Why Most Meniscus Tears don’t need Surgery

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A meniscus tear is one of the most commonly diagnosed knee injuries – and also one of the most misunderstood.

If you’ve recently been told you have a torn meniscus and that surgery is your only option – I want you to take a deep breath and pause for a moment… Because in most cases – especially if you’re over 40 – there’s a very good chance you can avoid the operating room altogether.

Let me explain.

The meniscus is a rubbery, C-shaped piece of cartilage that acts like a shock absorber between your thigh bone and shin bone. You have two in each knee – one on the inside (medial) and one on the outside (lateral). Their job? To help your knee glide, bend, twist, and bear weight with more ease and efficiency.

Meniscus tears typically occur in two major ways. The first is sudden trauma – often from twisting or pivoting during sports or a misstep. The second is more subtle and due to age-related degeneration. As we get older, wear and tear can gradually weaken the meniscus – making it more prone to tears – even when there is no obvious incident.

But here’s something most people don’t realize… It’s entirely possible to have a meniscus tear but not experience any symptoms.

A study published in the New England Journal of Medicine found that 35% of adults over 50 had meniscus tears on MRI – yet no knee pain. Another study from JAMA reported that 60% of people over 65 had torn menisci on imaging, but again, no symptoms. What does that tell us? That just because a tear shows up on your MRI doesn’t mean it’s the source of your pain – or that it needs to be surgically fixed.

OK – I know what your next question is… Why do some tears cause pain while others go unnoticed? It all comes down to knee mechanics.

A meniscus tear by itself doesn’t always cause symptoms. But if your knee isn’t moving well – or if the tear disrupts how your bones, joints, and muscles interact – it can lead to irritation in the meniscus or the surrounding structures. When your knee mechanics are off, your body starts to compensate. These compensations put extra stress on nearby tissues, trigger inflammation, and ultimately result in pain. The tear may start the problem – but it’s the mechanical dysfunction that keeps it going.

This is why so many people who undergo arthroscopic surgery to “clean up” their meniscus continue to struggle with pain months – or even years – later. If the underlying joint dysfunction isn’t addressed, the surgery won’t fix the root problem. I’ve seen countless people feel better temporarily after meniscus surgery, only to have the pain return because the same dysfunctional movement patterns were never corrected.

So what should you do instead? Focus on restoring proper mobility first and then strength.

Mobility refers to your joint’s ability to move freely and fully. Strength refers to the muscles around your knee providing the right amount of stability. When a tear disrupts either of these, it puts strain on the knee and surrounding structures. That’s when swelling, irritation, and instability begin to show up.

The first step to healing a meniscus tear naturally is not jumping into strength exercises, as many people do. It’s actually restoring mobility first – making sure the knee can bend, extend, and rotate the way it’s supposed to. Only then should you begin a strategic strengthening program that supports proper movement and joint alignment.

And no, you can’t just go on YouTube and pick random exercises. You need guidance from a specialist who understands mechanical knee pain – someone who knows how to assess your knee joint function and prescribe movement in a way that supports true recovery.

In my 23 years of practice, I’m happy to report that I’ve worked with hundreds of people who were told they needed surgery – but never got it. The secret was helping them restore natural knee function and resolve their pain without invasive procedures, which often lead to complications like scarring or infection. In fact, those who chose the natural route typically return to walking, running, and enjoying life without limitation faster than their surgical counterparts.

Still not convinced? Let’s look at the numbers. 

Research shows that 70–80% of people over 40 with meniscus-related knee pain get full relief with conservative, specialized treatment. That means no cortisone, no surgery. Yet arthroscopic meniscus surgery remains one of the most common orthopedic procedures in the country.

Why? Because MRIs are persuasive, and the belief that “a tear must be fixed” is deeply ingrained in most people’s thinking. But imaging doesn’t tell the full story. Pain is more complex than what you see on a scan – and knowing that research has shown your knee can function well despite a tear is something you should pay close attention to.

Let me re-iterate something for you one more time… The key to healing a meniscus tear naturally lies in restoring proper knee function (sometimes even hip and back function). That means mobility first, then strength – prescribed strategically and adapted as you progress.

So what should you do if you’ve been diagnosed with a meniscus tear?

  1. Don’t panic. Not all tears need to be fixed.
  2. Get a second opinion from someone who specializes in mechanical knee pain – not just someone who reads MRIs.
  3. Avoid quick fixes like cortisone injections or surgery unless truly necessary.
  4. Start working with a specialist who understands how to address mobility and strength in a way that’s specific to your knee – and your life.

You owe yourself the chance to explore natural recovery first. For most people, it’s not only possible – it’s the better long-term solution.

If you’re struggling with knee pain and unsure what path to take, feel free to reach out. Whether you want to avoid surgery, get a second opinion, or simply better understand your options – I’d love to help.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists for free by booking 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.

For the Dad Who Has Everything… Except Good Knees

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It’s that time of year when we celebrate the dads in our lives – and if the one in your life is anything like mine – then he’s probably a little tough to shop for. Maybe he already has all the tech toys and grilling gadgets he wants. Maybe he’s not one to ask for much. But if there’s one thing a lot of dads over 40 don’t have – but wish they did – is good knees.

