When exercise hurts your back instead of helps

Six Ways to Help Manage Knee Arthritis and Stay Active

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Knee Arthritis Treatment in Portsmouth, NH: 6 Ways to Stay Active Without Injections or Surgery

Knee arthritis is one of the most common forms of osteoarthritis, affecting more than 80% of osteoarthritis cases and nearly 19% of Americans over age 45. Here in Portsmouth, NH and across the Seacoast region, we see it every day – active adults who want to keep walking, hiking, golfing, skiing, and staying independent without being limited by chronic knee pain.

For many people, a diagnosis of knee osteoarthritis leads to chronic, debilitating knee pain that stops them from doing their favorite activities. Sometimes it is due to the limiting belief that once you have arthritis, you have “bad knees” for life. Other times it is because you have been told you have “bone-on-bone” in your knee and should scale back activity so you do not make it worse.

This line of thinking is flawed and often leads to unnecessary injections, procedures, and surgery. Being active is one of the best things you can do to manage knee arthritis and protect your joints long term.

But what if movement and activity hurt?

Here are six expert-backed strategies we use at our Portsmouth, NH physical therapy clinic to help people manage knee osteoarthritis naturally and stay active without relying on injections or surgery.

1. Strengthen Your Hips and Core

If your hips and core are weak, your knees take the hit.

Your thigh bone (femur) connects your knee to your pelvis. Your core strength controls your pelvis. If your pelvis is not stable, your femur struggles to stay in proper alignment, which increases stress through your knee joint.

At our Portsmouth physical therapy clinic, we prioritize hip and core strengthening for patients with knee arthritis because improving these areas often significantly reduces knee pain. If you have arthritis in your knees, minimizing unnecessary joint stress is critical. Strong hips and a stable core help prevent flare-ups and keep you active longer.

2. Keep Your Knees Mobile

Mobility before stability is a principle we emphasize with every joint, but especially the knee.

Your knee needs to bend fully so you can squat and pick things up, and it needs to straighten fully to provide stability when walking. When either of these motions is limited, surrounding muscles and ligaments absorb more stress, which can aggravate arthritis symptoms.

Many people in the Seacoast area are told that stiffness is simply part of arthritis and something they must accept. But even a 10 percent improvement in knee mobility can create meaningful functional gains, reduce daily discomfort, and help you avoid more invasive treatments.

Limited motion is often treatable – even with arthritis.

3. Do Not Stop Your Activities

When people hear they have arthritis, especially if they have been told it is “bone-on-bone,” they often think slowing down will protect their knees. In reality, inactivity can make symptoms worse.

Research consistently shows that severe joint pain among adults with arthritis is worse with inactivity. Movement improves blood flow, maintains joint nutrition, and preserves muscle strength.

Interestingly, only about 15 percent of patients with evidence of knee osteoarthritis on X-ray report symptoms. That means many people are walking, biking, hiking around Portsmouth, and enjoying their favorite activities despite what imaging shows.

The key is smart activity, not no activity. Continuing to move is one of the most powerful ways to prevent arthritis from progressing and to maintain independence as you age. If pain is limiting you, working with a knee pain specialist in Portsmouth, NH can help you modify activities safely and effectively.

4. Optimize Your Footwear and Walking Mechanics

Your feet have a direct impact on your knees. If you wear unsupportive shoes or walk with poor mechanics, your knees absorb more stress than they should.

Over time, this increased strain can worsen arthritis symptoms. Supportive footwear that promotes proper alignment and cushioning can reduce unnecessary joint loading.

Walking is one of the best low-impact activities for knee arthritis. If you experience knee pain while walking around Portsmouth or on local trails, a professional gait assessment can identify weaknesses or imbalances contributing to your discomfort and help you choose footwear that supports your specific needs.

5. Choose Natural, Joint-Friendly Pain Relief Options

Your knees work hard every day. If you have arthritis, finding relief without relying on medications, injections, or surgery can be life changing.

Natural pain relief strategies can help reduce inflammation and improve mobility. Heat therapy and targeted stretching reduce stiffness by increasing circulation and relaxing surrounding muscles. Massage and foam rolling improve blood flow and ease muscle tension around the knee.

Regenerative treatments such as shockwave therapy, EMTT, and dry needling are becoming popular alternatives to cortisone injections. These approaches stimulate your body’s natural healing response rather than masking pain or contributing to long-term joint breakdown.

When used appropriately, these strategies can help you manage knee arthritis while staying active and avoiding unnecessary procedures.

6. Manage Inflammation with Diet and Hydration

Chronic inflammation can worsen arthritis symptoms, but nutrition plays a significant role in joint health.

Anti-inflammatory foods such as fatty fish, leafy greens, berries, and turmeric support joint function. Omega-3 fatty acids from fish oil may reduce inflammation at a cellular level. Supplements like collagen and glucosamine-chondroitin may support cartilage health and joint lubrication for some individuals.

Hydration is equally important. Water helps maintain joint cushioning and reduces friction within the joint.

Simple dietary changes combined with appropriate supplementation can complement your physical therapy program and support long-term knee health.

Final Thoughts on Knee Arthritis Treatment in Portsmouth, NH

Even if you have been told you have “bone-on-bone” or advanced arthritis, you can still improve your knee health.

