Failed Knee Surgery

Knee Surgery Gone Wrong? It’s More Common Than You Think.

/in , /by

Arthroscopic knee surgery is one of the most common surgeries performed. Despite research telling us that it’s not nearly as effective as most people are led to believe.

Science tells us that people who do undergo arthroscopic knee surgery are likely to have knee arthritis that advances rapidly. This results in a total knee replacement that you could avoid.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint. It’s done if  you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

Well… it is until it isn’t.

The big problem is that arthroscopic knee surgery is not necessary for most cases of knee pain.

If there is a complication – which there are many even with “minimally invasive” procedures – you could end up being worse off than when you went in.

Plus – if you never even needed the surgery to begin with – you just put your knee through unnecessary trauma that you’ve got to now heal from. This further delays you from addressing the root cause of your knee pain.

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

An early research study from 2002 by JB Moseley and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery.

Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment.

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery more than ever?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain. If you’ve gotten physical therapy and it wasn’t effective, people believe that the physical therapy “didn’t work”.

But more often than not, you just haven’t found the right physical therapist yet – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery.

And then there’s the elephant in the room…

It’s very common for knee pain to be coming from somewhere other than your knee. Knee pain can come from your ankle, hip, or back. One study showed that 40% of the time – knee pain is caused by your back – even when you don’t have any back pain.

MRI’s add even more confusion to this. It’s entirely possible to have degenerative changes, a torn meniscus, or advanced arthritis in your knee – and still have your knee pain stemming from a source other than your knee.

Over the course of my 20 year career, I’ve seen many knee surgeries go wrong.

Most of the time, it has nothing to do with the procedure itself. It has everything to do with an incorrect diagnosis going in. Say your knee pain can be resolved conservatively. Then you put it through unnecessary trauma (surgery). There’s a good chance you’re going to have more problems afterwards. You get knee surgery when your knee problem isn’t even coming from your knee. Then you’re definitely going to have problems afterwards.

The moral of this story is to make absolutely certain that:

1) Your knee problem is really a knee problem and

2) You’ve fully exhausted all (quality) conservative therapy options before going under the knife.

Remember that 70% of all knee pain cases do not need surgery.

Science has proven this. Don’t resort to knee surgery unless you’re 100% sure you really need it. Because it can go wrong and when it does – it’s much harder to come back from then if you had avoided it to begin with.

Want help with your pain now? CLICK HERE to talk to one of my specialists for free – you can tell them all about your knee pain and we’ll let you know if we can help. 🙂

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 her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

Holding Knee with Arthritis

Three Tips to Protect Your Knees From Arthritis

/in , /by

Knee arthritis is one of the most common forms of osteoarthritis.

Knee arthritis accounts for more than 80% of all osteoarthritis and impacts at least 19% of Americans over the age of 45.

For many, a diagnosis of knee osteoarthritis leads to chronic, debilitating knee pain that stops them from doing all of their favorite activities. Sometimes it’s simply due to the limiting belief that once you have arthritis – you’ve got “bad knees” for life.

Other times it’s because you’ve been told you have “bone on bone” in your knee and there’s nothing you can do – except to scale back on activity so that you don’t make it worse. This line of thinking is flawed and often leads people to unnecessary procedures and surgery. One of the best things you can do to protect your knees from the debilitating effects of arthritis is to keep moving.

Here are three tips to help you protect your knees from arthritis as you age – so that you can keep doing all of your favorite activities and avoid any major procedures or surgery:

1. Strengthen Your Hips and Core

Your knee joint is situated just below your hips and core. And research has shown that when you have poor control of your upper leg muscles – you get more stress through your knee joint.

The strength of your upper leg muscles is very much dependent on your hip and core strength. Your thigh bone – or femur – connects your knee and your pelvis – and your core strength controls your pelvis.

If your pelvis isn’t stable – your femur is going to have a difficult time staying in alignment – which will ultimately have an impact on your knee joint. If you’ve got arthritis in your knees, it’s critical you minimize any added stress to your knee joints.

Strengthening your core and having good hip strength is going to help prevent and minimize the symptoms of arthritis and keep you doing activities you love longer.

