Shockwave Therapy

What is Shockwave Therapy and Should You Consider it?

What is Shockwave Therapy and Should You Consider it?

If you’ve been reading my articles for awhile – you’ll know that I’m generally not a huge fan of passive modalities – especially when used in isolation. However, every now and then one comes along that grabs my attention. A few months ago – Shockwave Therapy treatment did just that – so I started doing my research…

Shockwave Therapy is a revolutionary, non-invasive treatment protocol that utilizes high-energy acoustic (sound) waves to treat chronic musculoskeletal pain conditions, as well as soft tissue/sports-related injuries. To give you an idea of how powerful it is – it was initially used by urologists to treat and break up kidney stones. Over the last few years, the orthopedics and sports medicine practitioners have started to apply the technology in their respective fields, and are happy with the results.

So what is Shockwave Therapy and how does it work?

Shockwave therapy – otherwise known by its technical name of Extracorporeal Shock Wave Therapy (ESWT) – utilizes high-energy “shock waves”. These Sound-waves promote and accelerate the body’s own natural healing process. When the shockwave treatment is applied, there is a transference of energy from the shockwaves into the targeted tissue area. This triggers a biological response that helps to aid and accelerate the healing process. The biological responses include stimulation of cell regeneration, improved blood flow, and formulation of new blood vessels (neovascularization). All are designed to speed up soft tissue healing and provide relief from pain. Some folks feel pain relief right away, for others it takes a few sessions. 

Research is still being done to evaluate the full effectiveness of shockwave therapy – but so far we are seeing really good results for persistent, chronic conditions such as plantar fasciitis, tennis elbow, patellar tendonitis (runner’s knee), and shoulder tendonitis. Anytime you have a chronic condition involving tendonitis, the treatment protocol required to get true healing and rehabilitation is highly specific and generally takes 7-9 months. You also want to avoid things like ice and anti-inflammatories because it impedes the healing process. This can be hard for a lot of folks since chronic tendonitis tends to be painful. This is one of the reasons I love Shockwave Therapy. It not only enhances the healing process of tendons and other soft tissue – but it helps to relieve pain at the same time.

Ok – now that you know a little bit more about Shockwave Therapy. Is this a treatment you should consider for yourself?

Have you been suffering from a chronic or persistent soft tissue injury or tendonitis? Are the treatments you’re currently trying not quite getting you back to 100% as fast as you’d like? Then this might be something valuable to add into the mix. It could very well be the missing link needed to give your soft tissue healing the boost required to get you over the hump you’re currently at.

Another great reason to consider trying Shockwave Therapy is that it’s very safe and completely non-invasive. It doesn’t require any kind of incision, use of  anesthesia, or needle punctures such as with steroid injections. This significantly reduces the risk of any type of infection or complication after your treatment. Plus, the treatments are short. They only last about 15-20 min to get significant pain relief and powerful tissue healing.

The last thing I’ll say about Shockwave Therapy is that although it’s very safe and designed to reduce pain, there can be some short-term pain and discomfort associated with this treatment. As well as temporary skin redness and minor swelling. For those with extremely low pain tolerance, this treatment can take some getting used to. Shockwave Therapy is also very noisy. The treatment is administered through a handheld device that pulses and makes a noise throughout the duration of your session. That – combined with potential temporary pain/discomfort – causes some to shy away from giving Shockwave Therapy treatment a try. But luckily the treatments are short, so it makes these minor adverse side effects more tolerable.

So, if you haven’t yet heard of Shockwave Therapy, hopefully this helps you have a better understanding of what it is.

And most importantly, decide for yourself if it’s something worth considering. Especially if you’ve been suffering with a persistent soft tissue or tendon injury for quite some time. While it’s not a miracle cure by any means, I have seen fantastic results since beginning to incorporate this technology into my own practice. I like it because there’s a lot of scientific evidence to support its efficacy. Plus it’s a safe, non-invasive alternative to so many other pain-relief techniques that is designed to leverage the body’s own natural healing response.

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 learn more about Shockwave Therapy, visit her website 

Plantar Fasciitis

Don’t let Plantar Fasciitis Ruin Flip Flop Season

Good weather is on its way and if you haven’t already broken out your flip flops – it’s only a matter of time before you do. The only unfortunate thing about flip flop season is the coinciding rise in plantar fasciitis that typically comes with it.

