Why We Age Faster Than We Should – And How Medicine 3.0 Changes Everything

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Why We Age Faster Than We Should — And How Medicine 3.0 Changes Everything (Portsmouth, NH)

If you haven’t yet read “Outlive: The Science and Art of Longevity” by Dr. Peter Attia, I highly recommend it—especially if living your healthiest years right now matters to you. Dr. Attia, a physician known for his work in healthspan and preventative medicine, explains why our current medical system (what he calls Medicine 2.0) focuses too heavily on treating disease instead of preventing it.

In “Outlive,” Attia introduces Medicine 3.0, a proactive and prevention-based approach to longevity. Instead of waiting for disease to show up, Medicine 3.0 focuses on early action, long-term strategy, and building the physical capacity needed to stay healthy and independent through your 60s, 70s, and beyond.

Central to Attia’s philosophy are the “Four Horsemen” of chronic disease:

  • metabolic dysfunction
  • cardiovascular disease
  • cancer
  • neurodegenerative decline

These conditions often appear in our 50s and 60s—but the biological changes that cause them begin years (often decades) earlier. That’s why the most powerful time to intervene is long before symptoms appear. And that applies directly to the work I do every day as a mechanical pain specialist here in Portsmouth, NH.

Where Most People Overlook Longevity: Musculoskeletal Health

You can fuel your body with nutrient-dense food, build strong muscles, and improve your cardiovascular capacity—but if you’re dealing with chronic back pain, knee pain, hip pain, or shoulder pain, it becomes nearly impossible to maintain the type of movement needed for long-term health.

Just like the Four Horsemen, musculoskeletal problems usually develop silently from small mechanical issues that go unaddressed for too long. When identified early, nearly all of these issues are fixable—and often preventable.

This is exactly where Medicine 3.0 and mechanical pain science overlap:

  • early intervention
  • optimizing function
  • preventing decline
  • treating problems while they’re small—not after they become debilitating

Below are five Medicine 3.0 principles that apply directly to your muscles, joints, and mobility.

1. Movement Quality Matters More Than You Think

Longevity isn’t just about being active—it’s about moving well. Poor movement patterns, stiffness, or instability eventually lead to breakdown, even if you’re exercising consistently.

  • Medicine 2.0: Wait until something hurts
  • Medicine 3.0: Optimize movement before pain appears
  • Good joint mobility, core stability, balance, and coordination are fundamental for long-term health, independence, and injury prevention.

2. Small Aches Become Big Ones When Ignored

A tight low back after sitting…
An achy knee after pickleball…
A stiff neck when you wake up…

These are early warning signs. Medicine 2.0 teaches you to ignore them until they become severe. But by that point, the problem is harder—and more expensive—to solve.

Mechanical issues are easiest to fix early, and addressing them now protects your joints, prevents chronic pain, and helps you stay active well into older age.

3. Your Mobility Declines Long Before You Notice It

Just like cardiovascular decline, mobility fades slowly over decades. You lose hip extension, ankle mobility, rotational strength, and postural control long before you notice anything in daily life.

The good news?
Mobility is highly trainable, even into your 70s and 80s.

The key is to address restrictions early—not once you already “feel old” or start modifying activities due to stiffness.

4. Strength Training Doesn’t Work When Form Is Poor

Strength training is one of Attia’s non-negotiables for longevity. But strength training performed with poor mechanics can do more harm than good.

Learning to:

  • hinge properly
  • stabilize your hips
  • engage your core
  • align your spine

…keeps your joints safe and allows you to build strength without injury.

The best time to learn proper mechanics is before something breaks down—not after you’re dealing with a herniated disc or chronic tendon pain.

5. Imaging Shows Structure—But Not the Full Story of YOU

X-rays and MRIs show bones and tissues, but they don’t show mechanical dysfunction, such as why:

  • your back hurts more with sitting
  • your hip improves with walking
  • your knee flares after lifting

Most musculoskeletal pain is mechanical in nature, meaning it responds best to mechanical solutions like movement, load management, and corrective exercise—not just medication or rest.

This aligns perfectly with Medicine 3.0:
Treat the whole person, not just the scan.

The Bottom Line: You Have More Control Over Your Future Than You Think

Medicine 3.0 teaches us that aging isn’t something that just “happens”—it’s something we can influence with early, strategic action.

Nowhere is this more true than in your musculoskeletal system.

When you:
✔ take small signals seriously
✔ strengthen intelligently
✔ move with intention
✔ address problems early
✔ ask for help before pain becomes disabling

…you protect your ability to stay healthy, active, independent, and fully engaged in life for decades to come.

About Dr. Carrie Jose

Dr. Carrie Jose, DPT, is a Physical Therapy Specialist and Mechanical Pain Expert and the owner of CJ Physical Therapy & Pilates in Portsmouth, NH. She writes for Seacoast Media Group and helps active adults stay mobile and pain-free without medications, imaging, or surgery.

To get in touch or request a discovery visit, visit cjphysicaltherapy.com or call 603-380-7902.

Daily rituals to boost immunity in colder weather

7 Daily Rituals to Strengthen Your Health This Season

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7 Daily Rituals to Strengthen Your Health This Season (Portsmouth, NH Wellness Guide)

As colder weather settles into Portsmouth and the Seacoast, it’s more important than ever to take care of your body and mind. Between busier schedules, fluctuating temperatures, holiday stress, and increased travel, your body works overtime this time of year. But staying healthy isn’t just about avoiding illness—it’s about supporting the systems that help you move well, think clearly, and feel balanced through the season.

