The Location of Your Pain may NOT be its Source…

One of the most confusing topics we deal with in our practice is pain. And there’s lots of advice out there on what to do about it…

Should you rest or move? Apply heat or ice? See a doctor or let it go away on its own?

Before you can even think about a solution to your pain, you must first accurately determine where it’s coming from. If you have pain in your knee, but it’s actually coming from your back, the best knee treatment in the world is not going to fix it.

Inaccurate diagnosis of pain is a BIG reason why so many people suffer longer than they need to, and undergo unnecessary surgeries.

You must accurately determine the source of your pain for treatment to be effective, and the location of your pain alone is not a reliable way to do that.

For example, I’ve seen people in my office with what they think is unrelenting tennis elbow, only to find out it was actually a problem in their neck causing it. I’ve seen people disappointed after a failed knee surgery, because the problem was never in their knee and actually coming from their back.

Isolated extremity pain (knees, elbows, shoulders) is one of the most misdiagnosed problems we see in our office.

A recent study by Richard Rosedale, et al. in the Journal of Manipulative Therapy investigated this – and it was found that over 40% of people suffering from isolated extremity pain actually had a spinal source of symptoms.

In other words, their extremity pain was actually coming from their neck or back.

I can’t tell you how many times we’ve seen folks with unexplained shoulder pain lasting months or years get better as soon as we begin treating their neck, even though they never had neck pain.

Same for knees…

It’s possible to have knee pain that is caused by your back, without ever hurting your back!

Confused? I don’t blame you.

But more importantly, how do you figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, knee or foot pain – and you don’t ever recall a specific injury to it – you MUST consider that it could be coming from your spine.

There’s a 44% chance that it is!

Where this gets really confusing is that typically your doctor will order an MRI when you’ve got isolated knee or shoulder pain that won’t go away. And if you’re over 40 years old, the MRI will almost always show “something” – a torn rotator cuff, torn meniscus, arthritis, or wear and tear.

Remember that these are normal signs of aging in everyone, and may not be the cause of your pain.

If you haven’t already had your spine checked properly as a possible source, you can’t rely on these findings (or the location of your pain) as an accurate diagnosis. That is how people end up having surgeries they don’t really need.

Whenever someone comes into our office with isolated extremity pain, we don’t even look at it without an exam of their neck and back first.

By moving your spine repeatedly, and in certain directions, we can often produce – or take away – the pain you’re feeling in your knee or shoulder.

Why?

Because if the pain in your extremity is caused by a pinched or aggravated nerve, moving your spine around is going to influence that, and tell us where the source really is.

An MRI and X-ray won’t be able to determine this for you with certainty – because sometimes your nerve only gets irritated when you move a certain way – or when you’re in a certain position. Since MRI’s and X-rays can’t see what’s going on while you’re moving, you can’t rely on those tests alone to tell you exactly where your pain is coming from.

If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source.

That source could be your spine.

And if you’re considering some kind of surgery or procedure, you definitely want to rule that out first.

Specialized movement exams like we do in our office are one of the most reliable ways to figure this out. If you’ve had unexplained pain in your knee or shoulder that isn’t going away, CLICK HERE to request a Free Discovery Session with one of our specialists.

Tips to Combat Arthritis this Winter

People tell me all the time: “I don’t need to check the weather anymore, my joints tell me what’s coming.” And as winter approaches, I know I’m going to be hearing more and more of this.

So why is it that arthritis sufferers tend to be impacted more during the colder, wetter months?

The actual science on this is inconclusive. Some studies have completely debunked the myth that weather can affect your joint pain, while others have shown that arthritis sufferers do indeed have what we call “weather sensitivity” — and they feel worse in the cold, especially when it’s about to rain or snow. The working theory behind this is related to barometric pressure. As a storm system develops, barometric pressure (atmospheric pressure) begins to drop. Some scientists believe that this results in expansion and contraction of tissue in and around your joints (tendons, muscles, bones, and even scar tissue). If those tissues are already sensitive due to arthritis, this could irritate them further. Additionally, the lower temperatures of winter are thought to increase the thickness of fluid inside your joints, making them stiffer and perhaps more sensitive to pain during movement.