The best thing you can do for your knees is to keep moving. The right strength program, improved mobility, supportive footwear, smart activity modification, and natural pain relief strategies can make a significant difference.

If you live in Portsmouth, NH or the surrounding Seacoast area and knee arthritis is limiting your ability to stay active, consider speaking with a physical therapy specialist who understands how to treat arthritis without defaulting to injections 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 you are local to Portsmouth, NH and looking for help with knee arthritis treatment, request a FREE Discovery Visit with one of her specialists to learn how to stay active and protect your knees naturally.

Why Your Knee Pain Isn’t Going Away – And What You Might Be Missing

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Knee Pain in Portsmouth, NH? 4 Hidden Causes Most People Overlook

Knee pain can be stubborn – especially if you’ve already tried stretching, strengthening, injections, or even surgery with little to no relief.

If you live in Portsmouth, NH or the Seacoast area, and you’ve been told your pain is simply “wear and tear,” arthritis, or aging – you’re not alone.

But here’s something most people aren’t told…

There are plenty of people with arthritis and age-related changes who have no knee pain at all.

So what’s really going on?

At our Portsmouth physical therapy clinic, we often find that knee pain isn’t always a knee problem. If your pain keeps coming back despite following conventional advice, one of these four lesser-known causes may be the real reason your knee pain won’t go away.

1. Your Knee Pain Might Actually Be Coming From Your Lower Back

Many Portsmouth residents are surprised to learn that nearly 40% of extremity pain originates from the spine – even when there’s no back pain present.

The nerves that control your knee function begin in your lower back. If those nerves are irritated or compressed, you may feel pain in your knee instead.

Signs your knee pain could be coming from your back:

  • Pain that moves up or down your leg
  • Discomfort that worsens with prolonged sitting
  • Knee treatments that don’t seem to work

This is why working with a mechanical back pain specialist in Portsmouth, NH can make all the difference. Treating the source — not just the symptoms – is key.

2. Weak Core and Hips Can Lead to Chronic Knee Pain

When most people think about core strength, they think about abs – not knees. But your core, hips, and glutes stabilize your entire lower body.

If these muscles are weak, your knees absorb extra stress. Over time, this can lead to:

  • Knee pain when walking or running
  • Instability on one leg
  • Pain after prolonged activity
  • Recurring knee flare-ups

At our Portsmouth physical therapy clinic, we frequently see knee pain resolve once proper hip and core stability is restored.

3. Limited Ankle Mobility Could Be Causing Your Knee Pain

Your ankles are the foundation of your lower body. If they lack mobility or stability, your knees compensate.

This is especially common in active adults in the Seacoast area who enjoy:

  • Running
  • Hiking
  • Golf
  • Tennis
  • Gym workouts

If your ankles are stiff or unstable, your knees take the hit. Improving ankle mobility can dramatically reduce stress on the knee joint.

4. Your Knee May Not Be Moving the Way It Should

One of the most overlooked causes of knee pain is mobility restriction – especially loss of slight hyperextension.

Most rehab programs focus on bending the knee. But proper knee mechanics require full extension – and often slight hyperextension. If your knee stops at “just straight,” it may still be restricted.

This is extremely common after knee surgery in Portsmouth-area patients, where full mobility isn’t always restored.

If one knee doesn’t move like the other, it may be time to work with a mechanical knee pain specialist who can restore proper joint motion.

Why Your Knee Pain Isn’t Going Away

If you’ve been dealing with persistent knee pain in Portsmouth, NH, there’s a strong possibility that:

  • You were given the wrong diagnosis
  • You’ve been treating the wrong area
  • Or your rehab plan didn’t address the root cause

The true problem may be coming from your back, hips, ankles, or movement restrictions that are placing secondary stress on your knee.

A mechanical pain specialist trained to assess the entire body can identify the real source and create a personalized plan to finally resolve your knee pain – without unnecessary injections or procedures.

Looking for Knee Pain Treatment in Portsmouth, NH?

If you’re local to Portsmouth or the Seacoast area and want answers, consider speaking with one of the specialists at CJ Physical Therapy & Pilates.

Led by Dr. Carrie Jose, our team specializes in mechanical knee pain treatment and helping active adults get back to walking, exercising, and living fully – without relying on injections or surgery.

Request a FREE Discovery Visit with one of our specialists to determine the true cause of your knee pain.

If you’re searching for:

  • Knee pain specialist in Portsmouth, NH
  • Physical therapy for knee pain near me
  • Natural knee pain treatment in Seacoast NH
  • Help for chronic knee pain after surgery

 

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Cortisone Shots for Knee Pain? Why You Should Think Twice.

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Knee pain can be incredibly disruptive – turning simple, everyday activities like walking, climbing stairs, or even standing up from a chair into painful challenges. In search of quick relief, many people turn to cortisone shots. By targeting inflammation in the knee joint, cortisone injections can temporarily ease pain and swelling, making them an appealing option when you’re hurting.

But cortisone shots are just that – a temporary fix. And they come with significant risks and downsides that are often overlooked. Let’s take a closer look at why relying on cortisone injections may not be the best long-term solution for your knee pain – and what you can do instead to find natural, healthier, and lasting relief.