After years of working with clients at CJ Physical Therapy & Pilates in Portsmouth, NH, I’ve seen how the simplest habits often have the greatest impact. These daily rituals support your immune system, keep your joints and muscles moving smoothly, and help you stay grounded—even during the busiest months of the year.

Here are seven easy wellness rituals you can start today to improve your immunity, mobility, and overall health this season.

1. Drink More Water Than You Think You Need

Hydration affects every aspect of your health. Water supports cellular function, helps fight infection, regulates inflammation, and stabilizes your energy. Even mild dehydration can leave you feeling tired, foggy, or more susceptible to illness.

Hydration doesn’t have to be boring—warm lemon water, herbal teas, or naturally flavored unsweetened beverages are great options. One of my favorites is hot water with lemon because it’s soothing and encourages slower, deeper breathing.

Keep a water bottle nearby throughout the day. When you’re busy, hydration is the first thing to slip—but also the fastest way to feel better.

2. Move Your Muscles Daily

Daily movement is one of the most powerful ways to support your immune system. Movement boosts circulation, helping immune cells travel efficiently while lowering stress hormones that weaken your immunity.

But here’s something you may not know:
Your muscles act like medicine.

When you activate them—especially through strength-based movement—they release anti-inflammatory proteins called myokines. These help regulate blood sugar, support metabolic health, reduce inflammation, and promote healthy aging.

Movement doesn’t need to be intense. On high-energy days, strength training or cardio works great. On low-energy days, try gentle Pilates, stretching, or a short walk around Portsmouth.

Consistency is key.

3. Protect Your Sleep Like Your Health Depends on It

Sleep is your body’s most powerful healing tool. During sleep, your tissues repair, your brain restores mental clarity, and your immune system releases proteins that help fight infection.

Poor sleep weakens immunity, increases stress, strains your metabolism, and affects your mood and focus.

Create a simple nighttime routine:

  • dim the lights
  • put your phone away
  • stretch gently
  • try herbal tea
  • read for a few minutes

When you sleep well, everything else feels easier—your movement, mindset, and overall health.

4. Eat Foods That Support Your Energy, Immunity, and Mood

Food is more than calories—it’s functional fuel.

Whole, colorful foods like vegetables, fruits, lean proteins, and healthy fats nourish your cells, balance blood sugar, and support your energy. Gut-friendly foods like yogurt, kefir, miso, and sauerkraut help strengthen your microbiome, which plays a direct role in immune health and emotional stability.

Start by adding one or two nutrient-dense foods each day. You’ll notice the shift quickly.

5. Stay Connected to Friends and Loved Ones

Human connection is one of the most overlooked wellness tools—especially during colder months when daylight is limited and holiday stress increases.

Loneliness and chronic stress weaken your immune system. Meaningful connection does the opposite—it boosts emotional resilience and lowers inflammation.

Connection doesn’t have to mean big events. A walk through downtown Portsmouth, a brief check-in call, or a quick coffee with a friend can shift your entire day.

Nurturing your relationships, even in small ways, supports your health all season long.

6. Spend Time Outside (Even When It’s Cold)

Fresh air and natural light are essential for healthy sleep cycles, vitamin D levels, mood balance, and immune function.

Even a five-minute walk outdoors can lower stress hormones and clear mental fog.

Yes, it’s tempting to stay cozy indoors during winter—but stepping outside helps break up stiffness, encourages gentle movement, and stabilizes your body’s natural rhythms.

If you enjoy walking, try building toward 10,000 steps per day, spread throughout your day.

7. Stretch and Breathe With Intention

Daily stretching increases circulation, reduces tension, and calms your nervous system—directly supporting your immune health.

Pair this with slow breathing and the benefits multiply. Deep breathing activates your deep core muscles, stabilizing your spine and preventing back pain. Since injury and pain add stress to your system, keeping your joints mobile and your core engaged becomes a key part of staying well.

Spend 5–10 minutes each day stretching your tightest areas:
hips • shoulders • chest • low back

These small daily rituals can dramatically shift your energy and posture.

Which Ritual Will You Start With?

You don’t need to master all seven rituals at once. Start with one or two that feel manageable. Small, consistent changes add up—especially when it comes to immunity, movement, and emotional balance.

If pain, stiffness, or injury is getting in the way, we’re here to help.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group.

To get in touch or request a Free Discovery Visit, visit our website or call 603-380-7902.

work out

6 Reasons Your Muscles Are the Secret to Staying Young

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When most people think about anti-aging, they picture creams, supplements, or the latest medical breakthroughs.

But one of the most powerful tools for staying young is something you’re born with – your muscles. Everyone knows muscles are key for strength and appearance, but research shows they do far more than that. Muscles act like living medicine inside your body. Every time they contract, they send out chemical signals that influence your brain, heart, bones, and immune system. In fact, researchers now recognize that maintaining muscle may be one of the most effective ways to protect your health, preserve independence, and extend your life.

So – what exactly makes building muscle such a potent anti-aging secret?

Here are six important ways your muscles act like medicine:

1. Muscles Fight Inflammation

One of the hallmarks of aging is something scientists call “inflammaging” – chronic, low-grade inflammation that damages tissues and raises the risk of cardiovascular disease, arthritis, and Alzheimer’s. But here’s what’s fascinating… When your muscles contract during exercise, they release anti-inflammatory chemicals known as myokines. One of the best studied is interleukin-6 (IL-6). Unlike the IL-6 produced by fat tissue, which fuels inflammation – muscle-derived IL-6 helps regulate the immune system and suppress harmful inflammatory signals.

