jobs).

The end result… you spend an hour or two at the clinic each week doing “supervised” exercises that may or may not be addressing your problem. As this model of care is becoming more and more standard, it’s impossible for the quality of your treatment not to suffer. Many folks I speak with say that traditional physical therapy is a “waste of time”.

Why bother going when they can do everything on their own at home?

Worse – when traditional PT does fail – what next? Most people go back to their doctors hoping for a different solution. But in most cases – after the perceived “failure” of PT – the logical next step involves unwanted procedures or surgery.

But what if you don’t need that? What if quality physical therapy could have fixed your problem – but you just didn’t know what that looked like?

Herein lies a major problem in the current management of musculoskeletal conditions such as back, neck, knee and ankle pain. It’s important that you understand what quality physical therapy is and isn’t – so that ultimately you can advocate for the best treatment – and not settle for anything less.

Let’s start with what quality physical therapy is not…

It’s not a bunch of general exercises and ultrasound treatments. It shouldn’t consist of you riding a bike for 10 min, lying on a hot pack with e-stim for 15 min, and then getting some generalized massage before they send you off on your way. And most certainly, quality physical therapy does not feel cookie cutter or like a waste of time.

Quality physical therapy treatment – on the other hand – is customized, specific, and obvious.

When you receive quality physical therapy – it’s about so much more than making you feel good and reducing your present symptoms. Of course that’s a happy byproduct. But quality physical therapy treatment should consist of a proper musculoskeletal diagnosis. This will explain to you exactly why you’re having symptoms.

No more guessing games. And spoiler alert – your physical therapist’s diagnosis – when done properly – is often different and far more specific than your doctor’s. From there – you should have a clear plan to eliminate and/or get your pain back to something manageable. In other words, you should feel so good that you never even would have called your doctor or PT in the first place.

But what’s the most important aspect of your treatment? What distinguishes quality physical therapy from the regular kind? It’s how things work and function when you’re not at physical therapy.

In other words – do you always feel good when you leave only for the pain to come back the next day?

You should leave every visit with a crystal clear path forward.

It’s critical that you know how to keep your pain gone after your physical therapy is finished as well as prevent it from coming back. Generalized, non-prescriptive exercises won’t be enough to accomplish this. You need very specific and purposeful treatment – and in a nutshell – that’s what quality physical therapy looks like. And you know what – it works.

When done correctly – 80% of all musculoskeletal problems can be resolved naturally and without procedures or surgery – even without pain pills for that matter. I love my chosen field and I continue to have faith in my colleagues. Quality physical therapy does still exist – you just may have to go hunting for it.

Sadly, the insurance-based model of physical therapy reimbursement has made it harder to deliver quality physical therapy for clinics. You may need to be prepared to pay out of pocket for some or all of your treatment in order to receive the quality physical therapy you deserve.

It’s worth the extra cost. Especially when you consider the alternative and risk of a failed procedure or surgery. That can have a much bigger “cost” at the end of the day.

Trust me – I’ve seen it.

Are you local to Portsmouth, NH?

If you’re dealing with pain – book a Free Discovery Visit with one of my Specialists. We will ask you what’s been going on -and determine if we would be the right fit to work with 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].

Suffering from Sciatica? The Do’s and Dont’s

January 23, 2023/in Back Pain, Movement/by Carrie Jose

Four out of five people will experience a debilitating back pain and Sciatica episode at one point during their lives. Sometimes this looks like severe back pain that lasts a few days and eventually goes away on its own.

But for some – especially those that have experienced more than one debilitating back pain episode over the course of their lifetime – they experience searing pain down their leg that may or may not persist over a period of time.

When you experience back pain followed by radiating leg pain – this is known as “sciatica”.

Sometimes the pain will only go to your knee, or be a dull ache in the side of your hip and leg. But other times it can manifest all the way down to your foot and be accompanied by numbness, tingling and a loss of strength.

The good news is that there is plenty you can do on your own to help yourself recover from sciatica naturally. But there’s just as much you can do – unknowingly – to make your situation worse.