Someone I was speaking with the other day recently asked:

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

This is a great question.

While yes, wearing more supportive shoes would certainly help. Ideally, if you can stay on top of your plantar fasciitis and/or prevent it all together, flip flops don’t have to be an issue at all and you can continue enjoying them all season long.

First – what is plantar fasciitis?

Quite simply, it’s inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot. Your plantar fascia 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. This leads to inflammation/plantar fasciitis.

What causes your plantar fascia to become inflamed?

Basically, it can be 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. 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 plantar fascia when you walk.

When the natural pronation/supination mechanism is disrupted, your plantar fascia will attempt to compensate. If this goes on uncorrected, your plantar fascia eventually becomes angry and irritated – resulting in a very painful case of plantar fasciitis.

So what do flip flops have to do with this?

Footwear can either “protect” your arch, or cause it to overwork. 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. But 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 should 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, it’s going to be a shock to your foot. And if you’re prone to plantar fasciitis already, it will flare up easily and quickly.

What can you do?

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. Also, making it a point to walk around without shoes as often as you can. Along with all of this, it’s a good idea to incorporate pelvic floor and core training exercises. The function of your pelvis can have a significant impact on your foot mechanics.

But what if your plantar fasciitis is too painful?

If this is the case, jumping into exercises may not help, and could even aggravate your plantar fasciitis.

But one treatment modality that is known to be effective for particularly painful cases is something called Shockwave Therapy (Extracorporeal Pulse Activation Technology or EPAT).

During a shockwave treatment, high pressure sound waves are delivered directly to the affected tissue to bring blood flow and accelerated healing to the injured and inflamed area (in this case your plantar fascia and surrounding muscles).

The treatment is non-invasive and gets very deep. Pain reduction can be seen in as little as one shockwave session, but the research shows the most effectiveness after six.

Shockwave therapy can help to significantly reduce your pain – and even swelling – from plantar fasciitis in the short-term. It will allow you to tolerate the exercises required to keep your plantar fasciitis gone for the long-term.

When addressed correctly, plantar fasciitis doesn’t have to be chronic and it doesn’t have to dictate your footwear selection.

Are you local to Portsmouth, NH?

CLICK HERE to learn more about our Shockwave Therapy treatment – one of my specialists will reach out to you and see if you would be a good fit.

If you’ve already tried a lot of different treatments for your plantar fasciitis and they haven’t helped – consider working with an expert. They can incorporate something like shockwave therapy. This combined with the exercises you need will make a difference and get you back to enjoying your flip flops again.

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, email her at [email protected].

Knee Pain

Knee Pain? Top 3 Causes and What You Can Do.

Knee pain impacts one-third of all Americans, and annoyingly interferes with activities of daily life. Such activities could be as simple as walking, squatting, going up and down stairs, and getting in and out of the car. This is in addition to the multitude of recreational activities knee pain can impact.

It’s the second most common complaint behind back pain when it comes to musculoskeletal problems. It’s one of the most common complaints I still hear about that started or worsened during the pandemic.

But what if there was a way to address some of the most common causes of knee pain on your own – without procedures or surgery?

Here are three of the most common causes of knee pain I see and what you can do to resolve it – naturally:

1. Patellofemoral Knee syndrome

Also known as “runner’s knee”, patellofemoral knee syndrome (PFS) is characterized by pain in the front of your knee. Usually this is just below or behind your knee cap. With PFS, the source of the pain typically comes from unwanted pressure around your knee cap. This will eventually results in inflammation and pain.

It’s very tempting to just get a cortisone shot or take pain pills to quickly reduce the inflammation and relieve your pain. But the problem with this approach is that you’re only putting a bandaid on symptoms. Inflammation is the result of an angry kneecap – not the cause. What you need to figure out is what is causing your knee cap to get angry in the first place.

Typically, PFS is the result of an imbalance somewhere in your body, typically from poor form and movement habits. Over time, this ultimately causes more pressure at your knee cap. If your hips, quads (front of the thigh), and hamstrings (back of the thigh) aren’t balanced and working together, for example, you could end up with problems with the way your knee cap tracks and functions. This will make your knee cap angry and inflamed over time.

When you figure out the true culprit behind the pressure and inflammation at your knee cap, you’ll not only be able to resolve and manage PFS naturally and for the long-term, but you can avoid temporary band-aid treatments.