This helps explain why U.S. studies, such as the long-running Alameda County Study, have consistently shown that physically active adults live longer and age with fewer health problems. In other words – every time you use your muscles – you’re helping your body reverse damaging inflammation.

2. Muscles Stabilize Blood Sugar

Muscle is the largest site of glucose disposal in your body. The more muscle you have – and the more you use it – the more efficiently your body processes sugar. Resistance training improves insulin sensitivity, which means your muscles can absorb glucose from the bloodstream more effectively.

A 2024 meta-analysis found that structured resistance training reduced HbA1c, a long-term marker of blood sugar control, by about half a percentage point – an effect comparable to some common diabetes drugs. For millions of Americans at risk for diabetes, maintaining and building muscle is one of the most powerful ways to keep blood sugar steady and prevent disease.

3. Muscles Strengthen Bones

Strong muscles don’t just move your body – they help to strengthen bone. Every time muscles contract against bone, they stimulate bone growth and increase bone density. This is one of the most effective natural defenses against osteoporosis, a disease that affects more than 10 million Americans and dramatically raises fracture risk.

As we age, fractures can mean the loss of independence. But by strengthening muscles through regular resistance training – you also strengthen the bones they attach to – creating a double layer of protection.

4. Muscles Protect Your Brain

Healthy muscles send protective signals to your brain. As previously mentioned – when you exercise and contract muscles – they release myokines. In addition to IL-6, myokines such as irisin and brain-derived neurotrophic factor (BDNF) stimulate the growth of new neurons, strengthen existing connections, and improve brain plasticity.

The benefits are measurable. Studies of older American adults have shown that maintaining muscle strength later in life is associated with sharper memory, slower cognitive decline, and reduced risk of dementia. Exercise also boosts endorphins, which elevate mood and help combat depression and anxiety. Keeping your muscles active is one of the most reliable ways to keep both your body and mind young.

5. Muscles Support Heart Health

We often think of walking or jogging as the best ways to support cardiovascular health. But research now shows that strength training deserves equal credit. Resistance exercise improves circulation, reduces arterial stiffness, and lowers blood pressure.

In a massive U.S. study of more than 116,000 adults – those who consistently met or exceeded physical activity guidelines – including strength training – had up to a 31 percent lower risk of death from any cause – and up to a 38 percent lower risk of dying from cardiovascular disease. These findings echo results from the British Journal of Sports Medicine, which showed that just 30 to 60 minutes of strength training per week reduced risk of chronic disease and early death. When it comes to your heart, strong muscles really are medicine.

6. Muscles Extend Longevity

Perhaps the most compelling evidence for the concept of “muscles are medicine” is its impact on survival. Studies consistently show that muscle mass and strength are stronger predictors of longevity than body weight or BMI. One U.S. study of college alumni found that those who maintained higher activity levels in midlife had significantly lower risks of heart disease and lived longer lives.

Muscle also serves as a critical protein reserve. When illness, surgery, or trauma strikes – your body draws on muscle stores to support healing, immune function, and tissue repair. People with greater muscle mass not only live longer but also recover more quickly when health challenges arise. Stronger muscles simply mean greater resilience.

The Bottom Line

Your muscles do far more than help you look fit or lift heavy things. They fight inflammation, regulate blood sugar, strengthen bones, protect your brain, support your heart, and extend your life. Best of all, you don’t need hours in the gym to see these benefits. Just 30 to 60 minutes of strength training per week, combined with regular movement, can produce profound results.

But if pain or injury is holding you back, don’t ignore it. The longer you wait, the harder it can be to bounce back – and the more you miss out on this natural anti-aging tool. If back, knee, hip, neck, or shoulder pain is keeping you from building muscle, talk to a physical therapy specialist who can help you return safely. With the right guidance, you can overcome those barriers and put your muscles to work – as they are your best-kept secret to staying young.

Looking for help and local to Portsmouth NH? Consider speaking to one of my specialists by clicking HERE.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Arthritis Pain Isn’t the End – How to Stay Active for the Long Haul

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Arthritis is one of the most common conditions I see in my clinic – and one of the most misunderstood.

Many people assume it’s just an inevitable part of aging, but what’s often overlooked is how much can actually be done to manage it naturally and effectively.

What frustrates me most is the message many people still hear – that arthritis pain is something you just have to “live with,” managed only through pills, injections, or eventually surgery. But the truth is that while arthritis may not be something you can erase or reverse – there are countless ways to manage your symptoms naturally, safely, and effectively – without becoming dependent on quick fixes that often backfire in the long run.

Here are just a few of the approaches I recommend to my patients who want to stay active and independent well into their later years – even with arthritis.

Move Every Day (Even When You Don’t Feel Like It)

When your joints ache, movement is usually the last thing you want to do. But ironically, it’s one of the best things you can do. Gentle, consistent exercise increases circulation, nourishes your cartilage, and keeps inflammation from settling in. Walking, biking, or swimming are excellent choices because they don’t put excess stress on your joints. Practices like yoga or Pilates improve balance and mobility, making daily activities easier and reducing the strain on your joints. And strength training – despite what many believe – is actually good for arthritis because it takes pressure off your joints by making the muscles around them stronger.

Even five to ten minutes of daily activity can mean the difference between feeling stiff all day or moving with more freedom. The less you move, the worse arthritis tends to get – so finding ways to stay active is one of the best investments you can make in your future health.