The Problems with Cortisone Shots:

1. Temporary Relief Without Addressing the Root Cause

Cortisone injections can offer pain relief that lasts for weeks or even months – but they don’t address the underlying issue of your knee pain. Instead, they mask your symptoms, allowing conditions like osteoarthritis, tendonitis, or mechanical imbalances to quietly worsen over time. By simply numbing your knee pain, cortisone shots act as a band-aid – covering up the real problem while harmful movement patterns and joint stress continue unchecked. This can eventually lead to more serious, long-term damage without you even realizing it.

2. Risk of Joint Damage

Since cortisone injections only offer short-term relief, many people end up getting them repeatedly. But over time, frequent cortisone shots can actually do more harm than good – leading to cartilage breakdown and weakening the tendons and ligaments around your knee. Research shows that repeated cortisone injections can accelerate joint deterioration, increasing your risk of needing knee replacement surgery down the line. This is especially concerning for active individuals who want to stay mobile, avoid major surgery, and protect their joint health for the long run. Many people aren’t aware of this – so it’s important to know the risks.

3. Disrupts Natural Healing

Inflammation, while painful and uncomfortable, is a vital part of your body’s natural healing process. It increases blood flow, delivers nutrients, and recruits immune cells to repair damaged tissue. Cortisone injections suppress this natural inflammatory response – easing pain and swelling temporarily, but at a cost. By interfering with inflammation, cortisone limits the delivery of key nutrients and healing cells needed to repair cartilage, tendons, or ligaments. Over time, this leaves your knee joint and surrounding tissues weakened, making full recovery harder to achieve. When knee inflammation does get out of control, it’s far better to choose natural healing accelerants that support your body’s repair process – rather than disrupt it.

4. Potential Side Effects and Complications

As with any injection or invasive procedure, cortisone shots come with potential risks, including infection. Other side effects can include increased blood sugar levels, skin thinning, and changes in pigmentation around the injection site. While these risks may seem minor, they deserve serious consideration – especially when the relief they offer is only temporary. Over time, repeated cortisone use increases the likelihood of experiencing these complications. It’s important to ask yourself if short-term relief is worth the growing list of potential long-term consequences.

What to Try Instead of Cortisone Injections:

When it comes to knee pain, I always advocate for natural and effective alternatives that not only alleviate discomfort but also promote true healing. Here are three proven methods that address the root cause of knee pain rather than just suppressing symptoms:

1. Regenerative Shockwave Therapy

Shockwave therapy is a non-invasive treatment that uses acoustic sound waves to stimulate the body’s natural healing processes. By creating micro-traumas in the affected tissues, shockwave therapy boosts blood flow and encourages tissue regeneration. This treatment has been shown to improve mobility, reduce pain, and help with conditions like calcific tendonitis and osteoarthritis. Unlike cortisone injections, which only mask symptoms and can contribute to tissue breakdown, shockwave therapy actively supports healing and long-term relief. When combined with EMTT (Electromagnetic Transduction Therapy), the effectiveness of shockwave therapy is further enhanced – EMTT penetrates deeper into tissues, increases cellular activity, and accelerates the healing process, giving you even faster and more lasting results.

2. Dry Needling for Muscle Imbalances

Dry needling is a highly effective technique for targeting muscle tightness and trigger points around your knee joint. By inserting thin needles into specific areas, this therapy helps release muscle tension, improve circulation, and restore proper function. Dry needling is particularly beneficial for individuals suffering from tendonitis, chronic stiffness, or muscular imbalances that contribute to knee pain. It encourages natural healing by allowing muscles to function more efficiently, reducing strain on your knee joint.

3. Working with a Mechanical Knee Pain Specialist

A mechanical knee pain specialist is trained to analyze movement patterns and pinpoint the underlying causes of your knee discomfort. Unlike general healthcare providers who may prescribe pain medications or generic exercises, these specialists take a customized approach – identifying joint misalignments, muscle imbalances, and faulty movement patterns to develop a personalized rehabilitation plan. They assess how the entire body contributes to knee mechanics, ensuring all contributing factors are addressed. This comprehensive, root-cause approach not only restores knee function and prevents future pain but also leads to more effective, lasting results compared to the temporary relief offered by cortisone shots.

A Smarter Path to Knee Pain Relief:

While cortisone shots may seem like a convenient and quick option, they do little to promote true healing of your knee pain and can actually cause long-term harm. Natural treatments – such as regenerative shockwave therapy, dry needling, and working with a mechanical knee pain specialist – offer a more effective and safer path to knee pain relief. Instead of masking pain, these alternative treatments address the root cause, restore function, and help prevent future injury – giving you real, lasting relief.

Knee Pain

Top Causes of Knee Pain and How to Get Lasting, Natural Relief

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Knee pain affects millions of people worldwide, often interfering with daily activities such as walking, squatting, climbing stairs, and even getting in and out of the car.

It is one of the most common musculoskeletal complaints, second only to back pain. Whether your knee pain started suddenly or has worsened over time – you might be wondering – what’s really causing it? And can you get rid of it naturally?