2. Iliotibial band syndrome

The causes of iliotibial band syndrome are very similar to that of PFS. Except that your pain and symptoms will be experienced on the side of your knee instead of the front. Your iliotibial band (ITB) is a large band of tissue that runs along the side of your thigh to the bottom of your knee. Your ITB is formed from a muscle in your hip called the tensor fascia latae (TFL). When your TFL gets overworked, your ITB suffers. It will result in what often feels like stabbing pain at the side of your knee.

The most common treatment I see for this is foam rolling and massage. While these are great modalities to relieve your symptoms, they don’t address the root problem. You must figure out why your TFL is being stressed and overworked if you really want to get rid of your pain. Typically, it’s due to weak glute muscles, the deep ones designed to stabilize your pelvis. Your TFL is neighbor to your glutes. So when they decide to be lazy, your TFL loves to help out, and eventually overdoes it. When you can get these two groups of muscles working properly together, you’ll put an end to ITB syndrome.

3. Osteoarthritis

This is a very hot topic and everyone wants to know if they have it. (Spoiler alert – if you’re over the age of 50 – you already do.) Osteoarthritis happens naturally over time and is a normal part of aging. The problem with arthritis is that it only gets paid attention to when you’ve got pain. Then it gets blamed for all your problems. Arthritis certainly plays a role in your mobility and quality of movement. But it’s not the “death sentence” that many make it out to be. Many people find out they have osteoarthritis in their knees and think they have to just “live with it” or get a total knee replacement.

Remember, arthritis is normal and it happens to everyone as they age. What is not normal is for you to think you’re helpless or have to avoid your favorite activities because of it.

Arthritis occurs when the protective cartilage that cushions the ends of your bones wears down over time. There isn’t anything you can do to reverse this process. But, there is plenty you can do to minimize the symptoms you get because of this condition. It all comes down to balanced joints and movement. The more mobility you have, and the more stability you have around your knees, the less symptomatic your arthritis will be.

Some key areas to focus on when you’ve got arthritis in your knees is good core and hip strength. As well as good flexibility in your hips and ankles. If anything is off in these areas, your knees will want to compensate. This could result in compression at your knee joint and aggravation of your arthritic symptoms.

There is no need to rely on pain pills, or believe that procedures and surgery are your only options when it comes to knee pain.

As you can see, three of the most common causes of knee pain are due to – or influenced – by movement problems. Therefore, movement should be your go-to solution – not something you avoid.

If you’re having difficulty using movement as your solution and you want to contact a movement expert who understands mechanical knee pain and can diagnose the root cause of your knee problem – consider speaking to one of my specialists!

In your free Discovery Session we will ask you all about what’s been going on & see if we would be a good fit to help you. Book your free discovery session HERE.

tendinitis and tendinosis

Why Cortisone Shots Often Fail in the Knee

When you’ve got nagging, persistent knee pain, it’s common for doctors to recommend a cortisone shot in the knee.

A cortisone shot in the knee, also known as corticosteroid injections, or “steroid shots”, works by reducing inflammation in your knee joint in an effort to alleviate pain. Sounds pretty straightforward, right?  Well… not so fast.

Assuming your knee pain is truly due to inflammation, then yes, a cortisone shot can be a successful treatment option. For example, it’s often used as a pain management strategy when you’re awaiting a major joint replacement surgery.

Advanced osteoarthritis is a common cause of knee inflammation.  The only real “cure” for this is joint replacement. Periodic cortisone shots may help give you the pain relief you need to pass the time until surgery. But this is a very specific and not common circumstance.

What we see more often than not is cortisone shots either working temporarily, or not working at all in your knee joint.

Patients are often told they need up to three cortisone shots to see results. There’s a problem with this approach. Every time you get a cortisone shot, you risk damaging the cartilage and tissue in your knee joint. This not only leads to irreversible joint damage, but more persistent pain in your joint that gets harder and harder to fix.

So when it comes to whether or not you should get a cortisone shot in your knee – you really want to make sure that the root source of your problem is inflammation.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the knee pain you are experiencing might be due to inflammation, the underlying cause leading to that inflammation could be something else entirely. Eight percent of the time the knee pain you’re experiencing is due to a mechanical or movement problem.