Fuel Your Body With Anti-Inflammatory Foods

What you eat matters. An anti-inflammatory diet can help reduce the swelling and stiffness that drive arthritis pain. Omega-3 rich foods like salmon or flax seeds, antioxidant-packed fruits and vegetables, and spices such as turmeric and ginger all have powerful healing effects. At the same time, cutting back on processed foods, refined sugars, and fried items can significantly improve how your joints feel – and it brings benefits for your overall health as well.

Think of food as medicine, because for arthritis it truly can be. Many of my patients notice a big difference in their pain levels and energy simply by reducing sugar and processed foods while adding more colorful fruits, vegetables, and healthy fats.

Prioritize Weight and Posture

Every extra pound you carry puts additional strain on your hips, knees, and back. Even small amounts of weight loss can dramatically reduce pressure on your joints and give you noticeable relief. But here’s something many people miss – posture can play just as big a role.

When you sit, stand, or walk with poor posture, you create uneven forces through your joints. Over time, this increases wear and tear, and can be aggravating to an already arthritic joint. Learning how to align your body correctly can protect your joints just as effectively as losing weight. The way you move every day, whether you’re getting out of a chair or bending to pick something up, can either help your arthritis or make it worse.

Don’t Let MRIs or X-rays Dictate Your Treatment

One of the biggest mistakes I see is when people let imaging results control their decisions. While MRIs and X-rays are useful in certain situations, they are not the whole story. Numerous studies have shown that people with severe degenerative changes on their scans often have no pain at all. In fact, research suggests that as many as 60–70% of people over the age of 50 show some level of arthritis or disc degeneration on imaging – even if they feel perfectly fine.

This matters because once you’re told your pain is due to what’s seen on a scan, you’re far more likely to be funneled toward procedures you may not need. Cortisone injections, for example, only mask pain and actually weaken tissue when used repeatedly. Arthroscopic surgery for knee arthritis has been shown to accelerate the very degenerative changes it’s supposed to help.

And then there’s the dreaded phrase: “bone-on-bone.” While this sounds scary, it does not automatically mean you need a joint replacement. Many people live full, active lives with joints that appear “bone-on-bone” on imaging, as long as they are moving well and keeping their surrounding muscles strong. If you rely only on what the picture shows, you risk missing out on safe, natural solutions that can help you stay mobile and independent.

Explore Longevity Treatments that Boost Healing

One of the most exciting developments in arthritis care right now is the rise of non-invasive therapies that actually help your joints heal and last longer. The combination of Shockwave Therapy (ESWT) and EMTT (Extracorporeal Magnetotransduction Therapy), for example, helps to stimulate blood flow, reduce inflammation, and restore mobility at the cellular level deep inside your joint.

Unlike cortisone shots, which only provide temporary relief while weakening tissue, these therapies encourage your body’s natural ability to repair itself. Many of my patients have experienced less pain, more mobility, and faster recovery – without downtime or drugs. Instead of masking symptoms, these treatments support long-term joint health and help you stay active well into the future.

A Final Word of Encouragement

If you live with arthritis – it doesn’t mean you are destined for a life of pain or dependence on invasive treatments or pills. Your body has an amazing capacity to heal when given the right environment. Whether it’s moving a little more each day, adjusting your diet, improving your posture, questioning unnecessary procedures, or exploring longevity treatments – there are always steps you can take to improve your quality of life.

Arthritis may be common, but it doesn’t have to define you or your future.

With the right strategies, you can stay active, independent, and doing the things you love for years to come. Local to Portsmouth, NH and looking for help?

Consider speaking to one of my specialists. CLICK HERE to book a free discovery visit.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Frozen Shoulder: Why the “Quick Fix” May Set You Back

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If you’ve ever suffered from a “frozen shoulder,” you know firsthand how debilitating it can be.

The shoulder pain and stiffness make it hard to reach into cabinets, fasten a seatbelt, or even sleep comfortably – and this condition can hijack your life for months, sometimes even years. The bigger problem is that the usual advice – to just “wait it out,” get a cortisone shot, or let a surgeon force the shoulder to move under anesthesia – can often do more harm than good. But there is a better way forward, and it involves working with your body instead of against it.

What exactly is frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, occurs when the capsule around your shoulder joint becomes inflamed and tightens. It affects more women than men, most often between the ages of 40 and 60. Metabolic health plays a major role as well. Conditions like diabetes, obesity, high blood sugar, and elevated lipids significantly increase the risk, likely because they contribute to inflammation and tissue changes in the shoulder capsule. As the capsule thickens and stiffens, motion becomes restricted and pain increases. Frozen shoulder usually progresses through three stages: the painful phase, the frozen (or stiff) phase, and finally, the thawing phase. The good news is that most cases resolve on their own. The bad news is that “on their own” can mean two to three years without the right care – and that’s a long time to put your life on hold.

Why “quick fixes” don’t work

One of the most common interventions people get pushed toward is manipulation under anesthesia. On paper, it sounds appealing: you go under anesthesia with a stiff shoulder and wake up with more motion. But the reality is more complicated. A large review reported that about 14 percent of people needed a second procedure, and the overall evidence base was weak, with most studies lacking proper control groups.

Complications, though not frequent, can be serious. Tears of the capsule, labrum injuries, rotator cuff damage, bone bruising, fractures, and even nerve injury have all been reported. For a problem that often improves with proper conservative management, exposing yourself to those risks doesn’t make sense. Manipulation might have a place for rare cases that fail everything else, but it should never be your first option.