Regardless of whether this phenomenon is myth or fact, it doesn’t make your pain any less real! The good news is there are things you can do to minimize pain related to arthritis as winter gets closer. 

There are two types of arthritis, inflammatory and non-inflammatory. Rheumatoid arthritis is the most common form of inflammatory arthritis, and osteoarthritis is the most common form of non-inflammatory arthritis. Although they have very different causes, weather changes can still have an impact, and there are still things you can do to minimize that impact.

Both forms of arthritis are characterized by one or more of your joints being inflamed.

Inflamed joints do not like to be compressed or irritated. It’s often why people will tend to rest and decrease their activity when they have pain. Add cold winter temps and weather to the mix (along with a pandemic), people just naturally do less this time of year. They think if they take the weight off their joints, or move less, they are protecting their joints. That’s actually not true. What protects your joints is strength and flexibility. The more mobile you are, the less likely your joints will get irritated, even arthritic ones. Have you ever worn a piece of clothing that’s too tight? You get irritated. Same with your joints! If they aren’t free to move, they get angry. The muscles around your joints and how strong they are also play a huge role in minimizing irritation.

In the absence of strength and stability, your body will do what it needs to compensate. The structures around your joint will contract to make your joints stiff and tighter in an attempt to give your joints the stability they are lacking. But arthritic joints don’t want to be stiff and tight, they want to be free and mobile! So if you suffer from arthritis, it’s critical that you have good mobility and good strength — period.

In general, the most important thing you can do for your arthritis any time of year, not just in winter, is to keep moving.

And you will move better when you’re strong and flexible. Movement gets blood flowing, which is our best and most natural form of anti-inflammation. Walking is the easiest and most practical way to get healthy movement daily, but biking and swimming are great choices too. You’ll also want to engage in some form of activity, such as Yoga, Pilates, or Tai Chi, that allows you to move your limbs, body and joints in a full range of movement. Cardiovascular activities like walking and biking won’t do that. Pilates is great because it emphasizes both full body strength (which helps balance out your joints) and it promotes flexibility at the same time. It’s why we like to use it in our office. Although it’s easy to just stretch and get more flexible, it’s important that you incorporate strength training into your routine also. Achieving good mobility AND strength is the secret to combating arthritis. Folks tend to only focus on the flexibility part, which is one of the common mistakes I see. 

I hope this helps you better understand why your arthritis might feel worse in winter, and what you can do about it! If you’re suffering from any kind of back or knee pain that is preventing you from being more active and mobile and therefore worsening your arthritis, check out our FREE Back Pain and Knee Pain guides. Just click to have the guide sent straight to your inbox with no obligations or strings attached!

Should You Heat or Ice an Injury?

Earlier this week, we put on a free Zoom workshop all about preventing and overcoming knee pain – and one of the questions that came up was if you should apply heat or ice when something is hurting. This is a VERY common question in our office, so we wanted to share the same advice we give to clients right here!

When to apply ice:

Generally speaking, the best time to apply ice is within 24 to 48 hours immediately following an injury. Application of ice during this stage has been shown to reduce the formation of edema and “secondary injury.” After that, it really becomes a personal choice. If you’re in pain, and ice makes you feel better, go for it! Some research has claimed that icing an injury after 48 hours is “bad” for you. But if you really dig into the research, it’s inconclusive on this topic. What I tell my clients is that if something feels irritated or inflamed – go for ice. It’s a much better and more natural alternative to pain pills!

When to apply heat:

Once you’re into the chronic stages of injury or pain, I’m generally a fan of heat. But the term “heat” is relative – and doesn’t necessarily refer to the application of a heating pad only. In fact, research has shown that heating pads are not able to penetrate deeply enough to actually have an effect on the injured muscle or soft tissue. But it does feel good… which can be beneficial in and of itself because when you “feel” better – your nervous system relaxes. If the superficial heat can relax the nervous system enough so that you can actually tolerate the movements or exercises that WILL actually heal you – then I can see a benefit.

The BEST way to provide “heat” as a way to promote healing to an injury is through movement – but you need the right prescription. The mistakes I often see, especially around 2-4 weeks post injury, is that people aren’t moving enough (if at all), or they are overloading the tissue and moving too much.