So while the symptoms you’re experiencing could be inflammatory in nature, the root cause of your issue is not. A cortisone shot is not going to help your knee in this case. Or worse, you’ll get temporary relief that fools you into thinking it worked. This only delays treatment that will give you the long-lasting relief you’re looking for.

So how do you know if you have a true inflammatory problem in your knee?

Let me explain.

Let’s say you have some arthritis and general wear and tear in your knee joint. You have good days and bad days. The pain comes and goes. Certain movements and exercises make your knee feel better while others seem to really aggravate it.

This is a pretty classic presentation of a mechanical knee problem. The mechanical issue (aka movement problem) in your knee can irritate certain structures within your knee joint (like a meniscus or ligament) and cause it to be inflamed.

If you go ahead and just inject cortisone into this knee, it might relieve the inflammation for a short time. It won’t help the underlying movement problem. It’s only a matter of time before the cortisone wears off and the structures in your knee feel irritated again. Not only have you masked the problem, but now you risk creating actual damage to those structures from the cortisone. Studies have shown that repeatedly injecting cortisone into your knee (or any joint) can advance the formation of osteoarthritis.

Another interesting statistic is that 41% of knee pain has been shown to be coming from your spine – even when there is no back pain present.

In this case, your knee could really hurt and appear to be inflamed. If a doctor can’t find any real explanation for this from an X-ray or an MRI (because the real problem is coming from your spine), he or she may assume it’s just inflammation from wear and tear and suggest a cortisone shot. This is not going to help your knee. Once again you risk causing real damage to an otherwise healthy knee joint.

These are just a few examples of where cortisone shots are unnecessary and can go wrong when incorrectly prescribed.

Have you recently had a cortisone shot in your knee and it didn’t work? It could  be that you never actually needed it. Or that the symptoms (inflammation) was being addressed instead of the underlying cause.

If you are considering a cortisone shot in your knee, it’s always a good idea to get a second opinion to make certain you really need it. A mechanical pain expert can tell you whether or not your knee pain is truly due to inflammation. If your knee pain is due to a movement problem (80% of time it is) then a proper movement prescription is your answer.

Are you local to Portsmouth, NH and looking for help with your knee pain NOW?

Consider speaking to one of my specialists.

Tell them about your knee pain and they’ll see if we would be a good fit to help you!

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].

Hip Pain

Hip pain not going away? Three Reasons Why.

Hip pain is not nearly as common as knee or back pain, but it still impacts much of the population and it can be quite debilitating – especially when it doesn’t go away.

People routinely report hip pain in the side of their hip and in their groin. They may even complain that it radiates into their back and down their thigh. When this goes unresolved, it impacts your ability to walk, play golf, squat, bear weight on one leg, and even sleep through the night.

The big question, though, is why does it go away from some and persist for others?

If your hip pain isn’t going away – here are three reasons why:

1. You need a hip replacement

This is probably the most legitimate reason your hip pain isn’t going away. Your hip joint has become so arthritic and worn down that it’s time to get a new one.

But here’s the thing to keep in mind, whether or not you need a hip replacement should not be decided by your X-ray – it should be decided by your symptoms. Far too many people rely on the “bone-on-bone” diagnosis from imaging to be the determining factor. But there are hundreds of people walking around with fully functioning hips that have bone-on-bone and don’t need joint replacements yet.

When you need a new hip, the presentation is typically constant, unrelenting pain along with severely restricted mobility. In these instances, getting a new hip is going to be life changing and it should have a significant impact on your hip pain.

2. You’ve been mis-diagnosed

This is the most common reason why hip pain doesn’t go away. Just about everyone I see in my office with hip pain tells me they’ve been diagnosed with “hip bursitis”, when in reality, only 15% of women and 8% of women have true hip bursitis.

Hip bursitis occurs when you have inflammation of the bursa on the side of your hip. It’s typically caused by blunt trauma to your hip, or overuse/imbalance of the musculature there. It’s actually extremely easy to resolve so if your hip pain is persisting, this is likely not the reason.

The other common mis-diagnosis I see is that your hip problem is actually coming from your lower back. If you’ve got radiating pain into your thigh, you must always rule out that it’s not coming from your spine. Because if it is – and you don’t address it – your pain will never go away.

3. You’ve got the wrong treatment approach

If you don’t need a hip replacement, and you’ve got the right diagnosis, your hip pain should go away. If not, then we need to consider the treatment approach.