Here are some Do’s and Don’ts when it comes to sciatica.

The Dont’s:

1. Avoid resting in bed or on the couch.

While it may feel better in the moment – lying in bed or on the couch will ultimately aggravate your sciatica. Sciatica is caused by pinching or irritation of the nerves in your lower back. When you lie in a slouched posture (such as in bed or on the couch) you will put unwanted pressure on these nerves, thus aggravating your symptoms.

The trickiest part about this is that you typically won’t notice the aggravation when you’re resting. You’ll notice it after the fact when you stand up or try to move around, and mistakenly assume the movement is what’s aggravating you instead of the relaxed posture you were just in.

2. Avoid child’s pose and stretching forward.

This is another big misconception about sciatica because it tends to feel really good when you’re “in the moment” and stretching your back forward. Not always, but often, sciatica is caused by a bulging or herniated disc that is pinching your nerve.

The position of bending forward does temporarily relieve pressure on your nerves – which is why it feels good at first – but it doesn’t last.

Stretching forward also opens up the space between your vertebrae. This can influence the protrusion (bulging) of your disc. If you allow your disc bulge to protrude more onto that nerve – your nerve will become more angry and aggravated – as will your sciatica.

3. Don’t let your MRI decide treatment.

As I mentioned in our first two examples, sciatica often involves bulging discs and irritated nerves. And an MRI will typically confirm this. But here’s the thing – tons of people out there have bulging discs showing up on their MRI’s and no symptoms at all.

What matters is whether or not your bulging disc is interacting negatively with your nerve – and that is typically influenced by poor movement strategies.In other words, if you learn how to move better, you can actually make your bulging disc inconsequential and your sciatica will dissipate.

So you should never let your MRI, alone, determine your treatment protocol when you’re suffering from sciatica. What’s more important is how your sciatica symptoms behave during movement. Research has shown this to be more reliable than imaging alone because it tells us in real time what’s happening to your nerves.

The Do’s:

1. Keep moving.

While it may seem counterintuitive to move when you’ve got pain running down your leg – it’s one of the best things you can do.

Try to stand and walk upright as much as you can and pay close attention to what happens in your leg. If the symptoms in your leg start to subside, then you’ll know that your body is enjoying that particular movement and that it’s helping your sciatica.

But here’s the catch – make sure the relief lasts. Lasting relief (vs temporary) is what we’re looking for and it tells us if the movement you’re doing is a good thing for your sciatica.

2. Watch your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. Remember that sciatica typically involves a pinched or irritated nerve – and irritated nerves are highly sensitive to postural changes in your lower back (especially slouched postures).

Whether you’re standing, sitting, or lying down – be sure to maintain a small curve in your lower back to minimize your slouch. This helps to keep pressure off your discs and already aggravated nerves.

3. Talk to a Movement Specialist.

While it’s entirely possible to rid yourself of debilitating sciatica without pain pills, procedures, or surgery, you’ll find it easier to do so under the guidance of a movement specialist who specializes in understanding back pain and sciatica.

Yes – you can get an MRI and go see a surgeon – but they aren’t movement specialists. They are surgical specialists. In order to get rid of your sciatica the natural way (with corrective movement strategies) – you need to work with someone who’s an expert in this.

Have you been dealing with back pain or sciatica? Or do you know someone who is?

If you”re local Portsmouth, NH, and you want help NOW for your back pain – Request a Free Discovery Session from one of my specialists. They’ll tell you if we can help and get you set up on a treatment plan 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 guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Back Surgery: Why it fails and do you need it

January 16, 2023/in Back Pain, Movement/by Carrie Jose

Approximately 500,000 Americans undergo back surgery to relieve their pain every year, and according to the Agency for Healthcare Research and Quality (AHTQ), this costs approximately $11 billion annually.

But what if I told you that only 5% of people undergoing back surgery actually need it – and worse – for many folks the pain ends up coming back. The American Society of Anesthesiologists estimates that 20-40% of back surgeries fail. If you’ve had repeated back surgery your risk of failure increases. Failed back surgery is so common that it’s gotten its own name – “Failed Back Surgery Syndrome” – which occurs when you experience continued pain in your neck, back, or limbs following any spine surgery meant to reduce pain.