Movement truly is medicine, and it’s one of the best and most natural ways to properly heal from an injury – but you MUST get the prescription right.

So there you have it. You can’t really go wrong with either modality. The general rule is that if it’s an acute injury – ice up to 48 hours. For anything else, we typically recommend heat.

If you’re presently healing from an injury and not satisfied with your progress – perhaps you’re just missing the correct prescription. If you’re wondering what that magical movement is, or you’re wondering if the current movement you’re doing is safe, get in touch!

Speaking of movement as a way to heal…

Our Pilates 101: Get Your Back to Health is back!

This is our signature program and it’s designed to help those dealing with lingering back problems learn to move and heal the RIGHT way – from the inside out with proper core strengthening. It’s also ideal for those that had recent back surgery and you’ve already been through your initial stages of general physical therapy.

Interested in learning more or getting on the VIP waitlist for the program? Click here!

Knee Pain while Running? Don’t Blame Arthritis

Is running bad for your knees? Does it cause arthritis?

We get asked these questions a lot, especially by clients who are in their 50s and 60’s and wondering if it’s safe to keep running.

The short answer is no — running is NOT bad for your knees! If you experience knee pain when you run, it’s not that you’ve “aged out” of the sport or that it’s causing arthritis in your knees. This is a very common misconception. In fact, research supports that running may actually be GOOD for your knees!

Staying strong, active, and mobile is your best defense always against osteoarthritis.

Therefore runners, because they are typically active and healthy individuals, often have healthier knees compared to non-runners.

Ok then — so if not arthritis — what really causes knee pain in runners?

In most cases, it’s simply a biomechanical issue that goes unaddressed over time. But the GOOD news is that once identified, these issues can actually be fixed with proper education and strengthening (best offered by movement specialists like us!).

Here are three of the most common factors we see that are often the true culprit of knee pain when you run (not arthritis):

1) Poor ankle mobility

Ankle mobility affects the way force hits your foot, which can impact your knee. If your ankle doesn’t move fully, freely, and adequately, excess forces will be shifted up to your knee. The knee may be forced to flex, rotate, and/or tilt more than it needs to. This, in turn, may result in unwanted loads that the tissues of the knee can’t handle. An expert in biomechanics and movement can not only help you identify if this is the true root of your “knee problem,” but can also help you improve your ankle mobility in order to prevent long term damage to the joints, tendons, and ligaments of your knees. We actually see this as a very common problem in those that have sprained or twisted their ankles in the past. If that’s you, this could be a reason why you’re suffering from knee pain while you run.

2) Weakness in your hips and thighs

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing good, balanced strength in your hips and thighs is critical. The hamstring and quadriceps muscles play a crucial role in stabilizing the patella, otherwise known as your kneecap. Since running is extremely repetitive on your joints, especially your knees, it requires they have good durability and endurance — something that is lost quickly when you neglect proper strength training. Often “wear and tear” in your knees (otherwise known as arthritis) will get blamed for your knee pain when in actuality, the loss of strength around your knees is what’s causing that wear and tear to feel worse than it needs to.

3) Unstable core

It may seem like running is all in the legs, but the stability of your pelvis and trunk have a huge influence on how your legs perform. You derive the majority of your power, speed, and stamina from your core muscles and glutes. Much like with ankle mobility, if your core is not performing adequately or efficiently – your legs will have to work harder. A stable core is key for developing and maintaining good balance and rhythm with any activity – but especially running. With a repetitive activity like running, efficiency and form is everything. Without a strong core, it’s impossible for your leg muscles and knee joints to work as efficiently as they were designed to, and it will be really difficult for you to maintain good and proper running form mile after mile. When your core strength is weak, and doesn’t have enough endurance to sustain the amount of miles you want to run, your knees will suffer.

What’s important for you to remember is that arthritis is NORMAL — everyone gets it as they age. 

What doesn’t have to be “normal” is for arthritis to stop you from running, or doing any other activity that you love. You can get surgery to fix the “wear and tear” in your knees, or injections to decrease the inflammation, but if you don’t check and address any underlying biomechanical issues, these fixes will be temporary and your knee pain will keep coming back. And worse… they could force you to stop running all together!