The most common mistake I see with hip pain treatment is implementing strengthening and stabilization exercises way too soon. The hip joint is one of the most mobile joints in our bodies. Because of that, it can be hard to detect when you’ve got some restrictions there. Having optimized mobility in your hip joint is paramount.

Without good, adequate mobility, your muscles will struggle to function as well as they could, and this can impact strength. I have a saying in my office: “mobility before stability”. And it’s for a good reason. If you don’t check mobility first, you risk strengthening and stabilizing around a joint that isn’t moving as well as it could. This could be a reason why your pain isn’t going away.

If you’ve got hip pain that isn’t going away, I hope this article has given you some food for thought.

Approximately 70-80% of all musculoskeletal problems, including hip pain, can be resolved naturally and without relying on pills, procedures, or surgery.

If you’re not having success with getting rid of your hip pain, then it’s important to question what you’re doing and consider that something has been missed. You deserve to live an active and mobile lifestyle doing all the activities you love.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists. Tell them about your hip pain and they’ll get you on a treatment plan right away – at the very least you’ll leave with some helpful tips moving forward.

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, email her at [email protected].


Tendonitis vs. Tendinosis – The BIG difference and why it matters

If you’ve ever suffered from tendonitis or tendinosis – then you know that it can last anywhere from a few weeks to several months!

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon. Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably, they couldn’t be more different. When tendonitis isn’t caught early enough or treated properly it can turn into tendinosis. The treatment for acute tendonitis is very different from chronic tendinosis.

Let me explain…

Tendonitis is an acute condition. The best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

When you don’t manage tendonitis properly, and it goes on longer than a few months, it can result in tendinosis. Tendinosis is a very different condition where the fibers in your tendon actually start to break down. The first thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you. I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again.

Passive treatments like ice, rest, and medicine will not help tendinosis. They might help to relieve any pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area. In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis. Making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right? Well technically it is, but the biggest problem is that this process takes time – up to 9 months in many cases. And most patients I come across simply don’t have the patience for this. Or they simply aren’t told about it.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time. You have to put just the right amount of stress to cause a little bit of pain. However, not so much stress that your tendon gets inflamed again. A properly trained physical therapist that is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time. The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry. So is half the medical community.

The take home points to remember are these:

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks. Treatment for this should involve passive modalities like ice and rest. The focus should be on what causes the tendon to get irritated innitially.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies. These will properly re-organize the tendon so that it can be strong again! This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

Luckily – we’ve introduced a brand new treatment modality in our office. It accelerates the healing of soft tissue and tendon injuries.

It’s called Shockwave Therapy and we are currently accepting new patients for this service. If you’re already a client – you will get this service at no charge. Just ask your specialist next time you’re in and see if you’d be a good fit for this treatment.

But if you’re not a current client – and are currently suffering from something like plantar fasciitis, tendonitis, or some other soft tissue strain or injury – you could be perfect for this treatment! Studies have shown about 70% reduction in symptoms in as little as 6 sessions.

While this won’t completely “fix” your tendon or soft tissue problem – it can have a significant reduction on your pain which will allow you to more easily do the work that WILL fix your problem.

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].

Want to lose weight in the New Year? Don’t let knee or back pain get in your way.

If you google “Top 3 New Year’s Resolutions” – you’re sure to find “losing weight” as one of them. While I’m not a dietician or nutritionist, I know that the majority of weight loss has to do with what you eat. However, exercise plays a role too, and that I am an expert in. 

Exercise stimulates endorphins and makes you feel better all around. The better you feel, the easier it will be to stay motivated about your weight loss goal.

Exercise also helps you burn more calories – which certainly isn’t going to hurt your weight loss journey.

But if you’ve got unchecked knee or back pain, not only will you find it challenging to exercise, you are going to be more stressed about it. Stress increases cortisol which interferes with your ability to manage weight. And if you can’t exercise at all because of pain, that will make it even harder to manage stress, never mind your weight. You can see how this vicious cycle from unwanted knee and back pain could completely derail your New Year’s goals.