Cortisone injections are another common recommendation. While these can provide short-term pain relief, they come with a big catch. Cortisone is not a healing agent – it simply suppresses inflammation. Multiple studies have shown that repeated cortisone injections can weaken tendons and joint tissue, which may actually slow long-term healing and set you back. Frozen shoulder already has a natural life cycle, and while cortisone can blunt pain temporarily, it does not change the overall course of the disease. Worse, relying on injections can delay the real solution: restoring mobility through movement and proper rehab.

Do you have the correct diagnosis?

Another important point often overlooked is that a doctor’s diagnosis of “frozen shoulder” may not always tell the whole story. Adhesive capsulitis is commonly misdiagnosed, because many shoulder problems can look and feel like frozen shoulder in the early stages. Stiffness and pain are not unique to adhesive capsulitis – rotator cuff injuries, labral issues, arthritis, and even postural or mechanical problems can mimic it.

A 2016 case study published in the International Journal of Sports Physical Therapy highlights this problem. A patient was referred with a diagnosis of adhesive capsulitis. But when evaluated using Mechanical Diagnosis and Therapy (a form of specialized mechanical therapy), the presentation was actually consistent with what’s known as a “shoulder derangement.” Instead of requiring the long and difficult course typically associated with frozen shoulder, the patient responded quickly to specific corrective movements – achieving full pain relief and restoration of motion within just a few visits. This underscores why it’s so important not to take a frozen shoulder diagnosis at face value. The right examination makes all the difference, and sometimes what looks like frozen shoulder is actually a mechanical problem that can be resolved much faster.

What should you do?

But let’s say you do, indeed, have frozen shoulder. While it’s true that in most cases you have to let it “thaw out” and get through the freezing stage, there are natural treatments that can speed this up. Non-invasive technologies like Extracorporeal Shock Wave Therapy (ESWT) and Extracorporeal Magnetotransduction Therapy (EMTT) give your body’s natural healing mechanisms a boost to aid in both pain relief and mobility.

Shockwave therapy uses acoustic waves to stimulate healing, increase blood flow, and help tissues remodel, while EMTT uses high-energy pulsed electromagnetic fields to influence cells at the microscopic level and calm inflammation. On their own, each has been shown in recent studies to reduce pain, restore motion, and improve function. But when used together, the results are even more powerful. Shockwave helps loosen the capsule and ease pain so movement becomes possible, while EMTT supports the healing process at the cellular level. This combination accelerates recovery, making it easier to progress with the stretching and strengthening that ultimately restore long-term shoulder health.

The real power of these therapies is how they fit into a bigger plan. Specific stretching techniques, corrective mobility drills, and later, strengthening exercises are still the foundation of recovery. But when you can reduce pain and inflammation more quickly with shockwave and EMTT, you unlock the ability to move sooner and with less fear. That means you don’t just get better – you get better faster.

Final thoughts

Frozen shoulder does not require surgery, force, or repeated cortisone injections. In fact, those approaches can cause setbacks or complications that make recovery even harder. A smarter path is to combine natural, non-invasive therapies like shockwave and EMTT with guided, progressive movement from a specialist. Research is showing us that these tools can help people reduce pain, improve range of motion, and shorten recovery time – all without exposing you to unnecessary risk.

If you’ve been told to “wait it out” or to sign up for an aggressive procedure, it may be time to get a second opinion. Frozen shoulder is tough, but it is not unbeatable. With the right plan, the right tools, and the right guidance, you can move past the pain and stiffness – and get your life back.

Sound like you?

Consider speaking to one of our specialists in Downtown Portsmouth, NH. Click here to request a free discovery visit.

Why Your Back Pain Isn’t Going Away – Even After Rest, PT, and Chiro

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In my 23-year career, back pain is probably the one problem that frustrates people the most. It affects your sleep, your mood, your energy, and your ability to enjoy the things you love. Plus, it becomes even more frustrating after you’ve tried all the “right” things – like physical therapy, chiropractic treatment, and even good old-fashioned rest.

If this sounds like your story, you are not alone. I work with people every week who have done everything they were told to do – and they’re still in pain. And it’s not because they didn’t try hard enough. It’s because the true root cause of the problem was missed.

I always say… If your treatment plan isn’t working, you either have the wrong diagnosis or a poor treatment strategy.

Let’s take a closer look at why some of the most common treatments for back pain – rest, physical therapy, and chiropractic care – don’t always work.

Rest is Not a Cure

When your back hurts, resting feels like the safest and most natural thing to do. And for an acute injury, some rest is helpful. But debilitating back pain episodes aside, resting for more than a day or two can actually make things worse.

Your spine needs movement. Movement keeps your discs hydrated, your joints nourished, and your muscles coordinated and strong. Avoiding movement out of fear can lead to stiffness, weakness, and more pain – not less.

Your nervous system relies on movement – and your body’s response to it – to help it learn and recover after injury. If you shut everything down at the first sign of pain, your brain can start to associate movement with danger. That’s how chronic pain problems begin.

The reality is, if rest alone cured back pain, we wouldn’t have so many people still suffering from it.

Your Physical Therapy Isn’t Prescriptive

The research tells us that exercise is one of the most effective treatments for back pain – which is why physical therapy should be the gold standard. Physical therapists are trained to be movement experts. They should be prescribing exercises that are designed to take your back pain away – and keep it gone – while using hands-on work and modalities selectively to help you move with less pain and more efficiency.

But sadly, this doesn’t always happen. I often see clinics that rely heavily on passive modalities like ultrasound or electrical stimulation for short-term relief. Then the exercise “prescription” ends up being a generic list of stretches and core exercises you could find on YouTube.