The good news is that, in most cases, yes. Many common causes of knee pain can be addressed without medications, injections, or surgery. Here are some of the top reasons behind knee pain and what you can do to find lasting, natural relief that doesn’t involve medication, injections, procedures, or surgery:

1. Patellofemoral Pain Syndrome (Runner’s Knee)

Also known as “runner’s knee,” patellofemoral pain syndrome (PFS) is characterized by pain in the front of the knee, usually just below or behind the kneecap. This condition is often caused by improper movement patterns and muscle imbalances that place excessive pressure on your kneecap, leading to inflammation and discomfort.

To alleviate PFS, it’s important to avoid excessive kneeling, squatting, or repetitive knee bending until the pain subsides. For long-term relief, focus on strengthening the muscles surrounding your knee, particularly the hips and thighs, to improve stability and reduce stress on your kneecap. Corrective exercises that promote proper kneecap tracking, such as step-ups and lateral band walks, can help to further optimize knee function and prevent future flare-ups.

2. Iliotibial Band Syndrome (ITBS)

ITBS causes pain on the outer side of the knee and is commonly seen in runners and cyclists. The iliotibial (IT) band is a thick band of connective tissue running from the hip to the knee, and when it becomes tight or inflamed, it can lead to irritation and pain.

While many people resort to foam rolling for relief, this only provides temporary symptom management. To address ITBS at its root, focus on strengthening the glutes and core, as weak glutes often lead to overcompensation and excessive strain on the IT band. Correcting pelvic imbalances and optimizing hip mobility will also be key for long-term relief. Additionally, taking a temporary break from any aggravating activities will allow the inflammation to subside and the tissues to heal properly, provided you’re taking an active approach to tissue healing versus rest only.

3. Tendinitis (Jumper’s Knee)

Tendinitis occurs when the patellar tendon, which connects the kneecap to the shinbone, becomes inflamed. This condition is common in athletes and individuals who engage in frequent jumping or repetitive knee movements.

A common treatment for tendinitis is cortisone injections, but these only provide temporary relief and may contribute to further tissue damage over time. Instead, consider regenerative treatments like Shockwave Therapy, which naturally enhances your body’s ability to reduce inflammation and accelerate tendon healing. Once inflammation is managed, strengthening the hamstrings, glutes, and calf muscles will provide better knee support and reduce tendon strain. Incorporating eccentric exercises, such as slow step-downs, can also help build tendon resilience and prevent future injuries.

4. Osteoarthritis

Osteoarthritis (OA) is the gradual degeneration of cartilage in the knee joint. While it is a natural part of aging, experiencing constant pain and limited mobility does not have to be. Many people believe that knee arthritis inevitably leads to surgery, but the truth is that optimizing movement and reducing inflammation can be powerful tools in managing OA long-term, even with “bone on bone” OA.

Rather than relying on cortisone injections and pain medication, consider alternative treatments such as Regenerative Therapy (specifically EMTT) to target inflammation deep at the cellular level. From there, implementing corrective exercises that strengthen the muscles surrounding the knee – particularly your quadriceps, hamstrings, and glutes – can reduce joint stress and help prevent inflammation from returning. Since inflammation is the primary driver of pain in OA, addressing it naturally through movement and strength training can help you avoid major surgery while still finding lasting relief.

5. Meniscus Tears

The meniscus is a piece of cartilage that cushions the knee joint. Over time, wear and tear can lead to meniscus tears – which cause pain, stiffness, and occasional knee locking. Many people assume that surgery is the only solution, but research has shown that placebo surgery can be just as effective as actual meniscus surgery, suggesting that natural recovery is possible.

Managing a meniscus tear naturally involves first addressing the inflammation caused by the tear. As previously mentioned, EMTT and Shockwave Therapy (especially when combined) can be particularly effective in reducing pain and inflammation, often providing immediate relief. Beyond that, focusing on proper knee mechanics is essential. In many cases, the issue isn’t the tear itself, but rather a lack of mobility and movement in the knee joint that continues to aggravate it. A mechanical knee pain specialist can help identify and correct these dysfunctions. Once inflammation is controlled and knee mechanics are optimized, strengthening and conditioning the surrounding muscles can provide long-term relief without the need for injections or surgery.

Finding Long-Term Relief Naturally

For most cases of knee pain, the key to lasting relief is movement – not rest, avoidance, injections, or surgery. Whether your pain is caused by an overuse injury, muscle imbalance, or arthritis – addressing the root cause with targeted exercises and mobility work is essential. Reducing inflammation naturally is also crucial for long-term joint health. If you’re struggling to determine the root cause of your knee pain or finding the right treatment approach – consider working with a mechanical knee pain specialist who can guide you toward the best non-invasive, long-term solutions.

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 Surgery should be your Last Resort for Knee Pain

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Arthroscopic knee surgery is one of the most common surgeries performed – despite research telling us that it’s not nearly as effective as most people are led to believe. Furthermore, the science tells us that people who do undergo arthroscopic knee surgery are more likely to have knee arthritis that advances rapidly – resulting in a total knee replacement that quite possibly 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?

Well… it is until it isn’t. 

The big problem is that arthroscopic knee surgery is actually not necessary for most cases of knee pain. If there is a complication – which exists even with “minimally invasive” procedures – you could end up being worse off than when you went in. Plus – if you never even needed the surgery to begin with – you just put your knee through unnecessary trauma that you’ve got to now heal from. This further delays you from addressing the root cause of your knee pain.