Here are four tips to help you not let knee or back pain get in the way of your weight loss in the New Year:

1. Mobility Before Stability

Your muscles can’t function at their best if you don’t have optimal joint mobility. In other words, you don’t want to strengthen around a joint that isn’t moving at its best, or you’ll encourage compensation. If your nagging back or knee pain is due to inadequate mobility, you’ll run into problems. You will be in more pain if you suddenly increase your exercise or activity level. We saw this happen at the beginning of the pandemic. People started walking and exercising more and we saw a huge influx of unexpected back and knee pain as a result. Their joints weren’t accustomed to moving so much and it highlighted the lack of mobility and compensations. Don’t let the same thing happen to you. Make sure all of your joints, including your spine, can move fully and freely without any pain before you begin a new exercise program.

2. Pace Yourself

It’s very tempting to go “all in” on your new exercise or weight loss goal… but remember… the tortoise (not the hare) won the race. It’s important to not beat yourself up if you’re not seeing immediate results. If you’ve been out of shape for a while and doing something completely new, expect to be sore. But if you’re limping around for days or experiencing sharp pain in your back or knee, there is a chance you overdid it or worse case injured yourself.

My general rule of thumb is to monitor your soreness on a scale of 1 – 10. I tell my clients to not let their pain go above a five when they are pushing themselves or returning to an exercise they haven’t tried in a while. If you find that your pain level goes above a 5, or persists at that level (or higher) for more than a day, there’s a chance you’re overdoing it and setting yourself up for an unwanted injury. When in doubt, listen to your body. And if you’re not sure what it’s saying – enlist the help of an expert.

3. Stay Hydrated

Most people don’t drink enough water during their regular day, never mind when they increase their activity level. Drinking lots of water has two great benefits: It will give you the extra hydration you need if you’re planning to be more active; and it will help you lose weight by curbing your appetite. Some additional benefits of staying hydrated include increased muscle strength and stamina, more lubrication in your joints, more supple skin, better cardiovascular function, and improved energy and mental alertness. One really easy tip to jumpstart your day is to begin with 10 oz of water first thing upon waking. And a good rule of thumb when you’re trying to stay adequately hydrated is to drink at least half your body weight (in ounces) of water every day.  

4. Get Assessed by a Mechanical Pain Expert

If you’ve got nagging back and knee pain, see a mechanical pain expert before you begin your new exercise routine. Your first thought might be to go see your medical doctor. However, it’s important to understand how different medical professionals assess different problems. Medical doctors are trained to screen your whole body and typically rely on imaging to make their diagnosis. This is a great approach if you’ve had an accident or trauma. Or if you are presenting with what could be a serious pathology. But for 80% of musculoskeletal pain – including knee and back pain – X-rays and MRI’s are overkill.  They put you at risk of being led down a path of unnecessary referrals, treatments, and procedures. They will definitely put you at risk of being told not to exercise at all.

A mechanical pain expert, on the other hand, is trained to assess your pain with movement tests – not imaging. This is going to reveal a much more realistic picture of what you can and can’t do. It will also reveal what movements will make you better or worse. This allows you to go into a new exercise routine with a more informed approach. Also, with a plan to exercise around your pain and make it better.

Is exercising and losing weight is part of your New Year plan? If so, I hope these tips help you go into 2023 with confidence. If you’ve got lingering or unwanted knee or back pain that’s not going away on its own – get it checked.


Are you local to Portsmouth, NH? – CLICK HERE to speak with one of my specialists. We will ask you about what’s been going on – and see if we would be a good fit to help!

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].


Spooky creaks and cracks coming from your knees?

Does the cracking in your knees “spook” you out?

Yes – it’s Halloween – and we’re having some fun over here… But in all seriousness – when it comes to cracking in your knees (or any joint for that matter) – people get nervous.

First of all, cracking in your knees (as well as your other joints) is quite common – and most of the time there’s a reasonable explanation for it.

Crepitus is the term used to describe any grinding, creaking, cracking, grating, crunching , or popping that occurs when you move a joint like your knee. You can experience this at any age – but it’s certainly more common as you get older.

So what causes crepitus – and should it be a concern…

The most common causes of crepitus include air bubbles popping inside your joint, tendons or ligaments snapping over your joint’s bony structures, or the degeneration of your joint’s cartilage that generally occurs with arthritis. You may experience uncomfortable sensations, or even a tiny bit of pain when this happens, but in most cases, none of this should scare or concern you.

It’s all a normal part of aging and wear and tear.

But if the cracking in your joints starts to become more regular – is accompanied by joint swelling and more constant pain – or if the cracking turns to “clunking” and your knee starts to feel unstable… then you’re smart to be concerned and it’s possible something more serious could be going on.