If your physical therapy didn’t work, it’s possible the true root cause of your back pain wasn’t correctly identified. Many cases of back pain are due to “derangement syndrome” – when something in your spine (like a bulging disc) disrupts normal movement. Unless you correct the way your spine moves – and learn how to maintain that correction – the pain keeps coming back.

Physical therapy must be prescriptive in nature. If you just want general exercises, you can find them online or go to the gym. Your back might eventually feel better – but you’ll never know what fixed it, and you’ll have no way to fix it again when the pain returns.

Chiropractic Adjustments Aren’t Always Enough

Chiropractic care can sometimes be the difference between being unable to move and finally being able to straighten yourself out – especially during an acute episode of back pain. But most chiropractic care is passive. It has its place, but problems arise when people rely solely on adjustments to stay out of trouble. Chiropractic care should be paired with prescriptive, active movement that retrains your nervous system and gives you tools to manage your pain.

Another issue I see is people who have relied on adjustments for years. Eventually, they realize the pain keeps coming back. That’s often because the joint being mobilized provides only temporary relief, while the root cause isn’t being addressed. Chiropractic adjustments also aren’t very specific. Your spine often needs precise movements, in a specific direction, repeated over time. When it comes to disc or nerve problems, it can take thousands of reps of the right movement to resolve the irritation and get the pain to stop. A chiropractic adjustment can sometimes disrupt that carefully prescribed movement plan – and then you’re back at square one.

This all might sound a bit “technical” to you, and that’s because it is. It’s also why so many people still suffer from back pain despite trying everything.

But don’t overthink it. Ask yourself: Is chiropractic care still helping? Are you relying on the adjustments less and less? If yes, you’re on the right track. If not, it may be time for a new approach.

What to Do Instead

There’s no one-size-fits-all solution for back pain. But successful treatment usually starts by asking better questions and taking the time to uncover the real root cause.

Is it your muscles? Your joints? A disc? A nerve? Or the way your brain and nervous system have adapted over time?

A thorough, mechanically based assessment often reveals things that X-rays and MRIs miss. In fact, imaging can sometimes lead to too much information – and send you down a path of unnecessary treatments that should be reserved as a last resort.

Once the true source of your problem is found, a plan that emphasizes active movement, education, and progressive activity is far more effective than passive treatments or rest alone. Passive treatments can help reduce symptoms quickly, but long-term success depends on learning how to care for your back with the right tools, the right guidance, and the right movements.

If your back pain isn’t going away – even after rest, PT, or chiropractic – it’s not a sign that you’re broken or destined for surgery. It could just mean the true cause of your pain hasn’t been found yet.

If you’re tired of chasing quick fixes and want real answers, we can help. Schedule a free Discovery Visit to uncover the root cause of your back pain and find out if we’re the right fit to help you get lasting relief.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Back MRI

Are your Back MRI results reliable? Research says otherwise.

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Whenever pain flares up – one of the most popular questions and concerns I get from clients is whether or not they need an MRI. 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.

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 don’t always 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 back problems – or joint problems in general – 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 your pain 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 and other age-related changes show up on an MRI.

What it’s important to understand is that disc degeneration, arthritis, and bulging discs are ALL a normal part of aging, but they often get blamed for problems they don’t actually cause. In other words, the source of your pain is often a movement dysfunction learned and repeated over time that is irritating you – not the age-related changes themselves. The best way to figure out if your problem is movement-related vs structure-related is… well… with a movement assessment… NOT an MRI.

So how does movement testing work and why is it more reliable than an MRI? 

This is a great question and not one that is easily explained… but I’m going to try!

When your back, neck or joint pain is mechanical in nature – one of the most important things to look at and pay attention to is how your pain behaves. Not necessarily where it’s located. With pain – the most important thing to determine is how it reacts against certain triggers and with different activities.

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 most reliable sign that your pain is “mechanical” in nature. It 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. Let’s say you “cut out” the structure – or inject it to make it numb – your movement problem hasn’t gone away and it’s only a matter of time before it starts aggravating something else.

Take home point…

MRI’s are a super powerful and amazing diagnostic tool – but their results when it comes to diagnosing neck, back, or joint pain MUST be taken with a grain of salt – and should absolutely be coupled with an expert mechanical joint evaluation before you decide on a treatment plan.

Because if you are dealing with chronic, long-standing aches and pains that have come and gone over the years – or have recently gotten worse – there is a 70-80% chance that it is a mechanical problem finally catching up to you and not a structural problem.

Figure out the root source of your neck, back, or joint pain by seeing a movement expert who specializes in mechanical pain FIRST. Because when you automatically assume that you need an MRI first, and you base your whole treatment plan off of those results – you can end up down a rabbit hole of unnecessary medical procedures or surgery that ultimately won’t give you the long-term relief you’re looking for.

Are you local to Portsmouth, NH?

Consider speaking to one of our specialists by clicking here.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Plantar Fasciitis

How to Survive Flip-Flop Season Without Wrecking Your Feet

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Flip-flop season is here – which means sunshine, beach days, and pool time. But it can also mean extra foot pain. And every summer around this time, we see an influx of people dealing with aching arches and stabbing heel pain – most commonly known as “plantar fasciitis”

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, enabling you to propel yourself during walking and running. When you land on your foot, your arch falls or flattens – this is called pronation. In response, your foot then stiffens or supinates, providing the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked, leading to what we call “plantar fasciitis”.

How Do Flip-Flops Contribute?