If you’re suffering from knee pain and it’s starting to impact your ability to run or do any other activity that you love, you might want to join us for our next live Zoom workshop: Preventing and Overcoming Knee Pain so you don’t have to stop activities you love! 

It’s FREE and happening on Tuesday, Aug 25th, from 6-7pm. Just follow this link to reserve your virtual seat.

people walking with face masks

Beyond the Mask: Five Ways to Build Immunity and Stay Healthy

The COVID-19 pandemic has changed so much of how we live, work, communicate, and think about our health. While precautions like face masks can be helpful, the best way to avoid getting seriously ill is to have a strong, healthy immune system. In our office, we’re helping people’s immune systems by making sure they stay active, healthy, and mobile. We’ve been helping people with back and knee pain recover quickly and manage their conditions from home, so they can get back outside and keep moving and exercising.

Exercising regularly is just one way to keep your immune system strong. Here are five more ways to make sure you’re building immunity during  these strange times!

 

1. Hydrate

 

Staying hydrated is one of the best things you can do for your health in general, but it’s especially important when you’re trying to fight disease. Each individual cell in your body that works for your immune system needs to be fully hydrated to perform its job optimally — and that all depends on how much water you drink!

 

2. Stay Moving

 

In the era of working from home and passing time with friends or family on Zoom, it can be hard to get up from your computer and make sure you’re staying active. But it is so important that we interrupt our sitting and make time to exercise! Keeping your blood flowing allows pathogens to be filtered out more efficiently — plus, sweat can even kill pathogens on the surface of your skin. 

 

3. Get Good Sleep

 

Sleep deprivation has been proven to increase the risk of illness, as well as increasing the risk of more serious long term effects. Sleep is when your body’s cells get to repair themselves — including those immune cells! Plus, getting enough sleep at night can help lower your overall stress. 

 

4. Eat Well

 

Nutrition is key for building and maintaining immunity. You should try to avoid processed foods and integrate more clean alternatives like nuts, berries, eggs, and fish. 

 

5. Get Outside 

 

Scientists are telling us that the novel coronavirus thrives best indoors, and out of UV light. All the more reason to get outside! Soaking up that Vitamin D will boost your immune system and just make you feel better in general. Not to mention that going outside is the one of the best ways to get exercise right now with gyms being closed! 

If you’re currently suffering from back, knee, or any other kind of pain that is preventing you from moving and exercising, give us a call.

We’re currently offering free consultations, both in-person and virtually, to help you figure out what’s going on and give you all the information you need to make the best decision about what to do next.

 

Noticing More Knee Pain during Quarantine?

Aside from back pain, the second most common complaint bringing people into our office these days is knee pain, and lately, I’ve seen a little surge.

Here’s why…

People are sitting a lot more, which leads to increased stiffness in your knees. And a lot of us are doing different kinds of activities than we did 6 weeks ago, which for some, is exposing knee problems they never knew they had.

I spoke to one gentleman last week (we’ll call him “Jack”) who had started walking every day, and running a little bit, because his gym had closed. After about 4 weeks of this, he began experiencing pain in the front of his knee. He put some ice on it, took a break from his daily walks and running, and also resumed some stretches that a former physical therapist had told him to do. This seemed to help, so he resumed his walks and running again. Three days into it… bam… his knee pain returned.

Our specialist team has opened up our schedules to answer people’s questions about what they can do at home right now to take care of any aches or pains.

So Jack took us up on that, because he wanted to know if his knee pain was something to worry about. Did he need to see a doctor? Did he need to let it rest some more? Were there specific exercises he could do?

He did NOT want to stop his walking and running routine, but he definitely didn’t want his knee to get so bad that it would keep him from returning to the gym when it opened back up. He’s 55 years old and staying active and mobile is VERY important to him. We spoke for about 20 minutes and I knew immediately that rest wasn’t going to work, and that X-rays or medication from a doctor wouldn’t do anything either. Those things would only mask the problem. They would take care of the pain in his knee – but wouldn’t correct the source of his problem.

Ironically, the truth about knee problems is that they’re often not actually knee problems!  

With most knee pain, we can trace the underlying issues to a locality directly below the knee (the ankle or foot) or directly above it (the pelvis, hips, core, and low back). If you don’t engage your core throughout your daily movement, it actually puts a huge amount of strain on your knees. As your legs swing and rotate, the torque that should be occurring through your pelvis and hips gets overloaded onto your knees. So as we age, we may start feeling a sense of wear and tear or weakness in our knees that actually comes from a lifetime of improper movement.