If you suspect something like this could be happening – get your knees checked out by an expert.

But assuming you haven’t let your knees get to the “concerned stage” yet… and the most annoying thing to you right now is the cracking, grinding, or crunching…

There are things you can do to prevent it from getting worse.

The first thing I always recommend is to keep moving.

Motion is lotion.

And regular movement throughout the day helps keep your joints lubricated. It’s like applying WD-40 to a creaky door hinge – when your joints creak – move them to lubricate them.

The second important thing to consider if you want to reduce crepitus and prevent it from becoming something more serious is your biomechanics.

Biomechanics refers to how well your muscles and joints function together.

If you’ve got imbalances – it will impact the way your joints move and function – causing more creaking and cracking.

For example, let’s say your hips are on the weak side. How your knees tolerate various activities depends a lot on how strong your hips are. I’ve experienced this first hand… I love to hike. And if my hips aren’t doing their part, I feel the entire hike in my knees, especially on the way down.

And you know what else happens?

My knees crack a lot more on the days after I hike.

The imbalances in my body cause more stress on my knees and the result is they crack a lot more. Now, as I mentioned previously, this isn’t a big concern for me… yet. My knees don’t hurt – they are just very noisy. But in the interest in prevention – I make a conscious effort to regularly stretch my quads, and strengthen my hips and core – so that I can keep this problem at bay and not let it get worse.

My FAVORITE way to do this is with Pilates.

Specifically… on the Pilates Reformer!

When you use the Pilates Reformer – it allows you to both strengthen and lengthen at the same time – as well as focus on your coordination. These three things – when combined together – help to significantly optimize your biomechanics.

If you’ve never used the Pilates Reformer and want to give it a try – check out our Pilates program HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth. To get a FREE copy of her guide to knee pain – CLICK HERE

Failed Knee Surgery

Knee Surgery Gone Wrong? It’s More Common Than You Think.

Arthroscopic knee surgery is one of the most common surgeries performed. Despite research telling us that it’s not nearly as effective as most people are led to believe.

Science tells us that people who do undergo arthroscopic knee surgery are likely to have knee arthritis that advances rapidly. This results in a total knee replacement that you could avoid.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint. It’s done if  you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

Well… it is until it isn’t.

The big problem is that arthroscopic knee surgery is not necessary for most cases of knee pain.

If there is a complication – which there are many even with “minimally invasive” procedures – you could end up being worse off than when you went in.

Plus – if you never even needed the surgery to begin with – you just put your knee through unnecessary trauma that you’ve got to now heal from. This further delays you from addressing the root cause of your knee pain.

The truth is that most people can get full relief of their knee pain as well as full restoration of knee function without any type of surgery or procedure. This is true for 70% of all knee pain cases.

An early research study from 2002 by JB Moseley and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery.

Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment.

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery more than ever?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain. If you’ve gotten physical therapy and it wasn’t effective, people believe that the physical therapy “didn’t work”.

But more often than not, you just haven’t found the right physical therapist yet – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery.

And then there’s the elephant in the room…

It’s very common for knee pain to be coming from somewhere other than your knee. Knee pain can come from your ankle, hip, or back. One study showed that 40% of the time – knee pain is caused by your back – even when you don’t have any back pain.

MRI’s add even more confusion to this. It’s entirely possible to have degenerative changes, a torn meniscus, or advanced arthritis in your knee – and still have your knee pain stemming from a source other than your knee.

Over the course of my 20 year career, I’ve seen many knee surgeries go wrong.

Most of the time, it has nothing to do with the procedure itself. It has everything to do with an incorrect diagnosis going in. Say your knee pain can be resolved conservatively. Then you put it through unnecessary trauma (surgery). There’s a good chance you’re going to have more problems afterwards. You get knee surgery when your knee problem isn’t even coming from your knee. Then you’re definitely going to have problems afterwards.

The moral of this story is to make absolutely certain that:

1) Your knee problem is really a knee problem and

2) You’ve fully exhausted all (quality) conservative therapy options before going under the knife.

Remember that 70% of all knee pain cases do not need surgery.

Science has proven this. Don’t resort to knee surgery unless you’re 100% sure you really need it. Because it can go wrong and when it does – it’s much harder to come back from then if you had avoided it to begin with.