So why then do we continue spending so much money on back surgery when the majority of people don’t actually need it – and when half the surgeries fail?

Back pain can be excruciating, debilitating, and have a significant impact on your quality of life and happiness.

If you’re in this situation, and told by a well-respected surgeon that surgery is your best option of taking your pain away and getting you back to living your life again, odds are good you will take that opportunity. And most of the time – surgery does take your pain away – initially that is.

But what surgeons don’t tell you is that your pain has a high likelihood of returning.

If you’ve had one “successful surgery” – you assume the next will go the same. But as mentioned above – the more back surgeries you have – the more likely they are to fail – and the vicious cycle begins.

So when should you get back surgery?

If you’ve had an accident or trauma that has resulted in major damage to your spine – you need surgery.

If you have urgent compromise to one of your spinal nerves you also need surgery. But let me preface “urgent”.

Your symptoms will be progressive and severe.

Signs might include problems with your bowel and bladder, sudden and worsening foot drop (loss of strength and ability to lift your foot and toes), walking will be difficult and progressively worsen, and nothing will take your pain away – medication and rest will barely touch your symptoms.

These cases are rare – but do require surgery to quickly decompress your nerve before permanent damage ensues.

But 70-80% of the time, back pain is what we call non-specific or mechanical.

And surgery is not recommended – and rarely works for this type or back pain.

Mechanical back pain can be acute and last for a few days, or can be chronic and come and go. You might have nerve pain with numbness and shooting pain down your leg, but it won’t be urgent like the situation described previously. The pain you feel is typically caused by irritation to soft tissue structures, discs, muscles, and joints. But the root cause of this irritation is from something different – and that is what we need to care about.

It’s why 50% of back surgeries fail.

Let me explain…

When you get an MRI to see “what’s causing” your back pain – it will typically show some form of bulging disc, degenerative discs, or lumbar stenosis. You will likely be told that these findings are what’s causing compression and irritation to your nerves.

They might try injections and medication first, but when that doesn’t work, they’ll recommend surgery. But here’s the catch. These findings show up in 60-80% of all MRI’s when you’re over the age of 50. But not everyone with these “abnormalities” has back pain.

In other words, you can have two people of the same age, with equal-looking MRI’s, and one will have pain while the other doesn’t.

How does that happen?

What research has shown over the years is that what shows up in your images rarely correlates with what’s causing your back pain.It’s why so many back surgeries fail – because we are messing with “abnormal” findings that are in fact – quite normal for your age. So if the structures aren’t the problem – then what is?

Most back pain comes from poor movement habits and lifestyle.

Over time, repeated, unbalanced movements will exacerbate or cause irritation to these structures that are considered “findings”. But you can’t fix your back problem by only addressing where the symptoms are.

You have to address the root cause. This is typically some combination of restoring full and free mobility in your spinal joints and balancing out flexibility and strength. When you move correctly – these structures are no longer bothered – and neither is your back.

I know what you’re thinking – this sounds way too simple and perhaps you’ve already tried physical therapy or something similar and it didn’t work. Sadly, not everyone understands – or even agrees – with the concept of mechanical back pain in the way I’ve just explained it.

But trust me, when you find someone who does, you’ll be amazed at how easy it is to fix your own back. You can then keep the pain gone – without ever having to see the inside an operating room.

Back surgery can be costly – both to your bank account and mental well being.

That’s a lot of money to risk when there’s only a 50% chance of the surgery working. There’s an even better chance that your pain will come back. If there’s a complication of any kind, then you’re looking at more surgeries. This is an almost certain loss in quality of life.

It’s worth it to do your due diligence. Find a movement specialist who understands mechanical back pain and can keep you out of the operating room.

If you’re dealing with back pain now and want to learn more…

We will be talking all about this and more in our upcoming Masterclass for Back Pain & Sciatica Sufferers.

The Masterclass is free – and happening on January 24th from 6-7 pm via zoom. Reserve your seat HERE – spaces are limited – and there’s a limited number of spots left.