Footwear can either “protect” your arch or cause it to overwork. Technically, 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. However, due to prolonged sitting and limited barefoot walking, the bottoms of our feet are not as conditioned as they should be. This is the real problem – not so much what you put on your feet. If you’re used to wearing supportive and cushioned shoes and then suddenly switch to flatter, less supportive flip-flops, it can shock your foot. And if you’re already prone to plantar fasciitis, it will flare up easily and quickly.

What Can You Do?

The good news is you don’t have to give up your favorite summer footwear entirely – you just need to be smart about how you wear them and how you care for your feet. Here are five simple tips and strategies to help you get through flip-flop season without completely wrecking your feet.

1. Choose Supportive Styles

Not all flip-flops are created equal. Those flat, flimsy styles you can pick up at the drugstore for five bucks? Probably not doing your feet any favors. They offer little to no support, and if your foot mechanics aren’t perfect, you’re asking a lot of your plantar fascia every time you take a step. A better choice is a flip-flop that gives you a bit of arch support and structure. Look for ones with a cushioned sole, some contouring through the arch, and even a slight heel cup to help stabilize your foot and keep it from sliding around. The right pair makes a big difference – a key factor for enjoying flip-flops pain-free.

2. Save Them for Short Distances

Even the most supportive flip-flop has its limits. They’re not designed for long walks, hours of standing, or sightseeing on vacation. Think of them like you would a slipper – something you wear for convenience or comfort in short bursts, not as your all-day shoe. If you’re going out for a full day of walking, or standing at an outdoor event, it’s better to switch to something more structured that supports your foot and ankle. Use your flip-flops strategically – around the house, to and from the pool, or for short errands. Giving your feet the right support when it matters most can go a long way in keeping them pain-free.

3. Strengthen Your Feet (and Your Core)

One of the best ways to prevent plantar fasciitis – or keep it from coming back – is to strengthen the muscles that support your arch and stabilize your entire lower body. Most people don’t think about exercising their feet, but they absolutely should. Working on things like toe strength, arch activation, ankle mobility, and balance helps condition your feet so they can handle different surfaces and demands. But don’t stop at your feet – your core matters too. The way your pelvis and deep abdominal muscles function has a direct impact on how forces move through your body when you walk. A weak or poorly functioning core can lead to poor movement patterns that put extra stress on your feet. Strengthening both your feet and your core can transform the way you move – and reduce the load on your plantar fascia dramatically.

4. Stretch and Massage Regularly

One of the most underrated things you can do to prevent or treat plantar fasciitis is to stretch and massage your feet on a regular basis. Tight calves, stiff ankles, and tension through the soles of your feet can all contribute to pain and inflammation. A few minutes of daily stretching – focusing on your calves and toes – combined with massage using your hands, a lacrosse ball, or a mobility tool, can make a huge difference. This kind of soft tissue work helps relieve tension, improves circulation, and keeps your plantar fascia mobile and healthy. 

5. Don’t Ignore Persistent Pain – Treat It Early

If you’re already feeling pain in your heel or arch that just won’t go away, don’t wait around hoping it gets better on its own. Plantar fasciitis becomes harder to treat the longer it sticks around, and it can quickly go from annoying to chronic. When that happens, exercise and stretching might not be enough to get you out of pain – and that’s where regenerative therapy comes in. Shockwave therapy (EPAT) is a non-invasive treatment that uses high-energy sound waves to stimulate blood flow and break up tight, inflamed tissue. It helps jumpstart healing in a way that rest and stretching can’t. EMTT (Extracorporeal Magnetotransduction Therapy) takes this even further. It uses pulsed magnetic fields to penetrate deeper into tissues and promote healing at the cellular level. Together, shockwave and EMTT are incredibly effective at reducing pain, accelerating recovery, and allowing you to tolerate the exercises and movement you need to fully resolve your plantar fascitis.

Bottom Line

Flip-flops don’t have to be the enemy. But if you’re not taking care of your feet, wearing them can easily lead to pain and frustration. By choosing the right styles, wearing them in moderation, and taking the time to strengthen and care for your feet – you can enjoy them all summer long without paying the price. And if foot pain does creep in, don’t ignore it. Get the right help early. Treatments like shockwave and EMTT, combined with expert-guided movement and strengthening, could be exactly what you need to survive flip-flop season pain-free – and keep your feet happy long after summer ends.

5 Natural Ways to Keep Your Knees Healthy and Moving This Summer

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When you live in New England, summer is a short and precious season. And you don’t want something like nagging knee pain ruining it for you. Whether you’re walking the beach, gardening, playing a round of golf or pickle ball, or tackling your favorite hiking trail – knee pain can quickly turn your favorite summer activities into frustrating experiences. 

The good news?

There’s a lot you can do – starting right now – to protect and support your knees naturally. 

Here are five of my top tips for helping people keep their knees healthy and mobile – so you can enjoy your summer instead of worrying about knee pain:

  1. Strengthen Your Hips and Core

Your knees don’t operate in isolation. They rely on surrounding muscles – especially your hips and core – for proper support and alignment. When these areas are weak, your knees can become stiff and painful due to the extra strain they have to endure to compensate. Strengthening your hips and core improves not only how your knees feel and function, but how your entire body moves. And the better you move as a whole, the less likely you’ll be to place unwanted stress on your knees.