Want help with your pain now? CLICK HERE to talk to one of my specialists for free – you can tell them all about your knee pain and we’ll let you know if we can 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 Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

Holding Knee with Arthritis

Three Tips to Protect Your Knees From Arthritis

Knee arthritis is one of the most common forms of osteoarthritis.

Knee arthritis accounts for more than 80% of all osteoarthritis and impacts at least 19% of Americans over the age of 45.

For many, a diagnosis of knee osteoarthritis leads to chronic, debilitating knee pain that stops them from doing all of their favorite activities. Sometimes it’s simply due to the limiting belief that once you have arthritis – you’ve got “bad knees” for life.

Other times it’s because you’ve been told you have “bone on bone” in your knee and there’s nothing you can do – except to scale back on activity so that you don’t make it worse. This line of thinking is flawed and often leads people to unnecessary procedures and surgery. One of the best things you can do to protect your knees from the debilitating effects of arthritis is to keep moving.

Here are three tips to help you protect your knees from arthritis as you age – so that you can keep doing all of your favorite activities and avoid any major procedures or surgery:

1. Strengthen Your Hips and Core

Your knee joint is situated just below your hips and core. And research has shown that when you have poor control of your upper leg muscles – you get more stress through your knee joint.

The strength of your upper leg muscles is very much dependent on your hip and core strength. Your thigh bone – or femur – connects your knee and your pelvis – and your core strength controls your pelvis.

If your pelvis isn’t stable – your femur is going to have a difficult time staying in alignment – which will ultimately have an impact on your knee joint. If you’ve got arthritis in your knees, it’s critical you minimize any added stress to your knee joints.

Strengthening your core and having good hip strength is going to help prevent and minimize the symptoms of arthritis and keep you doing activities you love longer.

2. Keep Your Knees Mobile

Mobility before stability is my mantra.

And I say this for just about every joint in your body. But it’s especially true for your knees. There are joints whose primary function is stability – and there are those whose major function is mobility.

Your knee needs to be mobile.

Its major purpose is to bend all the way so you can squat and pick things up – and it needs to straighten all the way to give you stability when you need it. When either of these motions are lacking – your ligaments and surrounding muscles will suffer.

A lot of folks just “accept” that their knees are stiff – especially if you’ve been told you have arthritis in your knees. The limiting belief is that stiffness is par for the course. But the truth is that if you keep your knees mobile as you age – you can not only maintain the mobility you have but improve what is lacking.

If your knees are stiff – start moving them. The thing to understand about arthritis is that it’s a normal part of aging. Debilitating mobility is not. Even a 10% improvement in your knee mobility – which can happen even if you’ve got arthritis – will result in huge improvements in your knee function.

It can be the difference between a natural solution to knee pain vs undergoing a major surgery like knee replacement.

3. Don’t Stop Your Activities

When people find out they have arthritis – and especially if they’re in pain – they often think that slowing down or stopping activity will help protect their knees.

This couldn’t be farther from the truth.

Study after study – including one from the Center for Disease Control – shows that severe joint pain among adults with arthritis is worse with inactivity. When you remain active, you keep blood flowing, your knee joints mobile, and your muscles strong. These are very important factors in managing your arthritis. Sometimes, the knee pain you feel when you’re doing certain activities has nothing to do with your arthritis. Statistics show that only 15% of patients with evidence of knee osteoarthritis on X-ray even had symptoms.

That means that the other 85% is walking, biking, and running around enjoying their most favorite activities – despite the fact their X-ray showed arthritis too. The point here is to keep doing your activities – whether you’ve got arthritis already or not – it’s one of the best ways to prevent and protect your knee joints as you age.

So – to review…

If you want to optimize your knee health as you age – which you still can even if you’ve been told you have “advanced arthritis” – prioritize your core strength, the mobility of your knees, and stay active.

Focusing on these three things can have a significant impact on how arthritis affects you – and can help you avoid major (often unnecessary) surgery in your future.

Is knee pain keeping you from doing your favorite activities? Are you considering a major procedure or surgery but not sure if you need it?

Join us on Tuesday Oct. 25th from 6-7pm for our Free Masterclass for Knee Pain Sufferers.

Sign up using this link —> Knee Pain Masterclass.

We hope to see you there!

Can’t make it live? All participants will receive a complimentary replay of the class 🙂

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].