The mainstream medical model is focused largely on treating symptoms rather than identifying the root cause of WHY the problem is occuring in the first place.

Pain pills, injections, and even surgery are often recommended before more conservative and natural treatments! And because these quick fixes are merely addressing the symptoms, the physical problems return for the majority of affected individuals. That’s because those knee issues actually stemmed from a different part of the body, and the knee will continue to be overloaded until those biomechanical problems are addressed directly!

Yes – we were able to figure ALL of this out from a FREE phone session.

The next step for Jack was an evaluation with our knee specialist. We scheduled a virtual session over Zoom, she was able to confirm the source of the problem. Turns out the muscles in his hips weren’t firing like they should and it was causing his knees to compensate and work harder than they needed to, which resulted in pain. So we got him doing the correct stretches and specific exercises that would train his hip and pelvis to work like they are supposed to.

In no time, Jack will be back to his walking and running routine, but he will ALSO be in better shape to return to the gym. One of his frustrations before was not being able to do as many squats as he wanted – because they hurt his knees. He had no idea that the problem was actually coming from his hips! So he is pretty excited to try his squats again once his gym opens back up.

If Jack’s story sounds familiar to you, schedule a call with us.

There is no point in sitting at home worrying, or scouring Google for what you should do to fix your pain. We can figure out what’s going on with you over the phone and I’ll let you know if you need to schedule a session with us, see a doctor, or if it’s something you can take care of on your own.

You could also join us for our FREE Virtual Knee Pain Webinar on Thur May 14th from 6-7p!

How to Tell Good Pain from Bad Pain

Over the last few weeks, we’ve been inundated with people asking for help.  And we’re so thankful for everyone who is reaching out! 

Since being quarantined at home and off their routines, people are noticing more knee pain and back pain (these are the two biggies) because they are either sitting more — or because they are DOING more.

The folks who have been sitting more have been complaining about more back pain and stiffness, tightness in their hip flexors and knees, and more tension in their necks.

However, the people who have been doing more are noticing increased or NEW aches and pains in their knees, muscles, and joints – and are wondering if this is “normal” or if it’s something to be concerned about.

For some, the aches and pains are quite harmless – and it’s easy enough to stretch out on your own at home. If you’ve been more active lately because you’ve been bored or suddenly have more time, these could be symptoms of “good” pain. It’s not unusual to have more soreness in your muscles and joints with increased activity or exercise.

But for others – these symptoms could be a sign of an underlying problem that was already there – and just now surfacing. And if that’s the case – simple home stretches that you look up online are not going to be enough – and could actually make you worse.

So how do you know?

One way is to look at how your pain behaves. Does it get worse? Or does it get worse, but not until later? Does your pain move around? Or does it come and go? Does it get better and STAY better the more you stretch? Or does the stretch only provide temporary relief — like a bandaid — and your pain just keeps coming back?

Understanding how your pain behaves is how you know whether or not you’re doing the right thing or the wrong thing.

And how your pain behaves is not as simple as “getting better” or “getting worse.” 

There is so much grey area when it comes to pain, and it’s where people get really confused.

For example, pain might seem like it’s going away, but then it comes back again. Does that mean you’re better? Or is the problem still there? Sometimes pain will move, and you think it’s a sign of improvement. We see this all the time with back problems. Pain starts in your back and is really painful, but then it moves to your butt, hip, or thigh and is more achy and not as sharp. You think you’re getting better — but most of the time this means your back problem is actually getting worse!

The truth is, you’ve got a 50% chance of getting it right and a 50% chance of getting it wrong. And if you fall on the side of getting it wrong, it can lead to a lot more problems down the line that you won’t be able to fix on your own from home.

The BEST way to figure out if your pain is normal — or if it’s something more — is to talk to an expert.

That’s what we’ve been doing ALL month here. As specialized physical therapists, we have been getting on the phone — or hopping on Zoom — to help you figure out what’s going on in your back, knees, or somewhere else.