Knee pain is one of the most common complaints I hear from the men over 40 who walk into my clinic – and it’s also the most common form of osteoarthritis. For some, it’s been a nagging issue for years. For others, it creeps in gradually – starting with a little stiffness when getting up from the couch, or a strange “click” here and there. Then one day, it hits you… Playing golf isn’t fun anymore, and going up and down stairs now feels more like a chore – because your knees just hurt all the time.

Yes, knee pain does become more common as we age – but not necessarily for the reasons you think.

People love to blame arthritis and “wear and tear” for just about everything. And while a previous injury or underlying arthritis might be present, they’re not always the primary culprits. What most people don’t realize – including dads – is that the root cause of knee pain is often mechanical. In other words, it has more to do with how your body moves (or doesn’t move) than what’s actually going on inside the joint.

Let me explain.

Your knees sit between your hips and ankles – two areas that are meant to move a lot and absorb shock. But if the hips or ankles aren’t doing their job properly (which is surprisingly common), that stress has to go somewhere – and the knees usually pay the price. Over time, poor mechanics can lead to pain, inflammation, and breakdown of the joint. But here’s the good news – if the pain is mechanical, it’s very treatable – and sometimes even reversible – all without drugs, injections, or surgery.

So why don’t more dads know about this?

For one, we’ve normalized knee pain – especially in men over 40. There are societal and cultural beliefs like, “You’re getting older, it’s supposed to hurt a little.” Or worse, “If it hurts too much, you can always replace it.” That kind of thinking is unproductive, unnecessary, and can even be dangerous. Yes, knee replacements are sometimes the right call – but far too often, they’re offered before the right conservative options have been fully explored. And with so many cutting-edge, non-invasive technologies now available that promote longevity and let you keep your original parts – dads should absolutely be exploring these options first.

But another big reason? Men – especially dads – tend to avoid asking for help. They’re used to being the fixers, not the ones getting fixed. Many try to “tough it out,” hoping the pain will go away on its own. Others pop ibuprofen or throw on a brace and carry on. But these strategies are just band-aids. They might provide temporary relief, but they don’t address the actual cause of the pain – and in some cases, they can even make things worse.

The real solution starts with a deeper understanding of why your knee pain is happening in the first place. Remember – 80% of all knee pain is mechanical in nature.

So if you or someone you love is dealing knee pain – here are a few important things to keep in mind:

  1. Rest isn’t always the answer.
    It might seem like common sense to rest an aching knee – but too much rest can lead to stiffness, weakness, and poor circulation. In many cases, strategic movement is far more helpful than immobilization.
  2. Pain doesn’t always mean damage.
    This is one of the most misunderstood aspects of musculoskeletal pain. Just because something hurts doesn’t mean it’s permanently damaged – and just because an X-ray shows “bone-on-bone” doesn’t mean surgery is inevitable.
  3. The site of the pain isn’t always the source.
    Knees often hurt because of a problem elsewhere – such as limited hip mobility, poor ankle mechanics, or even an undiagnosed problem in your spine. That’s why a full-body movement assessment is key to figuring out what’s really going on.
  4. Most knee pain is preventable – and fixable.
    With the right combination of movement-based therapy, strength training, hands-on treatment, and regenerative therapy – many people are able to not just reduce their pain – but eliminate it entirely.

So what does all of this have to do with Father’s Day?

If you’re looking to give your dad something meaningful this year, consider giving him a nudge to take care of himself.

Not with another gadget or tie – but with a shift in mindset. One that reminds him that pain isn’t something he just has to live with. One that encourages curiosity about his health, and reinforces that aging doesn’t have to mean giving up the activities he loves.

Because the truth is – most dads don’t want to sit on the sidelines. They want to stay active, strong, and capable. They want to travel, hike, golf, chase their grandkids around the yard, and keep doing the things that make life fun. And they can – if they learn to listen to their bodies and get the right kind of help.

So if the dad in your life has everything… except for good knees… Maybe this is the year to give him something more lasting than another toolset or polo shirt. Maybe this is the year to give him the reminder that his health is worth paying attention to. And that it’s never too late to move better, feel better, and get his knees back.

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How to Stay Injury-Free on the Golf Course This Season

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Golf is a favorite pastime for millions – and now that the season is in full swing here in New England – many players are eager to hit the course as often as possible. But when back, knee, elbow, or shoulder pain creeps in – those 18 holes can quickly lose their appeal – and even become depressing. Pain doesn’t just interfere with your swing. It can drain the joy right out of your game.

The good news? Many of the injuries that golfers suffer from are preventable. With a bit of foresight, the right kind of movement, and smart preparation – you can keep your body strong and your game on point all season long.

Here are five of the most common injuries I see golfers facing – and what you can do to avoid or recover from them quickly:

1. Back Pain

This is by far the most frequent complaint among golfers. The constant bending, twisting, and rotational force of a golf swing can wreak havoc on your spine – especially if your back is stiff or you spend a lot of time sitting during the week.

The best way to keep your back pain-free? Focus on improving your spinal mobility – particularly extension and rotation. Even perfect swing mechanics can’t make up for a back that lacks movement. Try adding daily backward stretching and limit prolonged sitting – especially on the days you know you’ll be golfing. These small changes can make a big difference in keeping your spine mobile and resilient throughout the season.