Three Reasons Back Pain Sufferers Avoid Exercise (and what you can do)

January 9, 2023/in Back Pain, Events & Workshops, Movement/by Carrie Jose

80% of the population suffers from what we call “non-specific low back pain”. Low back pain is typically chronic, comes out of nowhere, you have good days and bad days, and it’s not usually due to any recent or major accident or fall. If you’ve got back pain and you’re reading this – odds are pretty good that you suffer from non-specific low back pain. Research shows that exercise is the best treatment for non-specific low back pain.

But what do you do when your back pain keeps you from the thing that’s supposed to help you?

Here are three of the most common reasons I see that keep people with low back pain from exercising – and some tips for what you can do:

1. Fear

Let’s face it – back pain is scary.

This is the number one reason back pain sufferers don’t exercise. Is the pain you’re feeling good or bad? Should you be feeling any pain at all? Pain is confusing. When you experience pain during exercise, it can be difficult to know if it’s normal or a warning sign. For many, the safest thing to do (as they see it) is avoid any exercise or movement altogether until the pain subsides.

The problem is – when you try to resume movement again – the pain comes right back – and then you’re caught in a vicious cycle.

What you need to figure out is which movements are “good” and which movements are “bad” – and the good news is your body is going to tell you. If you hurt a little at first – but feel better the more you do something – and aren’t worse after – you can consider that movement generally safe and be encouraged to keep trying it.

But if you hurt during – and feel worse after – then that’s a sign to stop and back off. Pain is not something to fear – it’s just information. What’s important is how your back pain behaves over a period of time with a certain activity.

Fear of pain comes from not knowing what it is or what to do – but when you figure out how to “speak pain” – the fear goes away and you can have control over your body again.

2. Bulging Discs

Most people who suffer from long-standing low back pain eventually find themselves getting an MRI. And 60-70% of the time, it will show one or more bulging discs.

If you’ve been following me for a while, you know that most people over the age of 40 walk around with bulging discs – and that 65% of them feel no pain at all. In other words, if you’ve got a bulging disc, you can’t be certain it’s the cause of your back pain. Research proves this. And being told you’ve got a bulging disc is not a reason alone to avoid exercise.

Movement is actually one of the best things you can do for a bulging disc.

It may require some customization of your current exercise routine, but a movement specialist can help you with this. Don’t just stop or avoid exercise altogether just because you’ve been told you have a bulging disc. Go back to the rules of pain I mentioned above and let that be your guide instead.

3. You Were Told to Rest

Well-meaning doctors and family members who aren’t up to date on the latest back pain research will advise you to rest every time you experience back pain.

This might be reasonable advice when you’re dealing with an acute (sudden) episode of back pain – but it’s terrible advice for chronic, non-specific low back pain sufferers.

Rest is one of the worst things someone with chronic back pain can do. Since most people don’t have a thorough understanding of this concept, they find themselves in a yo-yo effect.

They rest to “heal” their back pain. When it’s gone they return to exercise – only to hurt their back again. I’ve seen so many people fall victim to this perpetuating cycle and it’s a big reason why so many back pain sufferers just give up on exercise entirely.

If it’s been a long time since you’ve exercised – start with 10 min of daily walking.

Walking is generally known to be one of the best things you can do for back pain. If for some reason walking increases your back pain – then that’s a good reason to see a back pain specialist (ideally one who understands how to heal your back with movement versus pills and procedures).

If you’re suffering from chronic, non-specific low back pain – and you’ve stopped exercising – know that you’re not alone.

This is such a confusing topic and there are so many mixed messages out there about what the “right” and “wrong” thing to do is. Don’t try to go at it alone. Exercise is good for your back, but you may just need a little help and guidance to get there.

Need help with Back Pain now? Are you Local to Portsmouth, NH? CLICK HERE to speak with one of my specialists. We will see what’s been going on with you – and get you on a treatment plan right away.