  1. Optimize Your Knee Mobility

One of the most important principles I share with patients is “mobility before stability.” If your joints are stiff, the muscles around them can’t function properly. When it comes to knees, that little bit of hyperextension or “give” at the end of your range isn’t just normal – it’s often a critical yet overlooked aspect of healthy knee function. I see this missed all the time in rehab protocols, especially after procedures like arthroscopy. It may seem minor at the time, but years later, that unaddressed stiffness can cause big problems. I also frequently see issues when one knee is significantly less mobile than the other – often due to a past injury – which can lead to imbalance and compensation elsewhere. When you optimize your knee mobility, your knees will move and feel better. So keep them moving – and stop “protecting” them so much. You may be doing more harm than good.

  1. Stop Sitting So Much

You hear this advice all the time when it comes to back health – but did you know that sitting too much isn’t great for your knees either? Prolonged sitting – whether at a desk, in the car, or lounging – can lead to stiffness and reduced circulation in your knees. It also tightens your hip flexors and hamstrings, which can place abnormal stress on your knee joints. Knees don’t like being in one position for too long. If you notice that your first few steps after sitting feel achy or painful, it’s a sign you need to move more. Make it a point to stand up, stretch, or take a short walk at least once every 30 minutes. These quick breaks go a long way in supporting knee health – and your spine will thank you, too.

  1. Choose Supportive Footwear

Footwear plays a significant role in how your knees feel. The shoes you wear impact how forces travel up through your legs – and summer favorites like flip-flops often provide little to no support. Poor footwear can alter your gait and posture, placing unnecessary strain on your knees. When choosing shoes, look for options that are comfortable and offer good arch support and cushioning – especially if you’ll be walking or standing for long periods. Also consider the width of your shoes, as feet tend to swell and widen in the heat during extended activity. Supportive sandals do exist – just be mindful of when and how long you wear less supportive styles.

  1. Work on Your Balance

Balance isn’t just important for fall prevention – it also plays a key role in how well your joints absorb and distribute force. Good balance ensures that your feet, ankles, and core work together to stabilize your movements. When that coordination is off, your knees often have to compensate, which can lead to pain and unwanted wear and tear over time. Simple balance exercises – or activities like yoga, which emphasize control and stability – can help retrain your neuromuscular system and reduce unnecessary strain on your knees. You’ll notice the benefits of improved balance in all areas of life, but especially during favorite summer activities like hiking, pickleball, beach walks, and paddleboarding.

If you’re dealing with persistent knee pain – even one or two of these strategies could make a noticeable difference.

And if your knee pain is keeping you from being active or doing your favorite summer activities, it might be time to seek expert help. A physical therapist who specializes in mechanical pain can assess your movement and identify the root cause – so you can get back to doing what you love – and without having to rely on pills or surgery.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Why Your Ab Exercises Aren’t Fixing Your Back Pain

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Why Your Ab Exercises Aren’t Fixing Your Back Pain

If you’ve been dealing with back pain for a while, chances are good that someone – whether a well-meaning friend, fitness influencer, or even your doctor – has told you to strengthen your core. It’s one of the most common recommendations I hear from people who come into my clinic. And while core strengthening can be helpful, it’s not the magic fix everyone hopes it will be.

Believe me, I wish it were that simple. But the truth is this: core strengthening alone rarely solves back pain – and in some cases, it can even make it worse.

Let’s unpack why.

Most persistent back pain is what we call “mechanical” in nature. That means the root of the problem is related to the way your spine moves (or doesn’t move) – not how strong it is. Mechanical back pain is typically the result of years of repetitive stress or poor movement habits. These issues can’t be fixed with planks, crunches, or “functional mobility strengthening.” Strengthening your core might make you feel a little better temporarily – but it won’t solve the deeper dysfunction.

Mechanical back pain tends to sneak up over time. It’s not the result of one big injury, but rather the accumulation of little things. Sitting all day at your desk. Constantly lifting and carrying your toddler. Spending weekends bent over in your garden or rotating through your golf swing. Eventually, these patterns start to cause subtle movement problems in your spine – and when left unresolved – those problems lead to pain.

Now here’s where things get even trickier.

When you go to your doctor – or get an MRI – you’re often told your back pain is from something structural: a disc issue, arthritis, or stenosis. But these findings are incredibly common, especially after age 50, and don’t always correlate with your actual pain. Plenty of people have these “abnormalities” and feel just fine. What’s more likely is that your mechanical problem is irritating these structures – not the other way around.

So if you’ve been religiously doing your core workouts but not seeing progress – this might be why. You’re treating the symptoms, not the cause. You have to relieve the mechanical irritation happening around these structures in order to get full pain relief. And core strengthening – not even surgery – will cut it.

To truly get rid of mechanical back pain, you need to address the underlying movement dysfunction. This requires a very specific and individualized approach – something you won’t find on YouTube, in a gym, and definitely not in a doctor’s office. Once that’s resolved, core strengthening does become incredibly valuable. In fact, it’s a key part of staying pain-free and preventing future flare-ups after your back pain is gone.

But timing matters – and I get it – most back pain sufferers have little patience when they’ve been in chronic pain. By the way – I don’t blame you. But if you jump into a core strengthening program too soon – or focus on the wrong exercises – you’re more likely to aggravate your symptoms rather than help them – and prolong your chronic pain.

Here’s the bottom line:

If you’ve been working on your core and not seeing results, don’t assume you’re doing it wrong or that you’re destined for a surgery or procedure. You might simply be skipping a crucial step – mobility before stability. Get your mechanical back pain properly diagnosed and addressed first. Once your mobility is restored and the foundation is solid – then your core strengthening efforts will stick. And your back will thank you.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.