Arthritis and Joint Pain Archives - CJ Physical Therapy & Pilates

Don’t let Plantar Fasciitis Ruin Flip Flop Season

April 24, 2023/in Arthritis and Joint Pain, Movement/by Carrie Jose

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].

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

Tips to Avoid Injury When You’re Over 50

June 7, 2021/in Arthritis and Joint Pain, Back Pain, Movement as Medicine, Physical Therapy/by Carrie Jose

Most of our clients are aged 50 or above, and staying as active as possible while they age is a big priority for them. As we get older, our bodies do need more care and maintenance to not only age well but avoid injury.

Here are some of my top tips I like to give clients to help them stay active and mobile, avoid injuries, and continue doing everything they love.

1. Keep Moving

You’ll often hear me say: “You don’t get stiff because you get old, you get old because you get stiff.” If you want to stay healthy and mobile, you need to keep moving. One of the biggest concerns I hear from folks aged 50+ is whether they should start modifying what they do because of arthritis. Remember, arthritis is normal. It happens to everyone as they age, and it’s rarely a reason to stop doing your favorite activities. In fact, research has shown that activities like running, when done consistently and with proper form, can prevent knee arthritis! The effects of arthritis worsen when you don’t move, which is when I typically see people having problems. Common “injuries” like meniscal tears and bulging discs are more likely to occur in arthritic joints. But the more active you stay, the less likely you are to be impacted by ailments such as this — and the better your joints will feel.

2. Maintain a Healthy Diet

Both osteoporosis and heart health become bigger concerns as we age, and what you eat can have a direct and positive influence. With osteoporosis, your risk of injury, especially from a fall, becomes much greater. Greens like kale, spinach, and arugula are awesome for your bones, along with citrus fruits, fish, and nuts. These foods help your bones stay strong and durable. According to Health magazine, “The risk of a heart attack climbs for men after age 45 and for women after age 55.” As you enter middle-age, increasing the presence of foods like unsalted nuts, unprocessed oatmeal, raisins, blueberries, and even dark chocolate (over 70% cacao) can help keep your heart healthy. Before making any drastic changes to your diet, especially if you’ve got comorbidities such as diabetes or kidney disease, you’ll want to check with your doctor or dietician. But otherwise, paying attention to your diet can have a big impact on how healthy you keep your heart and bones.

3. Work on your Balance

Balance is one of the first things to go as a person gets older, and it’s one of the most crucial factors in helping you prevent falls and avoid injury. Slips and falls due to poor balance can lead to broken bones and fractures, which become more common and harder to recover from as you age. But if you’re intentional about improving your balance when you exercise, it’s not too late to improve it. While there are many great balance exercises you can do at home, I always recommend incorporating balance strategies with movement and activity. Because rarely do we fall when just standing still. Try standing on one leg when you brush your teeth, place one foot up on a stool when washing dishes, walk around on your toes and heels during commercials. These are really easy strategies to incorporate into your daily living. And of course, activities like walking regularly, Tai Chi, Yoga, and our favorite — Pilates — are also great to promote good balance.

4. Strengthen your core

Having a strong core is beneficial at any age, but especially as you get older. Strong abs, hips and buttocks (all part of your core) help you to sit and stand more upright, prevent back and neck pain, and will help you feel stronger and more confident in just about everything that you do. In our office, our favorite core-strengthening activity is Pilates. We especially love it for folks aged 50+ because it’s easy on your joints and it helps to promote flexibility at the same time. But what I love most about Pilates is that it teaches you how to strengthen your core properly and safely, two important things at any age, not just when you’re over 50. When you know how to properly engage and use your core, you start to incorporate it more into other exercises. Suddenly walking, running, Yoga, and lifting weights all become that much more effective, and you’re far less likely to get injured doing them.

5. Educate Yourself

Knowledge is power, and lack of it, is one of the biggest reasons I see people decreasing their activity levels when there is no reason to. People think that things like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities. But that’s not necessarily true! Most of the things I just mentioned are normal occurrences as we age, and having them show up on an x-ray or MRI is not a reason to change something you’ve been successfully doing for years. Plus, regular movement and exercise actually helps these problems. If you’ve got pain, that’s a different story. Talk to an expert who can help you figure out what’s going on, so that you can quickly get back to your activities and not make your pain worse. Whatever you do, try to avoid Dr. Google. It can send you down a rabbit hole and not all the advice you read will apply directly to you.

Arthroscopic Knee Surgery – Does it Even Work?

April 21, 2021/in Arthritis and Joint Pain, Knee Pain, Knee Pain, Movement/by Carrie Jose

While researching for my latest article in the Portsmouth Herald, I came across an interesting study titled: “Arthroscopy for degenerative knees – a difficult habit to break.”

The title of this study is telling.

Arthroscopic knee surgery is still 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.

Furthermore, studies now indicate that people who get arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that could have been avoided.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint 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?

But over the years, research has shown that this procedure is really not necessary in most cases.

Most people can get pain relief and restore function in their knees without ever getting surgery.

One of the earliest studies from 2002 by JB Mosely 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 shown similar results. Even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment like physical therapy.

Despite all this research, surgeons are still performing these procedures 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 and not giving therapy enough time to work.