We will be talking all about Back Pain in our upcoming Masterclass! Its free – via zoom – on September 19th. Reserve your seat here! Learn how to manage your back pain on your own – and get back to doing the activities that you love – pain free!

Ignoring Back Pain could Sabotage Your New Year’s Goals

January 2, 2023/in Back Pain, Movement/by Carrie Jose

Now that the Holiday’s are behind us – many people start to shift their focus to New Year resolutions.

According to statista.com – the three most popular New Year goals are:

Doing more exercise and improving their fitness
Losing weight
Saving money

Would you be surprised to know that if you are currently suffering from back pain – and you continue to ignore it – it could significantly impact your chances of success at achieving any of these goals?

Let me explain.

Let’s start with doing more exercise and improving fitness…

Most people think that if they start exercising more – especially their core – it will solve their back problem. Not necessarily.

While the research studies show (overwhelmingly) that exercise is one of the best treatments for back pain – what they don’t reveal is that there are typically some key things that must be in place in order for exercise to be effective.

For example, you must have good mobility before you start focusing on stability (or strengthening). If you’ve got a stiff back, general exercise could be all you need, and you’ll notice improvement. But you won’t know until you get going and by then it could be too late.

What if your back is stiff because it’s compensating for something – say a bulging disc or muscle weakness? If that’s the case, and you go all in with an exercise program in January, it’s only a matter of time (usually about 3 months in) before your back becomes worse, forcing you to abort your grand plan for the new year. When stability is there for a compensatory reason, it’s important to figure that out before adding more exercise or strengthening to the mix. This is one way back pain could derail your New Year’s resolution of doing more exercise and improving your fitness.

Say you want to lose weight this New Year.

This is a fabulous goal. And if you’ve got back pain, losing weight will surely help. But once again, it’s critical to understand why you’ve got back pain in the first place.

For example, being overweight is rarely the cause of back pain. A few extra pounds can certainly exacerbate your back problem, but it doesn’t usually cause back pain all on it’s own. The most common causes of back pain are mechanical (movement) problems. In other words – bad movement habits such as sitting all the time, bending and rotating too much, or having terrible posture can all lead to back pain slowly over time.

If you lose weight, but never correct these mechanical/movement problems, your back pain isn’t going to improve. When it comes to the process of losing weight, in addition to watching your diet, more exercise is often incorporated into a weight loss plan. If you’ve got back pain, it’s more than likely due to poor movement habits. More exercise will not address these, and worse, could exacerbate the problem. If your back pain increases, not only will you not want to exercise, but you could be more inclined to sit at home and eat more – completely derailing your New Year’s resolution of losing weight.

Finally – we come to saving money in the New Year!

What on earth could back pain have to do with this?

Well, you’ve probably heard the saying: “If you think wellness is expensive, try illness”. And this couldn’t be truer. When you ignore back pain, it’s only going to get more expensive to address later. As back pain worsens, you’ll have less willpower to bear it, and you’ll be more likely to opt for expensive fixes such as outpatient procedures and surgery. Not to mention the rehab that needs to take place afterwards for an optimal recovery and the expensive tests that need to take place before-hand to ensure you’re ready for surgery.

When you ignore a back problem it’s only a matter of time before it becomes unbearable. And when we’re desperate, we make poor decisions, which often leads to more money spent than necessary. All that money (and more) that you set out to save as part of your New Year’s goals eventually goes to waste. Instead, get in front of your back pain.

For 80% of back pain cases, there is a natural, movement-based solution.

Natural solutions are far less expensive – and much safer long term compared to something like surgery. While the impact of ignoring back pain may seem indirect when it comes to a New Year’s resolution of saving money – it will impact you in some way – at some point – in a monetary way if you don’t address it now.

When you’ve got back pain (or any pain for that matter) that isn’t going away, it’s your body trying to tell you something. Don’t ignore it. It’s only a matter of time before it gets worse and starts to derail more than just your New Year’s goals.

If you want to stop ignoring your back pain and you’re ready for some help – talk to one of my specialists! They’ll let you know if we can help – and if you’re a good fit for what we do. CLICK HERE to request a Free Discovery Session with one of my specialists.