It’s totally free to talk to us! We’ll let you know if what you’re experiencing is normal… and if what you’re doing is safe or not.

If you want to get on our schedule — and talk to one of us for free — just fill out this form.

You can talk to us in-person if you’re comfortable leaving your home, or virtually if you’re nervous about leaving. Both methods are equally as effective!

Whatever you do, don’t try to figure out your pain on your own — and don’t just throw pills, ice, or heat at it. This could lead to more problems down the line. Plus, if you let it get bad enough, you may be forced to go to Urgent Care or the ER — two places you DON’T want to be right now.

Instead, get on top of your pain and learn how to treat it properly so that you can be healthy and pain-free for the rest of quarantine! 

 

syringe

Steroid injections may do more harm than good, research shows

Have you been told you need to get a cortisone injection? Have you already tried them more than once? 

Research is now showing that cortisone injections may hurt more than help in the long run! 

The results of a recent study from Radiology has raised concerns in the medical community about potentially adverse effects on joints following corticosteroid injections. These injections are commonly used to treat arthritis, especially osteoarthritis of the hip and knee. The researchers in this study observed patients who had previously received steroid injections and found that some of the patients exhibited further joint damage on medical imaging tests. According to the original article, these patients presented with “accelerated OA [osteoarthritis] progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss.” 

The joint issues that can be triggered by cortisone injections don’t just show up right after the procedure — which makes it easy to see the steroid shot as a quick fix with no drawbacks.

And it’s true that there are usually no short-term side effects. However, when it comes to your joints, it’s all about the long game. And it’s worth noting that an analysis from the Cochrane Review in 2015 found that the benefits of steroid injections usually wear off after about six months…  meaning it’s a temporary “band-aid” solution to a bigger problem — a band-aid with the potential to result in permanent degradation of your joints!  

Arthritis is an issue we see all the time in our physical therapy practice, and that’s why patient and physician concerns with steroid injections are so relevant to us. Many of our clients have had injections suggested to them or have gone through with the procedure but not experienced any long-term healing. In many cases, this can be an overly simplified answer to the very complicated question of individual pain. Physical therapy, on the other hand, isn’t a one-size-fits-all solution. Our treatment model is entirely based around addressing the root cause of your pain instead of just providing temporary relief. Plus, we’re all about keeping your treatment non-invasive, movement-based, and entirely customized to YOU. 

If you’ve been told that you need a cortisone injection in your back, knee, or shoulder, think twice and get informed about other options!

If you’d like a NATURAL route to pain relief — and one that will make you more mobile and active at the same time — come talk with us! You can even schedule a FREE 30 minute Discovery Session with our specialists right now — no strings attached. 

knees

Happy Halloween! Spooky Noises coming from your Knees?

“What are those cracks and noises coming from my knees? Is there something wrong??”

Our clients come in with this question all the time. They usually feel nervous and fearful that the noises they hear may indicate something more serious is going on within the joint. Is there damage occurring whenever they hear this sound? Do they need to avoid activities that provoke these symptoms? Will they need to rely on pain pills and surgeries in order to maintain their mobility if their joints deteriorate? 

Crepitus refers to these clicking, popping, and creaking sounds that a large portion of the population experience on a regular basis.  This phenomenon can occur at any joint, but is most commonly reported in the knees, shoulders, ankles, hips, and spine. 

Although these noises often don’t produce any pain, they can cause anxiety. Individuals start to develop their own beliefs about what is going on, and ultimately alter their behavior to avoid these cracking or popping sensations.

What causes these noises?

Many structural factors can contribute to joint noises.  Some of the most common are:

  • Tendons rubbing along bony prominences (bumps on bones)
  • Nitrogen bubbles popping due to pressure changes within the joint
  • Small labral or meniscus tears that get caught or pinched as we move

However, we don’t have the luxury of utilizing x-ray goggles during our examinations.  This means that we often cannot be certain of exactly which structures are creating these sounds.  What we do know is they aren’t a reason to be highly concerned as long as they aren’t associated with pain or swelling in the affected joint.  

How can I prevent it from getting worse?

The best way  to prevent these symptoms is to keep moving!! Motion is lotion. Regular movement throughout the day allows our joints to lubricate themselves, kind of like applying WD-40 to a creaky door hinge.  Additionally, it’s important to keep the muscles surrounding your knees strong and balanced. This helps to offload the forces through the joint, which limits “typical” wear and tear on cartilage and bony structures.