The truth is that most people can get full relief of their knee pain as well as full restoration of knee function without any type of surgery or procedure. This is true for 70-80% of all knee pain cases.

An early research study 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 proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery at a higher rate than ever?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain beforehand. If you’ve gotten physical therapy and it wasn’t effective, people are led to believe that the physical therapy “didn’t work”. But more often than not, you just haven’t found the right physical therapist yet – or seen a physical therapy specialist who is an expert in mechanical knee pain. 

And then there’s the elephant in the room…

It’s very common for knee pain to be coming from somewhere other than your knee.

Knee pain can come from your ankle, hip, or back. One study showed that 25% of the time – knee pain is caused by a source in your spine – even when you don’t have any back pain. MRI’s add even more confusion to this. It’s entirely possible to have degenerative changes, a torn meniscus, or advanced arthritis in your knee – and still have your knee pain stemming from a source other than your knee. For example, in a study by Guermazi et al from 2012, they performed MRI’s on 504 people with pain-free knees. They found that 72% of these folks had bone osteophytes – indicating arthritis. And 25% of them had meniscus tears. So it’s important to not jump into knee surgery simply based on MRI findings.

My career has spanned over 2 decades, and I’ve seen many knee surgeries go wrong. Most of the time, it has nothing to do with the procedure itself, but everything to do with an incorrect diagnosis going in. If your knee pain can be resolved conservatively – and you put it through unnecessary trauma (surgery) – there’s a good chance you’re going to have more problems afterwards. If you get knee surgery when your knee problem isn’t even coming from your knee – then you’re definitely going to have problems afterwards.

The moral of this story is to make absolutely certain that 1) your knee problem is really a knee problem and 2) you’ve fully exhausted all conservative therapy options (including specialized physical therapy) before going under the knife.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Knee Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or request a copy of her Free Guide: 7 Easy Ways to Get Rid of Knee Pain – click here.

Knee Pain

How Mobility and Strength Are Key to Resolving a Meniscus Tear Naturally

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A meniscus tear is one of the most common knee injuries, and it’s known for causing significant pain, swelling, and restriction of movement that can seriously disrupt an active lifestyle.

While surgery may seem like the only solution – and perhaps that’s what you’ve been told – many people (80% in fact) can successfully avoid invasive procedures like cortisone and surgery if they want to. 

The key?

Focusing on specialized mobility and strength training of your knee. But first – what exactly is a meniscus tear and how does it cause problems for your knee?

The meniscus is a cartilaginous structure in your knee joint that acts as a shock absorber. It sits between your thigh bone (femur) and shin bone (tibia) and you have two of them: one on the inside of your knee joint (medial) and one on the outside (lateral). Together, they help distribute weight and cushion your knee during activities like walking, running, and jumping.

So how do meniscus tears happen?

You can get a meniscus tear suddenly from twisting or pivoting motions, or it can develop gradually over time due to age or wear and tear.

But here’s the thing… Sometimes – especially when your meniscus tear develops slowly – it can be damaged without feeling any knee pain or symptoms. For example, a study published in the New England Journal of Medicine found that 35% of people over the age of 50 had meniscus tears on their MRI, but no knee pain or other symptoms. In another study, published in the Journal of the American Medical Association – it was reported that 60% of men and women over the age of 65 who had a meniscus tear on their MRI also had no symptoms in their knees. What is the significance of this? It means that it’s entirely possible to “live” with a meniscus tear and not have any knee pain – which means it’s also entirely possible to avoid surgery and cortisone shots.

So why do some meniscus tears cause pain when others don’t? 

When you have a meniscus tear – it has the potential to disrupt your knee’s natural mechanics – but not all tears do.

When the mechanics of your knee are compromised, that’s when you experience symptoms. Why? Because faulty knee mechanics (over time) will cause compensatory strategies to happen in the joint itself – as well as the surrounding muscles and structures.

This is what actually causes pain – not necessarily the tear itself.

Simply going in and “cutting out” the meniscus tear will not solve the problem of faulty knee joint mechanics. It’s why so many people end up with no relief at all after surgery – or just temporary relief of pain that returns anywhere from months to years later. In 80% of knee pain cases that involve a meniscus tear – the faulty knee mechanics are what truly cause the problems and pain – not the tear itself. That’s why focusing on the joint mechanics and mobility first is more important – because if you can restore that – the tear often becomes a non-issue – just like all the people in those research studies.

Now – when I talk about knee mechanics – I’m referring to both knee mobility and strength – and how they work harmoniously together. 

Mobility refers to the ability of your knee joint to move smoothly and freely through its full range of motion. Strength refers to the stability around your knee joint – which comes from muscles and tendons. When a meniscus tear causes your knee joint mobility to be blocked and disrupted – meaning it’s unable to bend and extend properly – it puts stress on the surrounding structures and muscles – causing a cascade of events that eventually lead to pain and swelling.

To achieve natural knee pain relief after a meniscus tear – restoring mobility is the first critical first step – followed by strengthening. But a lot of people get this wrong. That’s why it’s important you work with a mechanical knee pain specialist who understands the intricate nature of a meniscus tear and how it impacts your knee mechanics. You can’t just do random strength and mobility exercises. They need to be prescribed to you in a specific and strategic manner so that you can “free” the tear and restore your knee mechanics. In other words, YouTube and Google won’t be able to help you.