2. Golfer’s Elbow (Medial Epicondylitis)

This injury happens when the tendons on the inside of your elbow become irritated – often due to repetitive swinging. But the root problem, however, frequently lies elsewhere. Weakness in your shoulder girdle or stiffness in your wrist can force your elbow to overcompensate.

To prevent and heal golfer’s elbow – don’t just focus on the elbow itself. Work on improving shoulder stability and wrist mobility as part of your regular conditioning. In more stubborn cases – regenerative therapies like Shockwave Therapy or EMTT can speed up healing and reduce inflammation – helping you stay on the course without resorting to cortisone shots or any downtime.

3. Knee Pain

Walking the course and rotating through your swing can put a lot of pressure on your knees – especially if you lack strength in your core and hips – or have unstable feet and ankles. Your knees aren’t designed to power your swing, but they often get overworked if other areas aren’t pulling their weight.

Most knee pain in golfers is mechanical, not structural. Meaning, it’s caused by faulty movement patterns rather than actual damage, even when imaging shows said “damage”. The good news? With the right strengthening and stabilization exercises, you can typically resolve your knee pain naturally – no injections or surgery required.

4. Rotator Cuff (Shoulder) Injuries

The rotator cuff is responsible for stabilizing your shoulder, and it’s highly involved during your golf swing. If it’s weak – or if your mid-back and core aren’t supporting it – your rotator cuff can easily become inflamed or irritated.

To prevent this, build strength not only in your shoulders, but also in your mid-back, lats, and core. These “powerhouse” muscles provide a solid foundation and reduce the strain on your shoulders. If your shoulder pain is persistent, regenerative Shockwave Therapy and EMTT (like in the case of golfer’s elbow) can be an excellent way to accelerate healing and reduce the need for medication, rest, or downtime.

5. Wrist and Hand Injuries

Sprains, strains, and other wrist or hand injuries are common in golf – often due to grip issues or poorly fitted equipment. But one commonly overlooked factor is your neck. Research shows that nearly half of all upper extremity pain can be traced back to the cervical spine – even if you don’t feel any neck pain.

If nerve irritation or stiffness in your neck is the true culprit – no amount of wrist strengthening will help – because the root cause has been missed. If your wrist or hand symptoms persist despite traditional mobility, strength and even manual work, it may be time for a full-body assessment by a mechanical pain specialist who can identify whether the issue is actually coming from somewhere else.

Final Thoughts

Golf injuries can be frustrating – but they’re often preventable and highly treatable when you know what to do or where to turn for the right help. By addressing problems early, using targeted movement strategies, and supporting your body with proper mechanics – you can keep playing pain-free all season long.

And when more advanced treatment is needed – especially for tendon or joint inflammation – non-invasive regenerative therapies like Shockwave Therapy and EMTT can offer fast, effective relief and accelerate recovery.

As a physical therapist who specializes in mechanical pain and movement dysfunction, I’ve helped countless golfers who thought their playing days were over – only to return to the course stronger and better than before. The key is addressing the true source of pain, not just masking the symptoms.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. To request one of her free guides for back or knee pain – visit her website: cjphysicaltherapy.com – or call 603-380-7902

Top 5 Arthritis Myths That Keep People in Pain

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If you or someone you love is living with arthritis — then you already know how frustrating it can be. Daily tasks become harder, favorite activities fall by the wayside, and you may start to wonder: “Will things ever get better?”

Even worse, many people living with arthritis fall victim to misguided advice.

Let’s look at five of the most common myths about arthritis management — and shed some light on what you can actually do instead:

Myth #1: “There’s nothing you can do — it’s just part of getting older.”

This is one of the biggest and most damaging myths of all.

While it’s true that arthritis becomes more common as you get older — and it’s considered a normal part of aging — it doesn’t mean you have to live with chronic pain or disability. In fact, many people with visible (even advanced) arthritis on X-rays and MRIs are living active, healthy lives with minimal to no pain at all.

Research supports this. A 2015 study published in Arthritis & Rheumatology found that more than 30% of adults over 60 had radiographic evidence of knee osteoarthritis — but only a portion of them had symptoms. In other words, just because your joints show signs of “wear and tear” doesn’t mean you’re doomed to pain.

The real issue is how you move — and how you use your joints. Strategic exercise, strength training, and natural therapies can drastically improve your mobility and reduce pain — regardless of your age or what your imaging says.

Doing nothing, on the other hand, is one of the worst things you can do.

Myth #2: “You should rest and avoid activity to protect your joints.”

If your joints hurt, don’t move them — right? That might make sense if you have an injury that requires an initial rest and healing phase. But that’s not the case with arthritis. When you avoid movement in an arthritic joint, you actually worsen your symptoms.

Too much rest leads to stiff joints, weakened muscles, and poor circulation — all of which contribute to more pain and less function over time. Movement helps lubricate joints, strengthen muscles, and prevent further degeneration.

I’m not sure why this myth is still so common — especially when just about every major orthopedic organization (including the CDC and the Arthritis Foundation) agrees that regular, low-impact physical activity is one of the best things you can do for arthritis.

The key is doing the right kind of movement. So if you’re struggling, work with an expert who can help you figure out the proper, targeted activity your body needs. But whatever you do — don’t fall for this myth.

Myth #3: “If your joint is bone-on-bone, surgery is the only option.”

Hearing the phrase “bone-on-bone” from your doctor can feel like a death sentence for your joint. And the typical recommendation? Joint replacement surgery.

But what if I told you that “bone-on-bone” isn’t always the actual reason for your pain — and that you’ve got options beyond a major procedure like surgery?

The first thing to understand is that what shows up on your imaging (like X-rays and MRIs) doesn’t always match up with your symptoms. A 2018 study in BMJ Open found that nearly half of people with severe osteoarthritis on imaging had little to no pain. And many people with significant joint pain showed only mild arthritic changes on their images.

Translation? “Bone-on-bone” isn’t necessarily the root cause of your problem. I’ve seen many people with this diagnosis successfully avoid major surgery and keep their original parts far longer than they thought possible.

When faced with this kind of diagnosis, the best thing you can do is pause — and explore your options. Surgery will always be there if you need it. But don’t rush into it or assume it’s your only option.

Myth #4: “Cortisone shots and medications are the best way to manage arthritis.”

Cortisone shots may provide short-term pain relief for arthritis — but they don’t actually fix anything. Worse, repeated cortisone injections have been shown to damage cartilage and accelerate joint degeneration over time.

One study published in JAMA (2017) showed that patients receiving cortisone injections for knee arthritis had worse cartilage loss at two-year follow-up than those who received a saline placebo — despite experiencing no significant difference in pain relief.

NSAIDs (like Advil) and prescription pain medications can also help dull pain, but they come with side effects — and, just like cortisone, do nothing to address the root cause of your symptoms.

If you’re relying on medication or repeated cortisone shots just to get through the day — or to delay surgery — it’s time to explore options that promote natural healing instead of just masking symptoms.

Shockwave Therapy and EMTT are two non-invasive regenerative therapies that do exactly that. These cutting-edge technologies enhance your body’s natural healing processes by targeting inflammation and tissue damage at the cellular level. And while more research is still needed, promising clinical evidence suggests these therapies may actually help reverse — or significantly delay — the progression of arthritis.

Do your own research — and be open to natural, forward-thinking treatment options that support your long-term joint health.

Myth #5: “Arthritis means you’ll never get back to the activities you love.”

This is one of the most heartbreaking myths — and it’s simply not true.

I’ve worked with countless clients who believed their days of hiking, gardening, traveling, or playing with grandkids were behind them — only to regain full function and freedom after following a personalized treatment plan.

And while surgery sometimes is the best option — especially if you’ve waited until your arthritis has become advanced — there’s a lot you can do to improve your outcome. Working with a specialist to build strength and prescribe targeted movement can make recovery faster and easier.

Plus, emerging research shows that using regenerative therapies like Shockwave and EMTT both before and after surgery may help accelerate healing and improve long-term outcomes.

Managing arthritis is absolutely possible when you take a natural, proactive, and personalized approach. You just need the right plan — and the right team to guide you.

Final Thoughts:

Arthritis is real — but don’t let myths and outdated advice keep you stuck. If you’re not sure where to start — or feel like you’ve already tried everything — speak with someone who specializes in mechanical pain and natural joint care. Often, the most effective solutions are the ones no one has told you about yet.

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.

How I’d Rehab Jayson Tatum’s Achilles Repair (And Why Regenerative Therapy Would Be My First Move)

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If I were lucky enough to be on Jayson Tatum’s rehab team following his Achilles tendon repair, I’d be pulling out all the stops to help him recover quickly, fully, and most importantly, safely. An Achilles injury is no joke – even for the fittest, most elite athletes in the world. But with the right approach and the right technology, a full recovery and return to play is possible. The key lies in combining solid, daily rehab with the best science-backed tools we have today. And in my opinion, regenerative therapy should be at the center of any post-surgical rehab protocol. That means making strategic use of shockwave therapy and EMTT (Extracorporeal Magnetotransduction Therapy) from day one.

The Challenges of Tendon Rehabilitation

The Achilles tendon is the strongest tendon in the human body – but also one of the most vulnerable, largely due to its poor blood supply. This, combined with the repetitive stress it endures, makes it especially prone to injury and rupture – particularly in a high-demand, explosive, and multidirectional sport like basketball. If not managed correctly, an injury to this tendon (like in Tatum’s case) can be career-altering.

Traditionally, rehab after Achilles tendon repair involves a slow progression – starting with immobilization and non-weight bearing, followed by conservative loading, manual therapy, and eventually a return-to-play protocol. But unless this process is executed meticulously, it often fails to fully restore tendon elasticity, strength, or neuromuscular timing – all of which are crucial for explosive power and returning to a sport like basketball, let alone elite-level competition. And when it comes to tendon rehab, there’s no shortcut. Tendons heal through a process of remodeling over time, and that healing requires precise, progressive loading. Most people don’t have the patience – or the team around them – to commit to this fully, which is why so many Achilles injuries become chronic and never quite the same.

What concerns me most in cases like Tatum’s isn’t just whether the tendon heals – but how well it heals. Does it remodel into a strong, elastic, load-ready structure? Or does it stiffen, weaken, and become vulnerable to future injury? This is exactly where regenerative therapy comes in. And hopefully for Tatum, he’ll not only have the right team around him – with the knowledge, tools, and strategy to deliver exceptional rehab – but one that’s also staying current on the latest advances in rehabilitation technology.

Why Shockwave and EMTT Are a Game-Changer

Both shockwave and EMTT are non-invasive regenerative technologies that stimulate your body’s natural healing processes. They don’t mask symptoms – they accelerate tissue regeneration, increase blood flow, and improve cellular repair at the source.

Shockwave therapy uses focused mechanical energy to create microtrauma in the tissue, which stimulates a healing cascade – increasing local circulation, activating fibroblasts, and promoting collagen production. A 2017 study published in The American Journal of Sports Medicine found that athletes recovering from Achilles tendinopathy who received shockwave therapy had significantly better outcomes than those who didn’t – with faster recovery times and greater functional improvement.

EMTT, on the other hand, uses high-frequency electromagnetic pulses to stimulate cellular metabolism and promote deep tissue healing at a cellular and mitochondrial level. It penetrates deeper than shockwave and operates on a different biological frequency, making it a perfect complement.

Used together, these therapies enhance each other’s effects – improving tissue oxygenation, reducing inflammation, and accelerating remodeling. A 2023 study in Orthopedic Reviews found that combining EMTT with shockwave improved tendon vascularity and collagen alignment in post-op Achilles patients, leading to faster return-to-sport metrics.

My Strategic Rehab Roadmap for Tatum

If I were working with Tatum, I’d coordinate with his surgical team to determine the ideal time to begin regenerative therapy – typically once the surgical site is closed and stable, within the first few weeks post-op.

In the early rehab phase – around weeks two to six – I’d focus on protection and early-stage regeneration. EMTT would begin two to three times per week to stimulate healing, reduce inflammation, and prevent early adhesions. It’s ideal during this phase because it’s non-contact, painless, and doesn’t interfere with the surgical site. I’d also initiate isometric activation of the calf and surrounding muscles and start gentle mobility work to nearby joints to minimize compensation.

As we progressed into weeks six to twelve – the tendon loading and remodeling phase – I’d introduce shockwave therapy once or twice a week to stimulate angiogenesis and collagen synthesis. EMTT would continue to support deeper tissue metabolism as the loading demands increase. At this point, I’d implement controlled eccentric loading of the calf complex – a well-documented method for rebuilding tendon strength. I’d also integrate targeted, low-load mobility and stability drills – including Pilates-based work on the Reformer – to restore foot and ankle mechanics and optimize posterior chain activation. The Reformer offers adjustable, low-impact resistance through full ranges of motion, allowing strategic reintroduction of load without overstressing the tendon.

By weeks twelve to twenty and beyond, the focus would shift to sport-specific training, plyometrics, and return-to-play. Regenerative therapy would continue as needed – not as a primary tool, but as support to keep the tendon adapting as the intensity ramps up. Many athletes feel ready before the tendon is fully remodeled, and this is where shockwave and EMTT help ensure tissue resilience. During this phase, I’d layer in multidirectional plyometrics, reactive balance drills, and functional movement assessments to restore proprioception and clean up any compensations.

Why This Matters (Even If You’re Not an NBA Star)

Maybe you’re not a professional athlete – but the same principles apply whether you’re trying to get back to the NBA Finals or just want to hike, run, or play with your kids pain-free. Tendon healing doesn’t change just because your jersey doesn’t say “Celtics.”

In my clinic, I’ve seen how combining regenerative therapy with intelligent loading strategies leads to better outcomes – fewer setbacks, stronger recoveries, and tendons that actually function. The result? Less scar tissue, better elasticity, and reduced risk of reinjury.

Final Thoughts

Rehabbing an elite athlete like Jayson Tatum takes precision, collaboration, and the best tools modern sports medicine has to offer. In 2025, that means going beyond traditional methods. It means using regenerative therapies like shockwave and EMTT to support faster, stronger, and more complete healing – from the inside out.

Whether you’re an NBA star or someone who just wants to stay active without setbacks, the principles are the same: treat the root cause, support your body’s natural healing, and never underestimate the power of regenerative healing.

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.

Shockwave Therapy

Four Non-Invasive Ways to Get Rid of Arthritic Knee Pain

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Knee arthritis is one of the most common and debilitating forms of joint pain affecting adults over 50. It’s a condition that slowly wears down the protective cartilage in your knee joint – leading to stiffness, swelling, and pain that can make even simple activities like walking the dog or climbing stairs feel like a chore. 

While conventional treatments like traditional physical therapy, cortisone injections, and pain medication have been used for years to offer temporary relief – they don’t always work for everyone – and they fail to address the root cause . The good news is that there are several non-invasive, natural, and cutting-edge alternatives that go beyond masking symptoms and instead aim to support your body’s ability to heal and repair itself – especially when traditional treatments have come up short.

Corrective, Therapeutic Movement Strategies:

Perhaps the most accessible (and free) non-invasive solution is movement. Now, it might sound counterintuitive – and even laughable – to consider this as a viable strategy for arthritic knee pain, especially when your knee hurts. But not all arthritic knee pain is due to the arthritis itself.

Let me explain.

Much of the pain you experience when you’ve got arthritis is due to joint immobility and the compensatory patterns that develop over time. When you can identify these faulty movement patterns—and correct them with specifically prescribed therapeutic movement strategies designed to fix the mechanics in your knee joint – you can get significant pain reduction in your arthritic knee. You’ll need to work with a specialist to figure out which specific movements (or set of movements) your knee needs, but once you know what they are, you can use them forever to manage your knee pain – and it won’t cost you a dime.

Weight Management

Extra weight – even just a few pounds – can significantly increase the load placed on your knees when you’re walking, climbing stairs, and moving through your day. In fact, research from Dr. Stephen Messier and colleagues at Wake Forest University found that for every pound of weight lost, there is a four-pound reduction in knee joint stress during daily activities. In other words, losing just 10 pounds can reduce pressure on your knees by a remarkable 40 pounds with every step you take. Healthy, manageable weight loss – through a combination of smart nutrition and regular activity – can make a meaningful difference in pain levels and joint function. And the benefits aren’t limited to your knees. Losing weight reduces mechanical strain throughout your body, supporting the health and longevity of other joints as well.

Adopt an Anti-inflammatory lifestyle

While most people associate knee arthritis with “wear and tear,” it’s also a condition fueled by chronic inflammation. When you reduce inflammatory triggers – especially through your diet – it can lead to noticeable improvements in how your knees (and other joints) feel. Eating more whole, unprocessed foods that are rich in omega-3 fatty acids, antioxidants, and healthy fats is a powerful way to calm inflammation naturally. Aim to incorporate fatty fish like salmon, sardines, and mackerel at least twice per week, along with daily servings of dark leafy greens (like spinach and kale), berries, walnuts, chia seeds, and extra virgin olive oil. Spices like turmeric and ginger have natural anti-inflammatory properties and can easily be added to meals or smoothies.

On the flip side – it’s important to avoid refined sugars, processed grains (such as white bread and pastries), and fried foods – which are all known to promote inflammation. Beyond food, other daily habits that support lower inflammation include getting 7–8 hours of quality sleep, managing stress with activities like deep breathing or walking in nature, and drinking enough water – typically half your body weight in ounces per day. These foundational habits not only help reduce knee pain – but they’ll support your overall health and energy levels as well.

Explore non-invasive Regenerative Therapy

One of the most exciting technologies to hit the market in recent years – and that’s quickly gaining popularity – is the use of non-invasive regenerative therapies like Shockwave Therapy and EMTT. What I love about these treatment options is that they work with (not against) your body’s natural healing ability to regenerate degenerated or inflamed tissue – a major contributor to the pain and stiffness associated with knee arthritis. Shockwave Therapy uses mechanical sound waves to increase blood flow, break down scarred or damaged tissue, and reawaken dormant healing cells in the affected area. EMTT (Extracorporeal Magnetotransduction Therapy), on the other hand, uses high-frequency electromagnetic energy to reduce inflammation at the cellular level – boosting mitochondrial activity, improving cellular metabolism, and accelerating tissue repair. It’s particularly effective at targeting bone marrow lesions and chronic joint inflammation – both of which are commonly seen in knee arthritis.

While each of these therapies can be effective on its own, recent studies have shown that using EMTT and Shockwave together significantly enhances treatment outcomes. A 2021 clinical study published in Orthopedic Reviews found that the combination of EMTT and Shockwave Therapy led to greater improvements in pain relief and functional mobility compared to either treatment alone – while also providing longer-lasting results. For individuals who have already tried traditional physical therapy or cortisone injections without success – this combination of cutting-edge technology offers a powerful, drug-free solution that doesn’t just mask symptoms – it promotes actual healing.

Take Control of your Knee Pain – Naturally

If you’re struggling with knee arthritis and feel like you’ve tried everything – don’t give up hope. Medications and injections aren’t your only options. And surgery does not have to be your next step. By combining strategic movement, healthy weight management, anti-inflammatory lifestyle choices, and cutting-edge non-invasive regenerative therapies – it’s absolutely possible to reduce knee pain and reclaim your mobility naturally – without having to rely on pills, injections, or surgery. The key is finding the right combination that works for you – and being proactive about exploring alternatives that go beyond standard prescriptions and treatment strategies.

Are you local to Portsmouth, NH?

If so, consider speaking to one of my specialists for free 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.

7 Fun and Healthy Ways to Celebrate Mother’s Day on the Seacoast

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Mother’s Day is a time to honor the incredible women in our lives. While flowers and brunch are timeless, sometimes the most meaningful gift is simply quality time spent together. This year, why not swap the restaurant waitlists and crowded gift shops for something a little more memorable?

Here on the Seacoast of New Hampshire, we’re lucky to have access to some of the most beautiful coastline, trails, and natural parks in New England. Whether your mom loves to move, relax outdoors, or try something new – there’s no shortage of ways to celebrate with her in a fun, active, and healthy way.

Here are 7 fun and healthy ways to celebrate Mother’s Day on the Seacoast:

 

Take a Scenic Coastal Bike Ride

Treat Mom to a leisurely bike ride along the Seacoast’s stunning shoreline. Begin in downtown Portsmouth and pedal out toward Rye via Route 1A. This route winds through the historic charm of New Castle, offers sweeping ocean views, quaint seaside cottages, and scenic beaches along the way. It’s the perfect mix of fresh air, gentle movement, and quality time – made even sweeter with a stop for coffee or ice cream along the way.

Explore the Rockingham Rail Trail

If Mom prefers a quiet ride or walk away from busy roads, the Rockingham Rail Trail is a fantastic option. This converted rail corridor stretches for miles through peaceful woodlands, wetlands, and charming rural areas. The wide, flat trail is perfect for casual biking or a long walk, and it’s ideal for chatting as you move at your own pace. Access points in Newfields allow for convenient parking to explore as much or as little of this trail as you desire.

Kayak or Paddle at Odiorne or Rye Harbor

If your mom loves being on the water, an afternoon of paddleboarding or kayaking could be the perfect outing. Paddleboarding challenges your balance and engages the core, while kayaking offers a more relaxed rhythm with a great upper-body workout. No gear? No problem. Local favorites like Portsmouth Paddle Co. and Portsmouth Kayak Adventures offer rentals, lessons, and even guided tours – making it easy for beginners to join in the fun.

Hike Mount Agamenticus or the Urban Forestry Center

If your mom enjoys hiking, there are plenty of local trails that offer both beauty and tranquility. Mount Agamenticus in York, Maine provides several loop trails and beautiful summit views. For something a little less strenuous, check out the Urban Forestry Center in Portsmouth. It offers peaceful, wooded trails that are perfect for an afternoon stroll. The forest and mountains are great places to unplug, breathe deeply, and enjoy each other’s company away from the hustle of everyday life.

Visit Nubble Lighthouse and Stroll the Marginal Way

Make a scenic drive to York, Maine and surprise Mom with a visit to the iconic Nubble Lighthouse. It’s one of the most photographed lighthouses in the country—and for good reason. After taking in the views, consider walking a portion of the Marginal Way in nearby Ogunquit, a picturesque oceanside path with sweeping vistas and benches for a rest or a nice chat.

Celebrate Mom’s Green Thumb

If your mom has a love for gardening, flowers, or nature’s beauty, spend part of the day visiting your favorite local nursery or garden center – and then help her get her hands dirty by planting something together. Whether it’s herbs, flowers, or even a raised veggie bed – she’ll appreciate the help and time spent together.

Stroll Through Prescott Park and the Portsmouth Waterfront

Put your best walking shoes on and take a walk through Prescott Park and along the Portsmouth waterfront. By mid-May, the gardens are beginning to bloom, and the salty air and river breeze make for a perfect spring stroll. Grab a treat from a local café, browse the shops, or simply sit and take in the view together.

Is Pain or Injury Keeping you from Enjoying these Activities?

Mother’s Day lands at a great time of year to get outside and do something active with your loved ones. But if nagging pain or injury is holding you back – or has you hesitant to try something new this season – it may be time to seek help from a mechanical pain specialist. They will help you figure out the source of your problem and provide you with natural treatment methods designed to get you out of pain and back to doing everything you love quickly.

Local to the Seacoast? CLICK HERE to speak with a specialist now.

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.

tight hips

Why Stretching Isn’t Solving Your Tight Hips

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If your hips always feel tight – whether during workouts, long walks, or just sitting at your desk – it can be incredibly frustrating. Not only is it uncomfortable, but tight hips often contribute to nagging lower back pain. And what’s even more confusing? No matter how much stretching you do, the tightness keeps coming back.

For me – that’s typically a clue that the problem isn’t what you think it is.

Muscles can feel tight for many different reasons – and not all of them have to do with flexibility. While some muscles truly are short and need to be lengthened – others feel tight because they’re overworked, weak, or compensating for something else. In those cases – stretching alone won’t solve the issue – and might even make things worse.

Let’s break this down…

Take your psoas muscle, for example. It’s one of your deep hip flexors and also plays a key role in spinal and pelvic stability. If your core and glutes (also spinal and pelvic stabilizers) aren’t doing their jobs – your psoas will kick in to help. That overcompensation can lead to it feeling chronically tight – even though it’s not technically “shortened”. So while the inclination will be to stretch your psoas – you’re actually putting an unintended strain on an already tired and stressed muscle. 

While stretching might give you a temporary break in this instance – it won’t address the real problem. You need to strengthen your deep abdominals, your core stability, and your glutes. When all of these systems kick in collectively, your psoas can finally relax – and your chronic tightness will resolve on its own.

But there’s one more thing most people don’t even think of –  and it’s that the tightness in your hip flexors could also be a symptom of a mechanical problem – not a muscular one.

Mechanical pain refers to pain (or tension) that’s caused by poor movement patterns or joint dysfunction, not necessarily tissue damage, compensation, or tightness. If the way your hips, pelvis, or lower back are moving is off – even slightly – your body will compensate. Over time, this leads to overuse of certain muscles – like your psoas, for example – which then feel constantly tight or strained. Unless the underlying movement problem is corrected, you’ll keep chasing symptoms instead of fixing the root cause by constantly stretching.

This concept of tightness due to overworking and compensation can happen to any muscle in your body. With hips in particular, your psoas isn’t the only culprit. Your piriformis and TFL (tensor fascia latae) can become victims of these patterns as well. In addition to your psoas muscle – your piriformis and/or TFL loves to pitch in and compensate for weak gluteal and core muscles as well. An overworked piriformis leads to difficulty sitting cross-legged – and a tight TFL can be painful and lead to IT band problems. You can stretch all you want – but if you don’t address the underlying cause and give these muscles a chance to relax – your hips will constantly feel tight. Plus, stretching in and of itself is a form of load on your muscle. You don’t want to add more load to an already tired and angry muscle.

The moral of the story? 

If your hips feel chronically tight – and stretching all the time isn’t making a lasting difference – it’s time to consider a different approach. Most people don’t think to strengthen a muscle that feels tight – but it might be exactly what your body needs. When it comes to your hips, the areas to assess are your deep abdominals and your glutes. Often, there’s an underlying weakness or movement dysfunction you just can’t see on your own. And if your muscle tightness stems from a mechanical issue – like poor joint alignment or faulty movement patterns – no amount of stretching or strengthening will fully work until that’s addressed.

A trained mechanical pain expert can help you identify whether it’s a strength problem, a movement problem, or a combination of both – so you can finally get lasting relief.

Feel free to reach out to our mechanical pain specialists if you’re local and looking for help 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.

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.

Back Pain

Think You’ve Got Piriformis Syndrome? It Might Actually Be Sciatica

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Think You’ve Got Piriformis Syndrome? It Might Actually Be Sciatica

A reader of this column recently wrote to me with the following question:

“I’m getting Physical Therapy for lower back pain and sciatica that is said to be from ‘piriformis syndrome’. My PT treatment has consisted of various exercises and some massage. Eight sessions in and no change at all. I’m still having pain when sitting or walking a distance. What now? Do I need an ultrasound or MRI to see if there is any damage or tear to my piriformis? Should I get an injection?”

When I hear something like this, my first thoughts are that either the diagnosis has been missed – or the treatment plan is all wrong – because you absolutely should be seeing some progress and results after 8 sessions of quality physical therapy.

Is it really piriformis syndrome – or is it sciatica?

These two conditions are frequently confused and all too often interchanged. The reality is, piriformis syndrome is far less common than you might think. In fact, research suggests piriformis syndrome is often misdiagnosed and may account for only 6–8% of all cases of sciatica-like symptoms (Boyajian-O’Neill et al., Am Fam Physician, 2008).

What’s the more likely reason for your radiating leg pain? That it’s coming from your lower back, not your piriformis.

Sciatica is a symptom – not a diagnosis

Sciatica refers to pain that radiates down the leg along the sciatic nerve. It can stem from a number of causes, but the most common – by far – is a mechanical problem in the lumbar spine. Things like a bulging disc, joint dysfunction, or even a poorly moving vertebra can irritate or compress a nerve root and cause sciatic pain.

Piriformis syndrome, on the other hand, involves the piriformis muscle compressing the sciatic nerve as it passes through the buttock. This can happen, but true cases are very rare – and diagnosing it correctly requires a process of elimination that most general practitioners and physical therapists don’t have the training to perform correctly.

Why mechanical diagnosis matters

Mechanical diagnosis matters because 80% of all musculoskeletal problems – including sciatica – are due to mechanical causes. And if you don’t take someone through a proper and thorough mechanical exam you will not be able to accurately diagnose the source of your sciatica. This is very likely what happened in this reader’s case.

A mechanical specialist will take you through repeated movements designed to map your symptoms and confirm specific responses to movement. This involves testing how your symptoms respond to specific repeated movements – like bending forward, arching backward, or twisting – and tracking which movements improve or worsen your pain. This is the only way to truly diagnose a mechanical pain issue. MRI’s and X-rays can’t detect mechanical pain problems – which is why they often lead to misleading diagnoses when used too soon.

Without a proper mechanical exam, treatment becomes a guessing game. Massage therapy, stretching, dry needling, and general exercises aimed at loosening your piriformis might feel good temporarily, but they won’t solve the problem if the issue is coming from your spine. Research shows that when mechanical diagnosis and therapy is applied correctly, it’s highly effective at resolving back and leg pain – even in cases that have failed previous treatment (May et al., J Man Manip Ther, 2006).

What to do if PT isn’t working

Let’s say your therapist did perform what they believe to be a thorough mechanical evaluation and still thinks it’s piriformis syndrome. And yet, you’ve gone through 8 sessions and feel no better.

This is a red flag for me.

In my clinic, we expect to see at least some change by session 4 or 5 – even if it’s small. If you’re not seeing meaningful progress by then, it’s time to reassess. That doesn’t necessarily mean it’s time for imaging or surgery. It may simply mean you need a different approach – or a more specialized provider.

A mechanical back pain specialist can help

When it comes to distinguishing between true piriformis syndrome and sciatica caused by a spinal issue, no one is better equipped than a mechanical back pain specialist.

These clinicians are experts at figuring out where your pain is coming from and what movement strategies will actually help you.

They don’t rely on vague diagnoses or cookie-cutter treatments. They use a methodical approach based on how your body responds to specific, repeated movements – and this approach has been shown to be highly effective for resolving back pain and sciatica.

The bottom line?

Piriformis syndrome is real – but very rare. If you’re dealing with leg pain, numbness, or tingling and have been told it’s from your piriformis, there’s a good chance it’s actually sciatica from a mechanical problem in your back. And that’s good news – because it means there’s often a clear and natural solution.

Find someone who specializes in mechanical diagnosis, and you’ll be one step closer to getting answers – and finally getting some 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.