What if I’m noticing pain or inflammation in the joint that’s making these noises?

If you have a specifically noisy joint that’s also painful or swollen, it’s best to come in for a formal examination with a physical therapist – ideally someone who specializes in movement mechanics.  We train you in correct, healthy movement that both relieves your body of pain in the short term and protects it from further damage in the long term.

If finding the solution to your problem is something you’re interested in, you can come in for a free Discovery Session at our practice in Portsmouth, NH! All you have to do is fill out this brief form here and we’ll contact you. Discovery Sessions are great for people who want to talk with a specialist about what might be causing their problem, and we’ll help you figure out what the next best steps are.  Our goal is to give you all the information you need so that you can make the best decision for your health – without any obligation or commitment.

We also know not everyone is ready to commit to regular physical therapy appointments, and that’s why we offer free health and posture classes!  These events are for people in our community who want really valuable, expert information about movement, pain, and overall wellness. We know it’s confusing out there with all of the information floating around on Google and Facebook, and this is a valuable first step towards getting some answers for your problem.

Hopefully you found this information helpful, and the only thing scaring you this Halloween will be haunted houses instead of the noises coming from your joints!

PS – If you found this information helpful, please share this with a friend or on your Facebook feed.

Research shows MRI’s not reliable for back pain

One of the most popular questions and concerns I get from clients is whether or not they need an MRI for their back or neck problem. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI – right?

Not necessarily.

Here’s the problem. 

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine.  But what we now know from research is that all those findings on an MRI rarely correlate with what’s actually causing your pain. One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain.  Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Let me explain.

When it comes to neck and back problems, what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature.  That means that your problem has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration show up on an MRI. Disc degeneration and arthritis are normal parts of aging, but they often get blamed for problems they don’t actually cause. The best way to figure out a movement problem is with… well… movement! Not an MRI.

But how do you know that it’s a mechanical problem and not something more serious?

The easiest way to find out is to ask a physical therapist who specializes in the spine, and specifically in mechanical neck and back pain.  But one sign you can easily recognize on your own is to take note of how your pain behaves. Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain? When your pain is variable, it’s the best sign that your neck or back problem is “mechanical” in nature and due to a movement dysfunction. And that also means you don’t need surgery or any kind of procedure to fix it! In fact, a procedure or surgery could leave you feeling worse off than before.

So what’s the big deal about getting an MRI?  Isn’t it good just to be extra-cautious?

In theory – yes.  But here’s what actually happens.  MRI’s are super powerful and amazing tools.  Because of this, they see everything – including normal age-related changes like I mentioned just a moment ago. They also pick up things like bulging discs.

Research has also shown that around 60-70% of the population walk around with bulging discs and have no symptoms. Why?

Because a bulging disc only gives you trouble if you are moving or positioning yourself in an unbalanced way.

If an MRI picks this up, the news is often more devastating than it needs to be and the typical advice is to get an injection or surgery.  Neither of these procedures will fix your movement problem. And what typically happens is the bulge comes back, or appears somewhere else. This is why being “extra-cautious”, and over-prescribing MRI’s when it comes to back and neck pain, is not a good idea. The outcome is usually that people end up dealing with invasive procedures and surgeries they didn’t even need.  

If you’ve had a bad accident, fall, or trauma – then an MRI is a good idea.  But if you are dealing with chronic, long-standing aches and pains that have come and gone over the years and have recently gotten worse – there is a 70-80% chance that it is a movement problem that has finally caught up to you.  It’s best to see a movement expert for this. We know how to tell if the issue is something more serious. We can also send you to a doctor right away if necessary. But when you automatically assume that you need an MRI first, you end up spending a lot of money (the average cost of an MRI is $150,000, and you have to pay a portion of this), and the likelihood of getting prescribed an unnecessary surgery or procedure is much higher.

If this story sounds all too familiar, or you’ve been told that you must get an MRI for your neck or back problem – feel free to reach out to us and we can help you sort through fact vs fiction.  You could also come to our next “Ask the PT Night” on October 23rd and ask your questions then!