If you’re confused – I don’t blame you – but the research doesn’t lie.

For most people, especially those over the age of 40, there’s a 70-80% chance you can get full relief of your knee pain after a meniscus tear, without any type of surgery or procedure. This is not a popular opinion by the way. Arthroscopic meniscus surgery is one of the most common (and profitable) surgeries out there. If a meniscus tear appears on your MRI – a common recommendation will be surgery. But if that’s not what you want – I’m here to tell you it’s entirely possible to resolve pain and dysfunction from your meniscus tear naturally. But you’ll want to work with a mechanical knee pain specialist to do that. Reach out if you need help finding one in your area.

Are you local to Portsmouth, NH? If so, consider speaking to one of my specialists in a Free Discovery Session. This 30-min session is a designed to: 1. Make sure we can help you 2. Make sure you’re a good fit for what we do. 3. Make sure we’re a good fit for you. Click here to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or sign up for her upcoming Masterclass for Knee Pain Sufferers – CLICK HERE or call 603-380-7902

Pain when gardening

Six Ways to Protect your Knees and Back when Gardening

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Gardening is a favorite activity for a lot of folks – and lately I have been hearing many people having knee and back pain when gardening. To add more frustration to this topic, you might not even notice the pain until hours or days afterwards, which can make it challenging to address.

The good news is that there are several things you can do to protect your knees and back while gardening.

Here are 6 of my favorite tips to manage pain when gardening:

1. Warm up first

Before diving into any activity that you know you’ll be doing repetitively and for more than a few hours, it’s a good idea to warm-up. It doesn’t have to be anything crazy or excessive and 10 min is plenty.

Typically, you’ll only be gardening during nice weather. So enjoy it by taking a walk around your neighborhood first. Then do some easy light stretching to lubricate your joints before you begin. It won’t take long but your knees and back will thank you.

2. Avoid bending from the waist

Lifting and carrying heavy bags of soil or plants can put a lot of strain on your back and knees. You really want to make sure you’re using proper posture and body mechanics to avoid problems.

When lifting, be sure to use your legs instead of your back and hold objects close to your body. If you hinge only from your hips, for example, which a lot of people like to do, you will put extra strain on the back of your knees and lower back. Get in the habit of bending your ankles, knees, and hips in unison – kind of like an accordion – so that you build good muscle and body memory and don’t even have to think about it next time you’re gardening or lifting.

3. Take frequent breaks

It’s easy to get lost in the activity of planting and weeding. But even if you’re choosing good postures like I mentioned above – your back and knees still need a break. Our joints don’t enjoy anything when done repetitively or for prolonged periods, but especially too much bending or sitting on your knees. When you bend too much and too often, the discs in your lower back can get aggravated, and when you’re sitting on your knees, it’s a lot of pressure and can annoy your arthritis.

I recommend setting a timer and giving yourself a break every 30 min to change positions. Simply stand up and get out of the bent or sitting posture. Your back and knees will thank you and you’ll be able to garden for much longer and without risk of injury.

4. Pivot instead of twist

Your lower back and knees aren’t really designed to rotate, they are designed for bending and extending. So if you’re not careful – you can strain these areas with poor twisting and turning mechanics. When you have to rotate, you’ll want to pivot from your pelvis.

What does this look like?

Make sure your hips are always in line with the object you are moving and maneuvering. Keep your ribs in line with your pelvis and your pelvis in line with your knees and feet – and always move them as a unit. While it’s ok to bend and twist from your waist or legs on occasion – you’ll find yourself in some trouble when you do this over and over again – especially if you’re already prone to back or knee pain.

5. Use ergonomic gardening tools

The right gardening tools can be of significant help when it comes to maintaining good posture and avoiding overuse of your muscles and joints. Long-handled tools can help reduce the need for bending and stooping, which as already discussed, puts strain on your knees and back when overdone. Another consideration is the weight of your tools. It might be worth the investment to swap out your older, heavier tools for more modern, lightweight alternatives.

When you have to lift something heavy – especially repeatedly – use a wheelbarrow. This valuable gardening tool will allow you to lift and move heavy things with significantly less strain on your back. If you’ve got to be on your knees or squatting a lot – consider using a gardening bench and/or knee pads. These tools will make it easier to sustain activities that require prolonged bending or kneeling.

6. Use beds to raise your gardens

Raised garden beds not only look pretty but they are extremely ergonomic. Especially if you suffer from more chronic back and knee problems. Raised garden beds are elevated off the ground. They are easier to maintain and limit the amount of bending you have to do.

Raised garden beds are relatively simple to build and create. Even if you’re not having problems now with gardening, if it’s an activity you love to do, you might want to consider it. Making the investment in raised gardening beds now could go a long way in preventing knee and back problems in your future.

Gardening has so many positive benefits for both your mental and physical health – and the last thing I want is for back or knee pain to get in your way.

If you are experiencing pain when gardening – Give these tips a try.

But if it’s not enough, don’t give up.

Enlist the help of a musculoskeletal pain and movement expert who can help you figure out the source of your problem and provide you with practical solutions so that you can get back to gardening as quickly as possible.

If you are local to Portsmouth, NH – consider speaking to one of my specialists.

It’s a free, no-obligation call where you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you.

Click here to speak with a specialist.

knee pain source

When Knee Pain Doesn’t Go Away – Consider your lower back.

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One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the knee pain source.

Is your knee pain actually due to a problem in your knee? Or is the root cause of your knee pain coming from somewhere else in your body?

Rosedale, et al published a study in 2020 that revealed 43% of all isolated extremity pain was coming from the spine. What that means is that you could have nagging knee pain, and no back pain at all, and your knee pain is the result of a lower back problem. I’m not going to get into the technicalities of how this happens. Generally speaking, it’s a mechanical problem in your lower back that causes irritation to nerves or structures that impact your knee – and only your knee.

But how do you know for sure?

One of the biggest clues you’ve missed the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, and stretching. Even physical therapy – but no matter what – your knee pain just won’t go away. It might get better for a short period, but it always comes back. If the lower back is not considered at this point, then it’s typically when knee doctors get involved. This is great if you’ve actually got a knee problem.

Knee pain that doesn’t respond to conservative treatment should be looked at further. But if your knee pain is a symptom of a problem in your lower back, and it’s missed, you risk having an unnecessary knee procedure or surgery that will only cause you more problems later.

Here’s a quick story about someone this happened to…

I spoke to a client the other day – we’ll call him “David”. He had surgery on his knee to clean out some cartilage and wear and tear from arthritis. They recommended this surgery because he had “failed” regular physical therapy treatment. Nothing else seemed to be resolving his knee pain. It was supposed to be a “quick recovery” and take his pain away because they assumed all his problems were due to arthritis. Well, three months later, Davids knee felt (and functioned) worse than pre-surgery. Now he had back pain to go along with it. To fix the new pain he was having they were recommending even more knee surgery. And now they wanted to do an MRI of his back.

How does something like this happen?

The biggest culprit is over-reliance on imaging to form a diagnosis and treatment plan. Leading you to have the wrong idea of your knee pain source.

If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60 to 80% chance they’ll find arthritis and/or meniscus (cartilage) tears. And this will be whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee. They might just blame your knee pain on it without looking at anything else. That’s exactly what happened to David. They blamed knee arthritis for his knee problem when it was actually coming from his lower back.

How do I know?

Luckily for David, he refused the second knee surgery. He went to a mechanical pain expert for diagnosis and treatment, and in 2 months both his knee and back pain were gone.

Do you have knee pain that won’t resolve with typical knee pain treatment? You must consider that it could be coming from your lower back before you undergo any kind of surgery or procedure.

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your leg – there is a good chance your knee pain is a symptom of a mechanical problem in your lower back and you should get it looked at.

skiing

Four tips to Protect your Knees and Avoid Injury when Skiing

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Skiing can put a lot of stress on your knee joints and if you’re not careful – lead to pain and injury.

Your knee joint requires both mobility and stability to function well. It’s important for your knee joint to be mobile enough to allow for a full range of motion. But, it also needs to be stable enough to support your body weight and absorb the forces that come with everyday activities. When it comes to skiing, mobility is going to protect your knees when you fall, and stability is going to keep your knees feeling strong as you twist and turn down the slopes. Maintaining a balance between mobility and stability is crucial for knee joint health in general. It certainly is crucial when it comes to skiing.

Here are four tips to help protect your knees and avoid injury when skiing:

1. Warm up before hitting the slopes.

When you take the time to stretch and warm-up your muscles before skiing your knee is not only going to feel better, but be better equipped to handle the stress of the day. Warming up helps to increase blood flow to your muscles and improve your strength, endurance and agility on the slopes.

When warming up, choose exercises that take your knee, hips and ankles through full range of motion. Plus – if skiing is a day trip for you, you’ve likely just sat in the car for an hour or more. Prolonged sitting puts extra stress and compression on your knee joint, especially in the front of your knees. Warming up your knees can help relieve this added stress on your joints before you hit the slopes.

2. Strengthen your upper leg muscles and core

Having good strength of your upper legs and core can help improve both the stability and alignment of your knee joint – which is important during skiing.

Your knee joint is surrounded by a complex network of muscles, ligaments, and tendons. When the muscles around your knee joint are weak, imbalanced, or simply not functioning well – this will cause your knee to move in ways that add extra stress to your joint. Given the stress skiing already adds, you don’t want to make your knee work any harder.

Strengthening your core and upper leg muscles will improve the alignment of your knee during activity, reduce the risk of injury, and improve the overall function of your knee – which can only help you when skiing.

3. Keep your Knees Mobile

Full and free mobility of your knee joint is important. It helps maintain the health of your joint and surrounding tissues.

When your knee (or any) joint doesn’t move well, you will get added stress on your ligaments, cartilage, and tendons. Your knees need to bend all the way so you can squat and pick things up.  They need to straighten all the way to give you stability when needed. When either of these motions are lacking – your knee joint suffers.

When it comes to skiing, if your ligaments and surrounding tissues are already stressed due to lack of mobility in everyday movement – they will certainly not be happy when you add the stress of skiing. Having a good mobility routine for your knees as a preventative activity is important. It’s going to really pay off when you go to hit the slopes each ski season.

4. Talk to a mechanical pain expert

70% of all knee pain is going to be mechanical in nature. Everything I’ve already described above is going to help you deal with mechanical movement faults that might be happening in your knee joint. But occasionally, despite all your best efforts, you need help from someone who specializes in mechanical joint pain.

Mechanical joint pain responds very well to what we call “corrective movements”. When you know what specific movement your joint needs to feel better, it literally acts like a prescription medication. You can use that movement any time you want to help relieve knee pain on your own. This is particularly advantageous when you’ve gone a little overboard on the slopes. You can “fix” your knee and be ready for the next day.

If you’ve already tried many of the strategies I mentioned, and continue to have knee pain when you ski, it might be worth visiting a mechanical pain expert to help set you on a customized path to preventing knee pain and avoiding an injury that requires more invasive intervention down the line.

It’s more fun to focus on the ski day ahead than worry about whether or not your knee joints can handle it.

I hope these tips help you to not only enjoy what’s left of ski season – but help you have healthier knees in general to keep enjoying all of the activities you love.

Local to Portsmouth, NH and need help with your knee pain NOW?

CLICK HERE to request a Free Discovery Session with one of my Specialists. They’ll ask you all about what’s been going on – and figure out if we would be a good fit to help.

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

golf injuries

Common Golf Injuries and How to Avoid Them

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Most golfers I know won’t let anything stop them from being out on the course – especially here in New England where the golf season is not very long.

But let’s face it, when something hurts, playing 9-holes is just not as fun.

Jack Nicklaus had it right when he said, “Professional golfers condition to play golf; amateur golfers play golf to condition.” That explains why 62 percent of amateurs will sustain a significant golf injury, typically because they’re out of shape, have poor swing mechanics, or don’t adequately warm up.

Here are three common golf injuries and things you can do to avoid them.

Elbow Tendonitis

Tendonitis is characterized as the painful inflammation of a tendon. It’s caused by repetitive movements that overload the tendon, eventually causing it to feel strained and overworked. When it occurs on the inside of your elbow, which is something that happens a lot with golfers, it’s called “golfer’s elbow.” The treatment is ice and rest initially (which means you don’t get to play golf for a while) followed by progressive and proper loading of the tendon to get it back to a healthy state. This whole process, if done properly, takes time… and it can certainly ruin your golf season if it’s not caught early.

What causes elbow tendonitis? We know that technically, it’s inflammation of tendons in your elbow. But what leads to that in the first place? Often weakness in your mid-back and shoulders along with mobility restrictions in your wrists. Your elbow is significantly influenced by what happens above and below it. If your mid-back and shoulder area are weak, the rest of your arm won’t feel supported and your elbow can get overworked. If your wrist is tight and immobile, your elbow will be forced to move more than it should, especially through a golf swing. This will cause extra stress on your tendons and eventually result in tendonitis. The best way to prevent this from happening is to make sure you’ve got adequate mobility in your wrists, and good strength in your mid back and shoulders.

Back Pain

One of the most common ways to hurt your back is with repetitive flexion (bending) and rotation (twisting). Well, what does a round of golf consist of over and over? Repetitive bending and twisting! Every time you swing that golf club, you’re putting your spine through one of its most stressful positions. And if it’s not prepared — it’s going to get injured.

One of the best ways to prepare your spine for a long and healthy golf season is to avoid a lot of sitting and keep it mobile. Sitting for prolonged periods makes your back more susceptible to injury in general, but especially if you’re going to be doing a lot of bending and twisting. Interrupting your sitting frequently during the day is a very easy way to minimize its harmful effects. 

If you lack adequate mobility in your spine, it will feel strained every time you try and swing your club. When you overstress a joint that is stiff, the muscles around it tend to tighten up and spasm in response. It’s important that you take time to optimize and maintain your best spinal mobility for golf season. This will significantly help to decrease the stress that occurs in your spine when you swing in one direction repetitively, and ultimately help you prevent a back injury.

Knee pain

Between walking 18 holes, and the repetitive twisting that happens at your knee when you swing a golf club, there’s the potential for lots of stress (and injury) through your knee joints. If you lack adequate mobility or stability in and around your knees, you’re going to have problems. Much like the elbow, the most common source of knee pain I see in my golfers comes from the joints above and below, and not from the knee itself. To keep your knees mobile and healthy and prevent them from getting overstressed during golf season, it’s important that you take measures to optimize the strength in your core and hips, as well as stability in your feel and ankles. 

The power in your golf swing should come from your hips and core, not from your knees (or back). If they aren’t very strong, your knees will want to try and help, and they are not designed for this. Your knees need to be loose and free during a golf swing. If not, the muscles and ligaments around your knee joint will take on unwanted stress. 

Another cause of unwanted stress to your knee joint is lack of support from your feet and ankles.

Your knees need a stable foundation if they want to bend and twist without stress. If stability below is lacking, your knees will tighten up in an effort to compensate. Moral of the story: make sure you’ve got mobile knees, a strong core and hips, plus stable feet and ankles, so that knee pain doesn’t derail your golf season.

Hopefully these tips help you understand why golf injuries happen and most importantly, how to prevent them. If you’re feeling stuck and looking for individualized expert help – request a FREE Discovery Session. We look forward to speaking with you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.