In our office, we often see people after they’ve tried regular physical therapy first. Since we have a more specialized approach, and we’re able to spend more time with our clients, we tend to get better results and can help clients avoid surgery all together.

But not all physical therapy clinics are afforded that luxury. In those cases, people are led to believe that the physical therapy “didn’t work,” and they get scheduled for surgery.

But what’s the big deal really?

If outcomes are the same regardless of whether you get surgery or not – why not just get it? It’s quicker, and far more convenient than going to weekly therapy appointments…

But despite the term “minimally invasive,” it’s still surgery.

You will have bleeding, swelling, and recovery time. There is trauma that is caused to the soft tissue in and around your knee that has to heal. There’s also the risk of infection, which comes with a whole set of different complications.

And then of course there’s the elephant in the room that nobody likes to talk about…

I’ve seen many of these arthroscopic surgeries performed that had clients feeling WORSE than before surgery. Because it turns out the procedure wasn’t even necessary. Luckily, we’re still able to rehabilitate them. But it’s completely demoralizing and discouraging for our clients.

In general, despite how small the procedure may seem, you want to avoid surgery whenever possible.

Although small, the risks that can happen with surgery simply aren’t worth it – especially when you can get the same results from natural, conservative treatment.

For some, arthroscopic knee surgery really is necessary. But for most, it can be avoided.

If you’re currently suffering from knee pain and want to learn more about what you can do to avoid surgery and heal your knee pain naturally and on your own – DOWNLOAD our Free Guide: 7 Ways to Get rid of Knee Pain Naturally.

5 Tips for Staying Active and Mobile as you Age

January 25, 2021/in Arthritis and Joint Pain, Movement, Nutrition, Posture, Running, Nutrition and Lifestyle, Strength and Mobility/by Carrie Jose

Most of our clients are in their 50’s, 60’s and 70’s, and they want to stay as active as possible as they age. However, as we get older, our bodies do need more care and maintenance to age well and avoid injury. Here are some tips we like to give our clients to help them stay active and mobile, prevent injuries, and continue doing everything they love!

1. Keep Moving

I always tell my clients: “You don’t get stiff because you get old, you get old because you get stiff.”

If you want to stay healthy and mobile, you need to keep moving. One of the biggest questions I hear from folks aged 50+ is what to keep doing or stop doing because of arthritis. Remember, arthritis is normal as you age and it’s rarely a reason to stop doing certain exercises. Research has shown that activities like running, when done consistently and with proper form, can actually prevent knee arthritis! A similar and equally effective exercise is walking. Consistent walks will build up your strength and endurance, something that declines as you age, and it helps your balance and coordination. If you walk outside, you can get some fresh air and Vitamin D, which is highly beneficial for a strong immune system – something we all need right now.

2. Maintain a Healthy Diet

What you eat directly affects your ability to keep moving. If you’re not keeping your bones and heart healthy, you’re not going to be able to exercise! Greens like kale, spinach, and arugula are awesome for your bones. Along with citrus fruits, fish, and nuts, these foods help your bones stay strong and durable, which is a big concern for our clients with osteoporosis.

When it comes to taking care of your heart, your diet can have a huge impact. According to Health magazine, “The risk of a heart attack climbs for men after age 45 and for women after age 55.” So as you enter middle-age, be sure to increase the presence of foods in your diet like unsalted nuts, unprocessed oatmeal, raisins, blueberries, and even dark chocolate (over 70% cacao) to help keep your heart healthy! If you have any comorbidities such as diabetes or kidney problems, be sure to check with your doctor or dietician before making any drastic changes to your diet.

3. Work on your Balance

4. Strengthen your core

Having a strong core is beneficial at any age, but especially as you get older. Strong abs, hips and buttocks (all part of your core) help you to sit and stand more upright, prevent back and neck pain, and will help you feel stronger and more confident in just about everything that you do. In our office, our favorite core-strengthening activity is Pilates. We especially love it for folks aged 50+ because it’s easy on your joints and it helps to promote flexibility at the same time. We use specialized machines that are beneficial for folks recovering from an injury, and we’ve got Zoom classes requiring no equipment at all that people can do from home. Yet another reason to love Pilates is that it doesn’t just work your core, but your entire body. You can even do portions of Pilates in standing, which helps your balance and coordination! If you’ve never tried Pilates before, we’d love to help you get started.

5. Educate Yourself

Knowledge is power, and a lack of knowledge is one of the biggest reasons I see people decreasing their activity levels unnecessarily. People think that issues like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities altogether. But that’s not necessarily true! Most of the things I just mentioned are normal occurrences as we age, and having them show up on an x-ray or MRI is not a reason to change an activity you’ve been doing successfully for years. Plus, regular movement and exercise actually helps these problems.

If you have pain, that’s a different story. Talk to an expert who can help you figure out what’s going on so that you can quickly get back to your activities and not make your pain any worse. Whatever you do, try to avoid Dr. Google. It can send you down a rabbit hole and not all the advice you read will apply directly to you. If you’re dealing with pain that is keeping you from your favorite activities, reach out to experts like us. We offer a FREE 30 minute Discovery Session just so you can ask questions, get honest answers, and figure out if we’re the right fit for your lifestyle.

Tips to Combat Arthritis this Winter

November 30, 2020/in Arthritis and Joint Pain, Back Pain, Chronic Pain, Knee Pain/by Carrie Jose

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!