2. Keep Your Knees Mobile

Mobility before stability is my mantra.

And I say this for just about every joint in your body. But it’s especially true for your knees. There are joints whose primary function is stability – and there are those whose major function is mobility.

Your knee needs to be mobile.

Its major purpose is to bend all the way so you can squat and pick things up – and it needs to straighten all the way to give you stability when you need it. When either of these motions are lacking – your ligaments and surrounding muscles will suffer.

A lot of folks just “accept” that their knees are stiff – especially if you’ve been told you have arthritis in your knees. The limiting belief is that stiffness is par for the course. But the truth is that if you keep your knees mobile as you age – you can not only maintain the mobility you have but improve what is lacking.

If your knees are stiff – start moving them. The thing to understand about arthritis is that it’s a normal part of aging. Debilitating mobility is not. Even a 10% improvement in your knee mobility – which can happen even if you’ve got arthritis – will result in huge improvements in your knee function.

It can be the difference between a natural solution to knee pain vs undergoing a major surgery like knee replacement.

3. Don’t Stop Your Activities

When people find out they have arthritis – and especially if they’re in pain – they often think that slowing down or stopping activity will help protect their knees.

This couldn’t be farther from the truth.

Study after study – including one from the Center for Disease Control – shows that severe joint pain among adults with arthritis is worse with inactivity. When you remain active, you keep blood flowing, your knee joints mobile, and your muscles strong. These are very important factors in managing your arthritis. Sometimes, the knee pain you feel when you’re doing certain activities has nothing to do with your arthritis. Statistics show that only 15% of patients with evidence of knee osteoarthritis on X-ray even had symptoms.

That means that the other 85% is walking, biking, and running around enjoying their most favorite activities – despite the fact their X-ray showed arthritis too. The point here is to keep doing your activities – whether you’ve got arthritis already or not – it’s one of the best ways to prevent and protect your knee joints as you age.

So – to review…

If you want to optimize your knee health as you age – which you still can even if you’ve been told you have “advanced arthritis” – prioritize your core strength, the mobility of your knees, and stay active.

Focusing on these three things can have a significant impact on how arthritis affects you – and can help you avoid major (often unnecessary) surgery in your future.

Is knee pain keeping you from doing your favorite activities? Are you considering a major procedure or surgery but not sure if you need it?

Join us on Tuesday Oct. 25th from 6-7pm for our Free Masterclass for Knee Pain Sufferers.

Sign up using this link —> Knee Pain Masterclass.

We hope to see you there!

Can’t make it live? All participants will receive a complimentary replay of the class 🙂

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 her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

Man getting knee pain treatment

Four Reasons Your Knee Pain isn’t Going Away

/in , , /by

Approximately 25% of adults suffer from chronic knee pain and for many, they don’t have a clear reason or diagnosis as to why. They’ve been told to accept that their knee pain is due to arthritis, age, or wear and tear. So why then, are some people able to get rid of their pain with proper knee pain treatment while others continue to suffer? It starts with the correct diagnosis. And for many chronic knee pain sufferers, this is the problem.

Here are four reasons why your knee pain might not be going away:

 

1. Mobility Before Stability

I’m a firm believer in this concept.

Our joints function better when they have full and free mobility. With knees in particular, everyone tends to focus on how well a knee is bending, but a lot of people miss when a knee isn’t fully straightening. Most knees have a certain amount of what we call hyperextension.

For example, your knee might look and feel straight, but if it’s naturally capable of “over-straightening”, and you don’t restore that completely, your knee will have problems.

I see it all the time, especially in folks who’ve had previous knee surgeries. If their full knee motion wasn’t restored properly during rehab, or perhaps they didn’t have any rehab at all (common practice now after most arthroscopic knee surgeries), knee pain will persist, and won’t go away no matter how much you strengthen it.

This isn’t something that can be seen on an Xray or MRI. Only a trained expert who knows how to look for this will be able to detect it, teach you how to restore it, and finally help you get rid of your chronic knee pain.

2. It’s Really a Back Problem

When the source of your pain is truly coming from your knee, it tends to be pretty specific and very localized to the knee joint itself. But if your pain tends to move around your knee, or perhaps travel up and down your leg, there’s a good chance your knee pain is coming from your back.

A recent study found that 40% of all extremity pain (including knees) comes from a source in your spine – even when you don’t have any back pain.

How does this happen? Typically it’s due to an irritated nerve that sends pain primarily to your knee and nowhere else. If you’ve been treating your knee for months and it’s either not going away or perhaps getting worse, consider that your knee problem is not a knee problem. Get your spine checked by a proper movement/mechanical therapist who can screen for this and figure it out.

3. Poor Core Strength

Your abdominals, low back muscles, hips, and glutes all make up what we call your “powerhouse” or core.

We all know that a strong core is important to help prevent back pain. But, it’s equally important for healthy knees. If your core is weak, or doesn’t activate properly, it will have an impact on how fluid your joints will move during activities.

If you aren’t stabilizing yourself well with a strong core, your knees might try to help out by adding stability. Knees aren’t really meant to do this – they are meant to be mobile. But when your body lacks stability, your joints stiffen up in response, which can cause knee pain over time or aggravate arthritis that’s already there.

If your knees chronically ache – especially during activities – this could be why. You can treat your knees all you want, but if you don’t also address the deficits in your core, your knees will continue to hurt.

4. Stiff Ankles

When your ankles are stiff it will have an impact on your knees.

Do one or both of your ankles lack mobility during certain activities? Especially running, hiking, and squatting?  Your knees may strain themselves trying to help out and compensate.

Over time, this pattern will lead to knee pain. Do you notice a lot of stiffness in the front of your ankles? Or pain/fatigue in the front of your lower legs after repetitive walking or running? This could be a sign that the real problem is coming from stiffness in your ankles.

Stop working on your knees and start mobilizing your ankles instead. Your knees should start to feel better in no time. Knee pain can be tricky to figure out – especially if it’s chronic. Arthritis, age, and wear and tear aren’t common reasons for chronic knee pain. But they are definitely reasons that mislead people into thinking they’ve just got “bad knees”.

At least 70% of the time, knee pain can be resolved naturally and with movement – but you must make sure you’ve got the correct diagnosis nailed down first.

Want some help getting rid of YOUR knee pain?

Talk to one of my specialists for free by CLICKING HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a copy of her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

3 Signs Balance Problems are all “In Your Head”

/in , /by

As we get older – balance problems tend to creep up on us.

Everything from poor vision to weak muscles to stiff joints can have an impact on how steady we are on our feet.

Activities like Yoga and Tai Chi are great for improving balance because they help you to focus and become more aware of how your body is moving. Having a strong core and leg muscles are also key.

But what if you’ve been working on all of these areas and your balance problems still haven’t improved?

There’s one other huge contributor to balance and it’s called your vestibular system. It’s one of our three major balance systems and it’s located in your inner ear – literally in your head.

Your vestibular system is responsible for sensing movement and changes in your head position and when it’s not working properly, it will definitely impact your balance.

How do you know if your vestibular system is dysfunctional?

One of the most tell-tale signs is dizziness, commonly known as “vertigo”, and it’s more common than most people think. Approximately 35% (that’s 69 million) of adults over the age of 40 have experienced some form of vestibular dysfunction.

This number gets even higher as we age and recurrence becomes more common with 80% of people over the age of 65. It doesn’t matter how strong you are, or how many times you practice standing on one leg – if your unsteadiness is from vertigo – you remain at a high risk of falling until you get this sorted out.

Vertigo is no fun and it can be extremely debilitating.

While medication can be used to reduce the sensation of dizziness, it tends to only mask the symptoms.

When the medication is stopped many people are faced with the same symptoms they started with.

The most common form of dizziness among older adults is from BPPV (Benign paroxysmal positional vertigo) and is only benign to those that haven’t experienced the debilitating impact it has on your daily functions. BPPV happens when a clump of crystals move within the inner ear-control center for balance, causing a severe spinning sensation when moving your head. It’s treated by moving the crystals in a specific pattern to get them back in proper alignment.

This condition becomes more common over New England winters when we do not get as much sunlight or vitamin D– which can make you more susceptible to changes in the inner ear crystals.

Vestibular hypofunction can also be a reason for dizziness or unsteadiness, and it typically happens after something like a whiplash injury or sudden attack that leaves you feeling scared and unsteady. Vestibular problems can be challenging to accurately diagnose.

Here are three signs that indicate your balance problems might be due to a vestibular dysfunction:

1. Things Spin When You Bend Over

Ever been in the middle of gardening, or getting in and out of bed, and things start spinning for no good reason?

People often mistake this for dehydration or low blood pressure. These are certainly possibilities, but it could also be from a dysfunctional vestibular system. Because this system is located deep within your inner ear, it’s most affected by large head movements. Movements such as bending over. If the system in your ear doesn’t keep up with how fast your body is moving – things start spinning.

While it’s common for this to happen from time to time, if it’s happening a lot, or gets so severe that you can’t stand up, then it’s worth getting looked at.

2. It’s Hard to Walk Around in the Dark

As we get older, vision is one of the first things to become impaired.

Vision is another major player in how well you balance. It becomes critically important that your other two systems – vestibular and proprioception – are in good shape.

If you have strong legs and typically don’t have a problem with balance during the day you may notice that at night or in dim lighting your balance always seems to be off. This could be a sign that your vestibular system is dysfunctional.

3. Crowds Make You Unsteady

Many of us dislike crowds.

Is the reason you avoid them is because you’re afraid of falling or you find that crowds make you dizzy? This could mean that your vestibular system is off.

Public, busy settings can overstimulate our nervous system, making it more difficult for your brain to coordinate with your inner ear.

Do you find that every time you’re in a busy grocery store you have difficulty remaining steady while looking around? But you’re always fine in your quiet home? It could be a sign that your vestibular system needs to be checked.

Do you notice any of these signs? Are you finding yourself off balance and more dizzy than usual? You could have a vestibular problem.

The good news is that vestibular dysfunction can be helped without medication. It’s done by training the brain to accommodate for these changes in your inner ear.

Are balance problems like Vertigo getting in the way of your everyday life?

It just so happens that we have a Vestibular Specialist on our team!

CLICK HERE to request a FREE Discovery Call with one of my specialists.

Someone from my client success team will call you right away. They’ll see if you are a good fit for what we do and figure out a plan to get you back to doing the activities that you love. So you can be pain free and reduce your stress levels the right way to be your best and most healthy self 🙂

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, neck, knee, or shoulder pain, email her at [email protected].

sciatica

Three Ways to Keep your Back from “Going Out”

/in , /by

Four out of five people will experience a debilitating back pain episode at one point during their lives. For many this will be from a pulled back muscle.

Typically, we put more effort into caring for our backs during those times than when we’re feeling good. But it’s critical that we take good care of our backs all the time, not just when we’re in pain.

The real secret to keeping your back healthy is in your daily habits.

Pulled a Back muscle? Here are three ways to take care of your back on a daily basis. So that you can keep it from “going out”:

 

1. Avoid sitting for prolonged periods.

When we sit for too long, the burden of our weight is placed abnormally on our spine and can cause damage over time. Before long, those small loads add up to real pain. It makes sense when you consider that our bodies were designed to stand, sit, crawl, run, kneel, bend and move through the world in many different ways. It was never designed to sit in one position for prolonged periods, day after day. Sit too long, too often, and it can lead to bulging discs and weak, brittle muscles that are prone to tearing and other damage.

The solution?

Limit your sitting to half-hour periods. Have a few minutes of standing in between, and you’ll reduce the uni-directional forces on your spine. If you sit for a long time at work or at home, stand up and walk around a little bit every thirty minutes. I give this advice to every single client I have who comes to me with back problems. It’s one of the easiest ways for the average person to prevent a debilitating back problem over the long term.

2. The curves in your spine matter

We have natural curves in our spine that help us handle stress and loads. Whether sitting or standing, it’s important to maintain these curves. When standing, our spinal curves occur more naturally and are usually easier to maintain. But when we sit, the protective curves in our spine are harder to maintain and often disappear, and you’re often completely unaware it’s happening.

While strong back and abdominal muscles are an important component to maintaining a healthy back, they do very little when it comes to sitting and maintaining those curves, which is a common misconception in the medical and fitness community.

Fortunately, the solution is simpler than you think. Using a lumbar roll every time you sit goes a long way in helping you maintain the natural curves in your spine – and with minimal effort or thought. The good news is you can craft one quite easily on your own using a small towel roll or pillow. Simply place it between the small of your back and the chair and it will help you to maintain the natural lordosis (or curve) of your lower back. Give it a try. You’ll be amazed at how effective this one simple tip is for helping to control and prevent back pain.

(Did you know we have Lumbar Rolls right here in our Portsmouth office? Email [email protected] if you’re local and want to get one)

3. Extend instead of bend.

Did you know that the average person bends or flexes forward between three and five thousand times per day?

That’s a lot of bending over time and eventually something will give – and it tends to be your lower back. Our spines crave balance, but unfortunately, our modern-day lives are designed to have us bending forward more than we should. Sitting in front of a computer, putting shoes and socks on, driving, house and yard work, even brushing our teeth are all daily activities that involve bending forward in some way.

To combat this, we need to make a concerted effort to extend instead of bend. A really simple exercise you can do every day is to stand and extend your spine. Place your hands on your lower back for support and then arch back as far as you can go. Repeat this 10 times, at least once per day. If you’ve never arched your back like this before, it may feel stiff or even hurt a little at first. But with a gradual increase in frequency, it will feel less stiff and more natural over the course of a few days. If it doesn’t, or becomes troublesome for you, then it’s important to speak with a specialist.

Getting rid of a back problem really isn’t as complicated as you think – and it could be as easy as starting with simple tips like these.

These tips are considered basic “back hygiene” that everyone should consider incorporating into their daily routine. But if you’ve had several back pain episodes year after year, or every few months, these tips may only take you so far and it’s important to enlist the help of an expert.

CLICK HERE to request a FREE Discovery Call with one of my specialists.

Someone from my client success team will call you right away and see if you are a good fit for what we do.


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 her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

physical_therapy_seacoast_nh_91

How MRI’s Lead Back Pain Sufferers to Unnecessary Procedures

/in , /by

Have you ever had back pain and wondered…Do I need an MRI to figure it out? One popular questions I get from clients is if they need an MRI when experiencing back pain or sciatica. It’s pretty standard protocol when you go see a doctor – but is it necessary?

In most cases… NO.

About 70-80% of back problems, even sciatica, are considered mechanical in nature and quite normal. That means there isn’t anything “serious” causing your pain.

Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist – and will typically require advanced medical intervention. An MRI can be useful in these cases to get more clarity before medical intervention begins. But when your back pain is mechanical in nature, an MRI is more often than not misleading – and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment…

You most likely have mechanical back pain.

The root cause of mechanical back pain can NOT be diagnosed by an MRI. If your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen SO many people with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem….

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually NOT the root cause of your back pain.

What typically happens is the MRI finds them, and your back pain gets blamed on them.

But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain. Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain.

That’s how we know the root cause of your back pain is coming from something else!

One notable study was the Lancet series. Three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian. In fact, he says: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Do you notice that certain positions or movements relieve your back pain? Or you feel better after walking and exercise? Your back pain is likely mechanical in nature. You don’t need an MRI to diagnose you.

Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does NOT respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc. Only to find that it didn’t help their problem. Or it came back again with a vengeance. After all, once you have surgery mechanical back pain can actually become more difficult to fix. Your tissues and ligaments are now compromised from surgical scarring. No matter how minimally invasive they say your surgery will be.

If you’re confused, I don’t blame you.

CLICK HERE to speak with one of my specialists for free. They will figure out the right treatment plan for you. And at the very least give you some helpful tips moving forward.

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 her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Back_Pain_Specialists_Portsmouth_NH

Failed Back Surgery Syndrome? You’re not alone.

/in , /by

Back pain impacts approximately 80% of the population. The response to that has been more and more back surgeries being performed each year. However, despite more surgeries being performed, people aren’t having any less back pain. In fact, those that do get back surgery only have success rates of 50%. After a few years, their results are no less successful than those who chose to have conservative interventions. Such as physical therapy and exercise, for the same problem. If you’re experiencing failed back surgery syndrome, you’re not alone.

The American Society of Anesthesiologists estimates that 20-40% of all back surgeries fail. That statistic gets worse for patients who have a second surgery. Estimating that only 30% of second back surgeries are successful. Should you have a 3rd or 4th surgery your success rate plummets. Only 5-15% of 3rd and 4th back surgeries have successful outcomes. Despite these statistics, approximately 500,000 Americans are still undergoing back surgery every year to relieve their pain. The Agency for Healthcare Research and Quality estimates that back surgery costs us $11 billion annually. That’s a lot of money to spend on something that isn’t even guaranteed to work. 

So why are we spending so much money on back surgery when for almost half of these people (and in some cases more), it’s not even successful?

Problem number one is if you’re dealing with debilitating back pain that is impacting your life and happiness. Surgery is often going to be a very attractive option. If you’re told surgery will take away your back pain, why wouldn’t you want to choose this approach?

The second major problem is with the way back pain is typically diagnosed. Nowadays, doctor’s rely on imaging (X-rays or MRI’s) to decide what’s wrong with you and to formulate a treatment plan. They rarely take the time to talk to you about the events that led to your back pain, examine the way you move, or make certain that what shows up in your images is actually responsible for your pain.

For example, if they see a bulging disc and you’ve got coinciding leg pain – they assume that’s the source of your problem and recommend you cut it out. If you’ve got severe degenerative changes or stenosis in your spine, they recommend fusion.

What’s the problem with this approach?

Things like bulging discs and degenerative changes show up in MRI’s and X-rays, and are quite normal. They occur naturally as you age. It’s no coincidence that before the invention of MRI’s – there were far less surgeries being performed. What we do know is that 50% of the time, back surgery fails. Could it be because we are going in and tampering with structures that have nothing to do with the source of our back problem?

Let me explain.

We now know from research that 70-80% of all back pain is considered “mechanical” in nature. Meaning, the root cause or your pain is due to restrictions in your joints. Or restrictions in soft tissue that impact the way you move. This, in turn, can make surrounding structures very angry and lead to pain. Findings such as bulging discs, disc degeneration, and stenosis are all a normal part of aging and there are plenty of people out there who have these exact same findings on their images – yet have no pain at all. That’s because for some, their joints move fully and freely, and these (normal) abnormalities don’t give them any trouble. But for those whose joints do not move well, that bulging disc has a better chance of getting irritated or causing something else (like a nerve) to get irritated.

Removing the disc, or fusing your spine, won’t take away your underlying mechanical movement problem. It will put a temporary band aid over it until the problem either re-occurs – or shows up in another section of your spine – often years later.

Does this help you to understand why so many back surgeries are unsuccessful? 

It’s such a common occurrence they even have a name for it – “Failed Back Surgery Syndrome”.

When your back pain is due to a mechanical problem – such as an underlying movement or mobility issue – surgery will not fix this. Additionally, MRI’s and X-rays can’t accurately diagnose it. When you do have surgery, you end up prolonging your problem further. Because you think that just because your back pain is gone, your problem is gone.

It’s only a matter of time before your pain returns, and it’s usually worse. Plus, your mechanical problem becomes more challenging to address once you’ve had surgery. But the good news is that it’s still possible to address it without a second back surgery. And it’s possible to address debilitating back pain without a first surgery altogether.

So if you’ve got back pain and are considering surgery, definitely think twice and be sure you’ve been fully examined by a mechanical back pain expert first. And if you’ve already had back surgery and it failed, still talk to a mechanical back pain expert. 

Remember that the odds of success for second and third back surgeries are very low. Even after a failed back surgery, it’s still possible to learn how to address back pain on your own and get back to doing everything you love. 

Did you know that we specialize in back pain – and have helped thousands of folks learn how to treat back pain completely on their own?

CLICK HERE to talk to someone from my team – especially if you’re considering back surgery and want to make sure you’ve explored ALL possible alternatives first.

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 her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Three Ways You’re Getting Back Pain Treatment Wrong

/in , /by

If you’re over the age of 40 and reading this, odds are pretty good that you’ve experienced back pain at least once in your life. In fact, four out of five people are impacted by back pain, and for many, it’s a constant back-and-forth year after year. Keep reading to learn three ways you could be getting back pain treatment wrong.

The first thing you need to understand is that back pain is normal. It’s hard to combat the everyday stressors our modern-day lifestyles impose on our spine. We simply weren’t meant to sit for hours each day or be crouched over electronic devices. Rather than have unrealistic expectations about pain-free lifestyles, we should instead be focusing on ways to naturally manage our own back pain.

Now keep in mind, I make a living off helping people recover from debilitating back pain. But that doesn’t mean I want you to suffer. Here are three ways we’re getting back pain treatment wrong.

1. Quick fixes and passive modalities.

Reliance on quick fixes or passive modalities is how most people attempt to treat their back pain. It’s also the number one reason why back pain returns. A passive modality is something that is done to you vs something you actively do on your own. It’s where you walk in somewhere, lie on a table, and receive some kind of treatment. This could be chiropractic care, massage, acupuncture, or even injections and surgery. You have no active role in the process – it’s completely passive.

Now, I’m not saying there is anything wrong with these treatments. They are great for easing symptoms related to back pain – especially tight, spasmatic muscles. (I have back pain myself and get a massage once per month.) But they shouldn’t be used in isolation. They need to be part of a more comprehensive, movement-based approach to addressing back pain at its source. Plus – you’ll find the relief you get from passive modalities is almost always temporary. And when your pain keeps coming back – it’s a sure sign you’re missing something. Don’t get back pain treatment wrong by relying on passive modalities.

2. Letting MRI’s make the decision.

Traditionally, the medical community diagnoses your back pain with images. If you’ve had back pain for a while, and especially if you’ve already tried some physical therapy, doctors will prescribe an MRI to “see what’s going on” inside your spine. The problem is that what shows up in your MRI doesn’t always correlate with what’s causing your back pain. In fact, 60% of the time, what you see on your MRI has nothing to do with the root source of your problem.

For example, your MRI might show a bulging disc in your spine. Well, did you know that bulging discs are normal and occur naturally as you age? You could have two people with the same bulging disc on their MRI and one will have zero back pain.

Why? Because the root cause of back pain is more complicated than your anatomy. Evidence from research tells us that 70-80% of all back pain is primarily caused by restrictions in your mobility – which is influenced by your habits and the way you move – not by what’s going on structurally in your spine.

So if your doctor lets your MRI make the decision, and recommends surgery to cut out a bulging disc that isn’t even the source of your real back problem, you’ve not only wasted a surgery, but wasted even more time not addressing the real cause of your pain. Letting MRI’s dictate your treatment plan is one of the most overlooked ways we’re getting back pain treatment wrong.

3. The wrong exercises.

One of the biggest problems I see when it comes to treating back pain is non-specific, non-prescriptive, generalized exercises that are designed to make you strong and perhaps even target your core – but it’s before the real problem gets addressed.

Almost 90% of the time, back pain is due to immobility in your spinal joints (vertebrae) that causes irritation of surrounding structures in your spine – such as discs, nerves and ligaments. What we know to be true is that these mobility restrictions can be freed up with very specific movements, in very specific directions, using a very specific frequency during the day.

Once the restriction in your spine is free and you’re moving normally, you can do any exercise of your choosing. It’s at this point that strengthening your core, for example, is beneficial. Because a strong core helps prevent future back pain episodes (but it doesn’t cure a current back pain episode).

To figure out which specific move you need to address your back pain will require help from an expert. But the good news is once you know what movement gets rid of your back pain, you can use it time and again to manage it on your own. But generalized exercises, when done too soon, is another big way we’re getting back pain treatment wrong.

If you’ve been suffering from back pain longer than you should, I hope this information helps you figure out where you might have been steered wrong.

It’s worth getting help from a back pain specialist who emphasizes corrective, prescriptive movement as a means to recovery – vs quick fixes, MRI’s, and generalized exercises.

Want help from one of our specialists? Request a Free Discovery Call HERE to see if you’re a good fit for what we do.

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 her guide to back pain CLICK HERE or visit her website at cjphysicaltherapy.com.

tight hips

Two Reasons People Avoid Exercise Over Age 50

/in , /by

Should you truly “avoid exercise” once you’re over 50?

Over the course of my career, I’ve worked with many folks over the age of 50 who are enjoying the same activities they did in their 40’s – including surfing, playing tennis, hockey, running, hiking, etc. – so the short answer is “No”. None of these activities are considered “easy on the joints” – and yes, you might have to make some modifications to continue enjoying them – but you certainly don’t have to avoid exercise if you don’t want to.

So why is it that some folks see age as just a number, whereas others see age as a time to slow down and stop doing certain things? 

Once you’re over 50, the two most common reasons I see people avoiding activities they love is because

1) they fear pain could be causing damage to their body and

2) they were simply told to by a medical professional. 

  1. Fear that pain could be causing damage 

When it comes to musculoskeletal pain, the pain itself is typically not the biggest concern for most. People are willing and able to tolerate a certain amount of pain at the expense of doing what they truly love. We do it all the time in our 20’s or 30’s. But as we age, fear starts to set in when we’re in pain. We naturally become more cautious with activity and begin to question what the pain could be doing to our bodies. Plus, as you get older, it becomes harder to recover from injuries, leading some to rationalize for themselves that it’s better to just avoid certain activities altogether because it’s “safer” than getting injured.

So does pain mean we’re doing damage? Not necessarily. Pain is simply a signal from your brain that it wants you to pay attention to something. You shouldn’t ignore it, but you don’t have to fear it either. Oftentimes, pain just means you might have to adjust or modify something. Once you understand what your pain is telling you – you can take appropriate action. This is one of the secrets to being able to continue your favorite activities well beyond your 50’s. Learn how to “talk” to your pain.

  2. A medical professional told you to avoid exercise 

When we’re younger, we’re more likely to address pain with a wait-and-see approach. But as we age, pain becomes a bigger concern and we’re more likely to seek professional medical help sooner. While this would seem prudent, the problem is there are a lot of well-meaning medical professionals out there who aren’t always up to date with the latest research. The consequence? Mixed messages and “old school” advice for many of their patients. 

For example, many doctors have come to rely on images (X-rays and MRI’s) to base their diagnosis of musculoskeletal pain and subsequent treatment plan/recommendations. If your X-ray shows “bone on bone” arthritis, they start talking about joint replacements – and/or tell you to stop doing any activity that could “damage” your joint further. But the current research disputes this line of thinking, and says 70-80% of all musculoskeletal problems (even when you’re over 50) can be solved without a procedure or surgery. How your pain behaves is what matters most. Not your age, arthritis, or images.

Here’s a real life case study that illustrates what I’m talking about.

Not too long ago, I met a 55-year-old woman (we’ll call her Kate). She was having knee pain that interfered with her hiking and running. She was told by her orthopedic surgeon that knee replacement was her only option. This was because of the “bone-on-bone” in her knee. Kate questioned the knee replacement and asked if she could wait. Her doctor’s response was to scale back on activity and stop running and hiking altogether. But just because Kate’s X-ray showed osteoarthritis in her knee, it doesn’t mean it’s the cause of her knee pain. Research tells us this. It’s entirely possible that Kate’s knee pain is due to something other than her “bone on bone” arthritis.

Did she really need surgery? And did she really need to stop running and hiking?  If she underwent a knee replacement without being sure if arthritis is truly the main cause of her knee pain, she not only risks unnecessary surgery, but would also be set back several months for recovery.

First, inactivity is one of the worst things you can do for arthritis.

People who stay active with weight-bearing activities are shown to have less arthritis than those who avoid doing things that compress their joints. Second, during Kate’s movement exam, we were able to quickly turn her knee pain “off” and then “on” again. That means her knee pain could not be solely due to the arthritis in her knee – because you can’t reverse “bone on bone” arthritis with movement and certainly not that quickly.

You can, however, successfully address a mechanical joint problem with movement – which is exactly what was happening. Mechanical problems in your spine or joints won’t show up on X-ray. So you don’t want to rely on images alone to make decisions about your pain – and certainly don’t rely on images alone to decide if you should have surgery or not. 

If you’re getting older, know that age related changes like arthritis are normal and nothing to be afraid of. