Running Over 50: Top 3 Injuries and What you can Do

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If you love to run, then you’re probably no stranger to running injuries.

But if you love to run and you’re over 50, not only are you more likely to suffer a running-related injury compared to runners half your age, but you’ll tend to suffer from different categories of injuries as well. In older runners, we tend to see more soft-tissue related injuries versus problems with joints and stress fractures. Part of this is due to the fact that older runners may have been running longer. This predisposes them to more long-term wear and tear that is typically associated with soft tissue injuries like tendinopathy and plantar fasciitis. Older runners also are more likely to have altered their running mechanics over time, another factor that leads to injury. Either way, the good news is that once you know what to look for, you can take proactive measures to prevent these common running injuries as well as treat them naturally.

Here are the top 3 running injuries I see in people over 50 and what you can do:

1. Plantar Fasciitis

Plantar fasciitis is a condition characterized by a sharp, stabbing pain in your heel or bottom of your foot. It often worsens with the first steps in the morning or after long periods of rest. This discomfort comes from inflammation in your plantar fascia, a thick band of tissue running across the bottom of your foot from your heel to your toes. Factors such as overuse, improper footwear, high arches, flat feet, and tight calf muscles can all contribute to the development of plantar fasciitis, whether you’re a runner or not.

Prevention measures for plantar fasciitis include incorporating regular stretching and self-massaging of your plantar fascia and calf muscles before and after running. Balance exercises that focus on strengthening the intrinsic muscles of your foot, along with maintaining a healthy weight can also help – as it will allow you to better control and manage the load that gets transmitted through your plantar fascia. But what if you’re already suffering from pain due to plantar fasciitis? Don’t just resort to rest and ice, which has been known to impede healing. Plantar fasciitis requires prescriptive loading of your muscles in order to remodel the damaged tissue. This, along with non-invasive treatments such as Shockwave Therapy designed to enhance blood flow to the tissue, can aid in accelerating your healing.

2. Runner’s Knee (Patellofemoral Pain Syndrome)

Runner’s knee is a term used to describe a variety of conditions that cause pain around the kneecap (patella) – and is often synonymous with patellar tendonitis. You’ll notice your runner’s knee most during activities that require knee bending, walking downhill, or descending stairs. Overuse of your quadriceps muscles, poor tracking of your patella, and any other muscle or joint imbalance that results in increased load to the front of your knee can all result in runner’s knee. 

Regular and balanced strength training of the muscles around your knee – particularly of the quadriceps, hamstrings, and hip muscles – is a key prevention strategy. Making sure you have good ankle and foot mobility is also important. Because if your foot doesn’t move well when you run, unwanted forces move up the chain into your knee, eventually leading to runner’s knee. If you’re already suffering from runner’s knee, then you’ll want to first mitigate your pain. Similar to plantar fasciitis – rest and ice won’t do much for you. Getting blood flow to the area – followed by carefully prescribed exercises designed to restore your mechanics and properly load your patella tendon – is what’s going to heal the irritated tissue in and around your knee and make it stronger.

3. Achilles Tendinitis

Achilles tendinitis presents as pain and swelling in the back of your heel or lower calf. Right where your Achilles tendon connects your calf muscles to your heel bone. Your Achilles pain will typically be most prominent during or after running. It may be accompanied by stiffness when flexing your foot. While the causes of Achilles tendinitis are very similar to that of plantar fasciitis, we see this occur most often with sudden increases in intensity or duration of training. Particularly, this happens when your body is not adequately prepared.

A gradual increase in training load, regular calf strengthening and stretching exercises, and proper warm-up and cool-down regimens can go a long way in preventing Achilles tendinitis. Be cautious of your footwear as well. Minimalist running shoes have become extremely popular. But, if you move into them too quickly, your Achilles tendon could become irritated due to the sudden change in load and force. If you’re already suffering from Achilles tendinitis, the treatment is quite similar to that of plantar fasciitis. The exception is that when it comes to tissue loading, you’ll want to focus more on your lower calf and Achilles tendon, versus the plantar fascia.

With all of these conditions, keeping yourself healthy and in good shape is crucial for prevention.

Enlisting the help of a running coach is also a good idea. They can address any potential issues with your running mechanics that may have occurred over the years. If you’re picking up running for the first time, or returning to it later in life, take it slow and easy. Consider talking to a movement expert who can detect and analyze any imbalances in your body. They can ensure that you’re moving and exercising correctly. Imbalances will cause you to compensate. This is not something that will be immediately obvious to you – until it’s too late.

plantar fasciitis

Best Treatments for Persistent Plantar Fasciitis – According to Science

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Ever had nagging foot and heel pain that’s so bad it feels like you’re walking around on glass? Yep – that’s called plantar fasciitis – and it impacts over 2 million individuals in the United States every year. 

Plantar fasciitis occurs when you have inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot.

Your plantar fascia is responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you suffer from plantar fasciitis – it’s not only annoying and painful – but can be quite debilitating. It keeps runners from running, walkers from walking, and eventually will cause problems up the kinetic chain (think knees and hips) when left untreated. Typical treatments for plantar fasciitis include everything from rest, ice, cortisone shots, orthotics, braces, exercise, and stretching. 

But which treatments are best? 

Depending on who you ask – you’ll get a lot of different answers – so let’s see what the science and research says. 

Cortisone Shots:

While there is plenty of evidence to support the use of cortisone shots for reducing pain and inflammation – it’s important to consider the consequences of how cortisone works. When you’ve got damaged, painful tissue from overuse or overstretching – such as what can occur with plantar fasciitis. The cells in your tissue respond by releasing certain factors designed to recruit blood vessels, stem cells, and healing factors. The inrush of these fluids causes temporary swelling and pain, but it also stimulates the laying down of new collagen. Collagen, a naturally occurring protein in your body that helps tissue to heal and become strong again. Cortisone works by shutting down this cellular process. Which is great because it stops the swelling and pain from occurring. But by doing so – it inhibits your body’s natural healing process.

This can result in weakened tissue that stays in a weakened state. Leaving you susceptible to repeated and sometimes permanent damage over time, especially if you keep getting cortisone shots. So while cortisone injections may appear to be the miracle quick-fix you’re looking for – it’s crucial you consider the long-term consequences that inhibited tissue healing could cause.

Regenerative Shockwave Therapy:

Unlike cortisone shots, this therapy aids in the tissue-healing process instead of inhibiting it. And there is good research and evidence to support its use with plantar fasciitis specifically. While it’s been successfully used in Europe for decades, it didn’t surface in the United States until around the year 2000. Shockwave Therapy uses acoustic sound waves to stimulate the same natural healing process described above. This can be especially useful in tissue that has already experienced damage. What I like about Shockwave Therapy – is that it’s completely non-invasive – compared to something like platelet-rich plasma (PRP) injections (another popular treatment for plantar fasciitis). With injections, there is always a risk of infection. You don’t have to worry about that with Shockwave Therapy. That, combined with promising evidence for significant pain reduction in as few as six sessions, makes this a wise treatment choice for plantar fasciitis.

Stretching and Strengthening Exercises:

For most musculoskeletal injuries (plantar fasciitis included) the research overwhelmingly supports the use of stretching and strengthening as an effective and long-lasting means of treatment. So why does this approach fail so often? And make us quick to resort to injections, surgery and other types of medical procedures to resolve musculoskeletal-related pain? The biggest problem I see is not with the stretches and exercises themselves, but with exercise prescription. That’s why you can’t just go to Google or YouTube and look for “the best exercises for plantar fasciitis”. Finding great and appropriate exercises isn’t the issue.

The problem is that you won’t know when and how to perform them – and you risk making your plantar fasciitis worse or resorting too quickly to a more invasive treatment option because you think the exercises just didn’t work. With plantar fasciitis specifically, the type of stretching and exercise you choose has to match the stage of tissue healing. You have to load the tissue just enough to cause the appropriate amount of tissue damage that will elicit remodeling of tissue fibers – but not so much that you elicit an inflammatory cycle, which will disrupt the remodeling process. The only way plantar fasciitis truly heals is through remodeling the damaged tissue. And this requires a perfectly prescribed stretching and exercise protocol – which can take up to 7-9 months to work.

So be cautious of the quick fixes, work with an expert, and be patient in this process – because stretching and strengthening really do work when done correctly for Plantar Fasciitis.

In the battle against plantar fasciitis, a prescribed combination of stretching and strengthening exercises, along with non-invasive passive modalities that work to enhance your body’s natural healing process tend to be the most effective. Stay away from ice, rest, and other invasive procedures that disrupt healing or interfere with tissue remodeling.  If your plantar fasciitis is chronic, understand that there’s still hope, but it may take some time. My advice is to talk with an expert who is up to date on the latest research, and who has a good understanding of tissue healing and remodeling.

Because ultimately – the best treatment for plantar fasciitis must involve a combination of these two things. 

Local to Portsmouth, NH? Discover how regenerative shockwave therapy can help! CLICK HERE to learn more and start your journey of pain relief.

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 to inquire further about Shockwave Treatment, CLICK HERE to talk to one of our specialists or call 603-605-0402

Shockwave Therapy

What is Regenerative Shockwave Therapy and Should You Consider it?

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What is Regenerative Shockwave Therapy and Should You Consider it?

If you’ve been reading my articles for awhile – you’ll know that I’m generally not a huge fan of passive modalities – especially when used in isolation. However, every now and then one comes along that grabs my attention. A few months ago – Shockwave Therapy treatment did just that – so I started doing my research…

Shockwave Therapy is a revolutionary, non-invasive treatment protocol that utilizes high-energy acoustic (sound) waves to treat chronic musculoskeletal pain conditions, as well as soft tissue/sports-related injuries. To give you an idea of how powerful it is – it was initially used by urologists to treat and break up kidney stones. Over the last few years, the orthopedics and sports medicine practitioners have started to apply the technology in their respective fields, and are happy with the results.

So what is Regenerative Shockwave Therapy and how does it work?

Shockwave therapy – otherwise known by its technical name of Extracorporeal Shock Wave Therapy (ESWT) – utilizes high-energy “shock waves”. These Sound-waves promote and accelerate the body’s own natural healing process. When the shockwave treatment is applied, there is a transference of energy from the shockwaves into the targeted tissue area. This triggers a biological response that helps to aid and accelerate the healing process. The biological responses include stimulation of cell regeneration, improved blood flow, and formulation of new blood vessels (neovascularization). All are designed to speed up soft tissue healing and provide relief from pain. Some folks feel pain relief right away, for others it takes a few sessions. 

Research is still being done to evaluate the full effectiveness of shockwave therapy – but so far we are seeing really good results for persistent, chronic conditions such as plantar fasciitis, tennis elbow, patellar tendonitis (runner’s knee), and shoulder tendonitis. Anytime you have a chronic condition involving tendonitis, the treatment protocol required to get true healing and rehabilitation is highly specific and generally takes 7-9 months. You also want to avoid things like ice and anti-inflammatories because it impedes the healing process. This can be hard for a lot of folks since chronic tendonitis tends to be painful. This is one of the reasons I love Shockwave Therapy. It not only enhances the healing process of tendons and other soft tissue – but it helps to relieve pain at the same time.

Ok – now that you know a little bit more about Regenerative Shockwave Therapy. Is this a treatment you should consider for yourself?

Have you been suffering from a chronic or persistent soft tissue injury or tendonitis? Are the treatments you’re currently trying not quite getting you back to 100% as fast as you’d like? Then this might be something valuable to add into the mix. It could very well be the missing link needed to give your soft tissue healing the boost required to get you over the hump you’re currently at.

Another great reason to consider trying Shockwave Therapy is that it’s very safe and completely non-invasive. It doesn’t require any kind of incision, use of  anesthesia, or needle punctures such as with steroid injections. This significantly reduces the risk of any type of infection or complication after your treatment. Plus, the treatments are short. They only last about 15-20 min to get significant pain relief and powerful tissue healing.

The last thing I’ll say about Shockwave Therapy is that although it’s very safe and designed to reduce pain, there can be some short-term pain and discomfort associated with this treatment. As well as temporary skin redness and minor swelling. For those with extremely low pain tolerance, this treatment can take some getting used to. Shockwave Therapy is also very noisy. The treatment is administered through a handheld device that pulses and makes a noise throughout the duration of your session. That – combined with potential temporary pain/discomfort – causes some to shy away from giving Shockwave Therapy treatment a try. But luckily the treatments are short, so it makes these minor adverse side effects more tolerable.

So, if you haven’t yet heard of Regenerative Shockwave Therapy, hopefully this helps you have a better understanding of what it is.

And most importantly, decide for yourself if it’s something worth considering. Especially if you’ve been suffering with a persistent soft tissue or tendon injury for quite some time. While it’s not a miracle cure by any means, I have seen fantastic results since beginning to incorporate this technology into my own practice. I like it because there’s a lot of scientific evidence to support its efficacy. Plus it’s a safe, non-invasive alternative to so many other pain-relief techniques that is designed to leverage the body’s own natural healing response.

Are you a local to Portsmouth,NH? CLICK HERE to learn more about the benefits of Regenerative Shockwave Therapy and how it can support your overall well-being.

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 learn more about Shockwave Therapy, CLICK HERE to talk to one of our specialist or call 603-605-0402.

orthopedic surgery

Three Science-backed Reasons not to Rely on Imaging for Orthopedic Surgery

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Approximately 7 million people undergo an orthopedic surgery each year in the United States. Topping this list are elective procedures (meaning they are not life threatening or urgent) such as ACL reconstruction, total hip and knee replacements, arthroscopic surgery (meniscus repairs, shoulder decompression, etc), and spinal fusions.

Now, what if I told you that of the top 10 elective orthopedic surgeries performed, only one (carpal tunnel syndrome) has real evidence to support that surgery will have a better outcome than conservative care. A recent study published by scientists in the UK hospital system and National Health service reviewed thousands of published studies in an effort to find out if orthopedic surgery was truly better than conservative care or placebo procedures. They found that sadly, thousands of patients are undergoing invasive procedures every year with known associated risks and complications. All while there was an equal or better alternative.

One of the biggest reasons this happens is because people rely on imaging (X-rays, MRI’s, CT scans) to determine whether or not they need surgery. Don’t get me wrong, this incredible technology has revolutionized the field of medicine and orthopedics. The problems occur when we fail to look at the full picture (no pun intended) and rely on images alone to make important decisions about our musculoskeletal health.

Here are three science-backed reasons not to rely on imaging alone when considering orthopedic surgery:

 

1. Imaging does not always correlate with symptoms

One of the most fundamental reasons why imaging alone should not dictate your decision to get orthopedic surgery is the well-documented lack of correlation between image findings and actual symptoms. 

Studies have shown that 20-25% of all people will show a bulging disc in their spine on MRI. This happens even when they don’t have any back pain. At least 50% of adults over the age of 50 will show torn meniscus or cartilage in their knees and feel completely fine. In 2013, The New England Journal of Medicine published a study that found one-third of participants with no knee pain had “abnormal” results in their imaging. This was while one-half of the participants who actually experienced knee pain had completely clear scans. 

We have to start normalizing what aging actually looks like on a scan. Just because you’ve got a bulging disc, torn cartilage, or even “bone on bone” arthritis – it doesn’t mean you need to rush into the operating room.

2. Risk of Over-diagnosis and Overtreatment

Overdiagnosis refers to the identification of conditions that aren’t actually causing symptoms or harming a patient. The biggest culprits here include spinal stenosis, joint arthritis, and degenerative joint conditions. One notable study from 2017 published in PLUS ONE, a peer-reviewed mega journal, found that at least 20% of arthroscopic knee surgeries were overdiagnosed and subsequently overtreated. How did they now? Because even though their scans showed things like “wear and tear” and torn cartilage, they had no relevant dysfunction or clinical findings. The only thing indicating they needed surgery was the overdiagnosis of normal aging in their knee.

A particularly sad story comes to mind as I write about this. I recall treating a man with spinal stenosis who was told by his doctor he needed steroid injections to calm the inflammation in his back. He had 6 weeks until his injections, and during that time, we were able to decrease his pain by about 80%. Since it’s impossible to reverse or stop spinal stenosis without surgery (because it’s related to wear and tear as you age), I knew that his pain was being caused by other unrelated factors. But following doctor’s orders, he still went through with the injections. Unfortunately, he had a bad reaction to the injections that left him worse off than when he started with me. His over-diagnosis of spinal stenosis led to a cascade of over-treatment and worse pain than when he started. 

3. Non-surgical treatments can be equally effective (if not better)

Orthopedic surgery should really only be considered as a last resort. No matter how routine or “non-invasive” the surgery is, there are still risks of infection and complication, and you want to avoid those at all costs. The problem with conservative treatment is that it takes longer to get to the same (or better) result. And let’s face it, we live in a quick fix world and rarely have patience for this, especially when you’ve got a scan that seems to say otherwise.

Study after study shows that arthroscopic knee surgery (in particular) has the same or better results when treated conservatively (physical therapy and exercise). In fact, when you get arthroscopic surgery on your knee, it increases the likelihood you’ll need a total knee replacement. With back surgery, we know that in the first year or two, your pain will be better or gone. But by year 2-3, if your symptoms haven’t crept back in yet, you’ll feel just as good as your peers who forewent surgery. But after year three, your back pain symptoms tend to return, and you’ll often feel worse than your friends who decided to take the conservative approach from the get-go.

The research continues to support that 70-80% of all musculoskeletal pain is mechanical in nature. Mechanical problems have to do with movement dysfunction and lifestyle/postural habits. They don’t show up in a scan, and they are best treated conservatively. When you see something on an image, it’s better to assume it’s irrelevant and that you fall into the 70-80%. This will protect you from being overdiagnosed and help you avoid potentially unnecessary procedures and surgery. Pay attention to your pain, symptoms, and overall function – they tell a much better story than your images.

Are you local to Portsmouth, NH?

Consider seeing one of my Specialists – they’re experts in mechanical pain. In a free Discovery Visit 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. It’s a no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health. Whether that’s working with us or not!

CLICK HERE to request a Free Discovery Visit.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

Pickleball

Six Reasons to Try Pickleball this Father’s Day

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If you’re looking for something fun and active to do this Father’s Day – why not try a game of Pickleball?

If you haven’t yet heard of pickleball – it’s quickly become one of the most popular racket sports in the country. It’s a paddle sport that combines elements of tennis, badminton, and ping-pong. Since the rules are fairly straightforward, it tends to attract people of all ages and skill levels – but it’s been a huge hit in the over-50 crowd. You can find both outdoor and indoor courts just about anywhere – and it provides a fantastic opportunity for the whole family to engage in a fun-filled day of friendly competition – while also honoring your favorite active dad.

Pickle ball also comes with a ton of health benefits. 

Here are 6 of my favorite reasons why pickleball is good for your health – and why I think you should give it a try this Father’s Day:

1. Get’s the Heart Pumping:

Since Pickleball is a dynamic sport – it keeps you on the move – making it an excellent cardiovascular workout. When you play pickleball regularly – it can improve heart health, increase endurance, and strengthen your cardiovascular system. Pickleball consists of both aerobic exercises as well as bursts of anaerobic activity – such as quick sprints and lunging on the court. This helps to elevate your heart rate in a way that is great for promoting overall hearth health and cardiovascular fitness.

2. Weight Management:

Everyone knows you need both diet and exercise to effectively manage your weight. When it comes to exercise – why not pick something fun that you know you’re more likely to do because it’s enjoyable. The continuous movement involved in the sport of pickleball helps to burn calories and increase your metabolic rate. But it’s not just cardio that pickleball is known for – there is a strength component too. This combination of both strength and cardio only adds to your calorie-burning – making it not only fun – but an efficient way to manage your weight.

3. Improved Balance and Coordination:

Pickleball requires you to move quickly, change direction, and react to the ball’s trajectory. These dynamic movements help to improve balance and coordination because they force the engagement of multiple muscle groups at once. When you have to anticipate shots from any angle, pivot at a moment’s notice, and reach for the ball – this helps to enhance something called proprioception – your body’s ability to sense position in space. Since pickleball is super popular with the over 50 crowd, anything that works on balance and coordination is something I support – since these two areas only tend to decline as you age.

4. Increased Strength and Endurance:

When you play pickleball – you have to do everything from swing the paddle, lunge at the ball, and reach for shots. These varied physical movements help to engage just about all the muscles in your body – particularly your arms, shoulders, legs, and core. When you play pickleball regularly – it’s going to lead to improved muscular strength and endurance. Plus, pickleball is generally low-impact – so you get to improve your strength and endurance while not having a huge negative impact on your joints.

5. Cognitive and Mental Benefits:

The strategic aspects of pickleball – such as shot placement, anticipating your opponent’s moves, and the adaptation to different playing styles – challenges your brain and enhances mental agility in a fun and active way. For example, just the hand-eye coordination required to track the ball and make split-second decisions sharpens your cognitive skills and improves your reaction time to things. When you play pickleball regularly – you’ll find that your focus, concentration, and overall mental well-being will simply improve.

6. Social Interaction and Emotional Well-being:

This is probably my most favorite health benefit of pickleball. For the younger crowd (30’s and 40’s) – it’s quickly becoming one of the hottest business and networking events out there. And for everyone else, it’s a fabulous social sport that encourages interaction and camaraderie. Regardless of who you play with – whether it be friends, family, or in a community league – pickleball fosters a sense of belonging and enhances social connections. Plus, the positive connections you find on the court can easily extend off the court – so it becomes a fun and active way to quickly expand your social circles and overall well-being. Your new pickleball buddy could suddenly double as your gym and walking buddy too.

So there you have it – six healthy reasons to try Pickleball if haven’t already.

And why not use Father’s Day as the perfect excuse to to make it a family affair. With any new activity, there’s always a risk of injury, so make sure you warm-up properly and go into  it with ease – especially if it’s your first time. And if you’re currently suffering from an injury that is keeping you from wanting to even try this super fun and accessible sport – consider talking to a movement or mechanical pain expert who can help you sort out what’s going on.

Are you local Portsmouth, NH?

Consider speaking to one of my specialists. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

CLICK HERE to request a Free Discovery Session with one of my specialists.

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 request a free copy of one of her guides to back, knee, neck or shoulder pain, visit her website www.cjphysicaltherapy.com or call 603-605-0402

morning neck pain

Three Causes of Morning Neck Pain and What to Do

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Waking up with morning neck pain puts a huge damper on your day right from the start. While neck pain may not be at the top of the list when it comes to debilitating musculoskeletal problems (aka people tend to just “live” with it) – it still impacts between 10-20% of the population at any given time – so it’s worth discussing. 

One of the most common problems I see with those suffering from neck issues is that seemingly out of nowhere they can go to bed feeling great – but wake up with a stiff and painful neck that can last up to a day or two. When this pattern starts to repeat itself and goes on for too long – you can end up with a chronic neck problem that doesn’t just show up in the morning – but will start to impact your day-to-day life and get in the way of things you love to do.

Here are Three Common Causes of Morning Neck Pain and What you can Do:

1. Sleeping position

Any joint – including those that make up your neck – will feel strained after being in a prolonged position for too long. In a healthy, uncompromised neck – this is fine if it happens on occasion. But if it’s happening once per month or more – it’s time to address your sleeping position.

Those that like to sleep on their stomachs, or with multiple pillows under their head, are going to have the biggest problems. When you sleep, you want to get your neck as close to what I call a “neutral spine” as possible. That means your neck feels relaxed, maintains its natural curves, and your ears, neck, and shoulder will be aligned on top of one another.  I find the best way to achieve this is by sleeping on your side – or on your back with just one pillow. If you’re a multi-pillow type of person – make sure you’re using the second pillow to hug and support your arm – or in between your legs – not underneath your head.

2. Clenching Your Teeth

While many people tend to associate clenching your teeth with TMJ – or jaw dysfunction, it can cause neck problems as well. When you clench your teeth, you’re also tensing the muscles around your neck. If you do this every night, and for prolonged periods, your neck is going to become very unhappy and start to have problems of its own.

Many folks are unaware they are clenching their teeth at night. But some signs this could be happening to you  include tense or fatigued jaw muscles in the morning, walking up with headaches, or a stiff and painful neck and shoulder when you first wake up. Clenching teeth is often a reaction to stress – so having a good end of day routine could really help with this problem. Be sure to shut off TV and electronics at least one hour before bedtime. Practicing some meditation and/or relaxation breathing just before bed could help too. If all else feels, a night guard could help as well. It won’t stop you from clenching completely, but it will protect your teeth and could minimize your neck pain.

3. A Bulging Disc

This isn’t spoken about too often, but if you’ve got a bulging or problematic disc in your neck – this could be the reason you’re waking up with a stiff and painful neck in the morning. When you lie down and “unload” your spine for a period of time – such as at night while sleeping – our intervertebral discs hydrate and actually get larger. If you wake up with a sudden movement – this could be all it takes to “pinch” that disc and cause your neck to feel “locked up” and with sudden pain.

Now, don’t feel like you need to go running to the doctor for an MRI to figure this out. It’s not necessary. Most people have bulging dics occurring normally as they age throughout their entire spine. They only become a problem when you don’t take care of your spine. When it comes to your neck, the biggest risk factors for turning a normal bulging disc into a painful and problematic one include behaviors such as looking down at your phone, tablet, or computer for too long and not being respectful of the fact that a healthy neck needs to move in all directions – not just forward and down. Doing some simple chin tucks frequently throughout the day and making sure your upper back stays flexible can go a long way in preventing (normal) bulging discs from becoming a problem.

I hope these tips help shed some light on why you might be waking up with morning neck pain and most importantly – what you can do about it. If you try some of these remedies and still find yourself unsuccessful – then it’s time to talk to a mechanical pain expert. There’s no need to rely on pain pills or expensive tests and procedures to resolve morning neck pain. Most of the time, problems like I’ve just described can 100% be resolved naturally and with the right “movement therapy”.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you.

It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

Click here to book a free Discovery Visit.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Treat the cause not symptoms

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Have you ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge?  Or place grocery bags on the counter?  You were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade.

This can occur for a number of reasons…

You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder. If this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation. You may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions.

This is more commonly known as shoulder impingement.

With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally.

The tempting and easy fix is to get a cortisone shot to calm the inflammation.

But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good.

The cortisone will temporarily mask your problem. It will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better. But, unless you address the reason for the crowded space, your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back.

For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned.

With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time. Or, more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.

Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury. The result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back FIRST.

If there are poor postural habits there, your shoulder will undoubtedly be impacted.

If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon).

Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it.

None of these solutions will give you the long-term solution you’re looking for.

The very last thing you want to do is choose passive treatment interventions or procedures. These either mask the pain or prolong the problem because they only address symptoms.

You want to do everything possible to preserve the integrity of your tendon. The best way to do that is by optimizing the mobility and strength around your shoulder joint first. Do this before resorting to more aggressive measures like cortisone or surgery.

Are you currently suffering from shoulder pain (or anything else) that is keeping you from doing things you love?

Are you contemplating surgery or a cortisone shot because you have been told it’s your best and only option?

Let me know and let us help!

We’re happy to provide a second opinion for you.

We will examine your shoulder and see how it responds to certain movement tests. Then we’ll be able to tell you – and show you – if your problem can be resolved naturally with movement instead of a procedure like a cortisone shot or surgery.

Our patients find that if they end up needing a procedure (which is rare) – they do so with peace of mind. This is because they’ve exhausted a natural, movement-based solution with us FIRST.

If you want to talk to us and see if what we do is right for you – CLICK HERE to request a Discovery Call with my client success team.

They’ll let you know if we can help and get you on our schedule as quickly as possible!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Neck stretches

3 Reasons Your Neck Stretches aren’t Working

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If you suffer from chronic neck stiffness or even pain – and you’ve done your due diligence when it comes to neck stretches – it’s time to consider you might be missing something.

It could be your stretching technique, you could be doing the wrong stretch altogether, or it could be that you shouldn’t be stretching your neck at all…

Let’s go over three reasons why your neck stretches might not be working and help you pinpoint where it’s going wrong…

 

1. You’re using the wrong stretching technique.

Although research studies are inconclusive regarding how long you should hold a particular stretch, most people feel good when they hold a stretch for 30-60 seconds. When it comes to technique, one of the biggest problems I see is not relaxing enough. If you’re tense, or gripping your muscles at the same time you’re stretching, it won’t work very well. It’s important to breathe and move easily into the stretch. If you try to force it or push through pain, you’ll likely tense up.

Now let’s say you’re doing everything right (not tensing or gripping) but your stretches still don’t seem to work. Some people (myself included) respond better to “moving stretches”. This is where instead of holding one static position for a prolonged period, you repeatedly move through one (or several) end-range stretches. Neck rolls are a great example of this. If your neck stretches haven’t been working, try adjusting the way you’ve been stretching. If you notice a difference right away then you have your answer – you were likely using the wrong stretching technique.

2. You’re doing the wrong type of stretch.

This one could be a little tougher to figure out on your own. There is a difference between corrective neck stretching and stretching to feel good.

For example, let’s say your neck is tightening up because you’ve been under a lot of stress or you just did a lot of activity that stressed your neck out. Generic neck stretches such as bringing your chin to your chest, or pulling your chin to the opposite shoulder (known as an upper trap stretch) may be all you need.

In fact, I do stretches like this regularly because I’m constantly leaning over to help patients. I stretch my neck to PREVENT it from having problems and because it feels good. But let’s say you already have a neck problem, or you have pain or numbness running down your arm. In these instances, generic neck stretching could make you worse. You likely need corrective stretches for your neck. Corrective stretches are specifically prescribed to address a particular problem, and prescribed at a specific frequency. They are different from the generalized stretches that are designed to feel good and relieve tension.

3. You shouldn’t be stretching your neck at all.

This is a very common problem we see here in our office. Folks come in with complaints of chronic tightness and discomfort in their neck and no matter how often they stretch or massage, it doesn’t go away.

Did you know that chronic neck tightness can be a sign of a weak core?

It’s quite common, and if that is the case for you, no amount of stretching will help (and can even aggravate your problem!) The deep, stabilizing muscles of your neck are connected by fascia to the deep muscles of your core. If your deep core is not working properly, then your neck will often kick in and try to help.

Ever notice that your neck is always sore or tight after a good ab workout?

This could be a sign that your neck is compensating for your core. Stop stretching your neck, learn how to strengthen your core the right way, and see a specialist who can help you.

If you’re dealing with chronic neck problems that aren’t responding to stretching, there’s a good chance you could be not stretching correctly, the stretches aren’t right for you, or you’ve completely missed the root cause of your neck pain and you shouldn’t be stretching at all.

Consider talking to a movement specialist who understands how to figure this out so you can get rid of your neck pain and back to all the activities you love!

Are you local to Portsmouth, NH?

Book a free discovery visit with one of my specialists HERE.

They will ask you all about what’s been going on – and help you make the best decision moving forward – whether that’s working with us not!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

Shoulder Pain

Persistent Shoulder Pain could mean Misdiagnosis

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Persistent Shoulder Pain could mean Misdiagnosis

We’ve been hearing a lot of complaints lately about shoulder pain. Your shoulder joint is one of the most complex and mobile joints in your body. It’s made up and supported by an intricate structure of bones, tendons, ligaments, muscles and connective tissue. They all work in unison to keep it functional.

You’ve got the head of your shoulder joint (looks like a round ball) inserting into a socket within your shoulder blade (your “wing”). This makes up your shoulder joint and is supported by a joint capsule, ligaments, and your rotator cuff muscles.

Surrounding and supporting your shoulder blade and shoulder joint is your cervical and thoracic spine. (neck and upper back). This has both large and small muscles helping to support your ability to push, pull, reach, and raise your arms overhead.

Intertwined within all of that is a delicate web of nerves and blood vessels… No wonder shoulder pain can be a challenge to treat – never mind diagnose.

If you see your doctor about shoulder pain, they will typically want to take a closer look via X-rays and/or MRI’s. X-rays will show you all the bony parts of your joint – to see if anything is broken and check for arthritis. MRI’s will see if anything is torn or worn away, such as rotator cuff or labral tears.

Relying on imaging to diagnose your shoulder pain can be tough. Or any joint pain for that matter.  It’s entirely possible to have arthritis, a torn rotator cuff, or torn labrum – and still have a perfectly functioning shoulder. The problem is we only get things looked at when we are in pain. So, there is no way to know for sure if you’ve had these “abnormalities” already, and if they are the true reason for your shoulder pain.

For example, it’s estimated that between 20-50% of people over aged 50 have “asymptomatic rotator tears”. Meaning – they walk around with a torn rotator cuff and have zero pain in their shoulder. Just because an X-ray or MRI says so – doesn’t mean it is so. And it’s a big reason why so many folks suffer unnecessarily with persistent shoulder pain.

If I meet someone with shoulder pain that hasn’t gone away – the first thing I question is whether or not we have the correct diagnosis. With shoulders, misdiagnosis is all too common given the complex nature of the joint and surrounding structures.

Here are some clues to help you figure out if your persistent shoulder pain has been misdiagnosed:

 

Where is your pain?

When pain is coming from the shoulder, the pain will typically be felt directly in three places. In front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) down the side of your upper arm. But it will never go below your elbow. If the pain goes past your elbow and into your forearm or hand – radiates above your shoulder into your neck (the upper trap area) – or deep inside your shoulder blade or middle back – odds are pretty good you’re dealing with a neck problem – and not just a shoulder problem.

If you don’t address your neck, your shoulder pain will continue to persist. I can’t tell you how many people I’ve seen get unnecessary rotator cuff surgery because of this misdiagnosis.

Have you lost mobility in your shoulder?

Lack of mobility is a common symptom associated with a rotator cuff injury or the dreaded “frozen shoulder.” These are, indeed, shoulder problems. So if your pain is persisting, you probably have the correct diagnosis, just the wrong treatment approach.

However, one overlooked area when it comes to shoulder stiffness is your middle back (thoracic spine). If your thoracic spine has mobility restrictions – or even weakness that leads to stiffness (our joints stiffen up to compensate for weakness/instability) – it will impact your shoulder joint. Stiffness in your thoracic spine can inhibit your shoulder mobility. Over time, this lack of mobility will irritate structures within your shoulder joint, causing pain.

If you’ve got persistent shoulder pain and feel like you’ve tried everything, get your middle back checked out. This could be your misdiagnosis.

Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening – it’s likely coming from your neck or upper portion of your middle back (cervicothoracic junction). It could be due to a bulging disc or a restricted/faulty movement pattern that is irritating nerve roots (or discs) in your spine. An isolated shoulder problem typically does not involve nerve root compression or irritation. Sometimes certain trigger points in your rotator cuff muscles can refer pain. But this usually feels quite different from what I’m referring to.

Do you consistently feel pain, numbness, tingling or burning in your shoulder blade, middle back, or down your arm? Especially if it seems to move around during the day? Then it’s likely not a shoulder problem. In the medical world we call this presentation “cervical radiculopathy”. If you continue to experience persistent shoulder pain and you’ve got any of the symptoms I just mentioned, this is probably your misdiagnosis.

Confused? I don’t blame you.

The moral of this story is that if you’ve got persistent shoulder pain and given treatment your best shot, then you’ve likely been misdiagnosed. Shoulder pain loves to disguise itself as a spine problem (neck and/or middle back) even when you don’t feel pain in your spine.

Whatever you do, don’t resort to any surgery or major procedures until you’ve thoroughly explored these areas with a mechanical pain expert who knows where to look.

If you are local to Portsmouth, NH…

Consider reaching out to one of my specialists by requesting a free discovery visit HERE. They will ask you all about what’s been going on – and see if we would be the best fit to help you.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

tight hips

Tight hips? Try strengthening instead of stretching.

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When you’ve got tight hips, it can interfere with your ability to enjoy walking, running, golfing, and just exercise in general.

Tight hips are not only annoying and achy, but they often contribute to lower back pain as well. But perhaps more frustrating than the tight hips themselves is the fact that no matter how much stretching you do – they never seem to loosen up. Typically when I hear this, it’s a big red flag for me that tight hip muscles aren’t actually your problem.

In other words, just because it feels like you’ve got tight hips – doesn’t mean they actually are tight.

 

Let me explain.

Your hip muscles can literally be shortened and constricted – in which case – they need lots of stretching. But they can also be “tight” due to weakness or being overworked. When muscles are overtaxed or undertaxed during an activity, they aren’t going to function well and they will find a way to compensate. And this compensation strategy can lead to chronically tight hips over time.

But here’s the thing…

When your hips are tight due to weakness and overcompensation, stretching will not help. Stretching might feel good in the moment, or give you temporary relief, but the tightness in your hips will continue to return until you identify and fix the real underlying problem.

Let’s take your psoas (one of your hip flexors and pelvic stabilizers) as an example to illustrate this concept…

Your psoas is one of your deep hip flexors that also has a connection to your lower back. Although it is capable of flexing (bending) your hip in some capacity – it has more of a stability role. When functioning properly it will assist in exercises like the crunch or sit up, and also work alongside your deep abdominals and glute muscles to help you maintain good upright posture when you’re sitting or standing.

Unfortunately the psoas gets blamed for a lot of things – most notably – tilting your pelvis forward because it’s “tight” and causing lower back pain. The theory is that if you stretch, massage, and “release” your psoas muscle, then you will balance out your pelvis, and your back pain and hip tightness will disappear. But sadly, this is rarely the case. More often than not, your psoas is tight because it’s overworking to compensate for your deep abdominals/core not working properly.

Do your hips ever cramp or feel achy during abdominal work?

Your inclination will be to stretch them but this will simply not work. You have to get your abdominals and deep core to start working properly so that your psoas can actually relax. Once your hip flexors are no longer doing all the work, they won’t feel tight anymore.

This concept of tightness due to overworking and compensation can happen to any muscle in your body. With hips in particular, your psoas along with your piriformis and TFL (tensor fascia latae) are the most common victims. We’ve already spoken about your psoas, but your piriformis and TFL love to compensate for weak gluteal (butt) muscles.

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 this story is that if you’ve got chronically tight hips and stretching all the time isn’t solving your problem, then consider a different approach. Most people don’t consider strengthening an area that feels tight but this could be what you’re missing.

When it comes to hips – the things to look at are your deep abdominals/core and your glutes/butt muscles. Often there’s an underlying weakness in one or more of these areas that you just can’t recognize. Do yourself a favor and talk to an expert who gets this.

Are you local to Portsmouth, NH?

Consider reaching out to one of my specialists by requesting a free discovery visit HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].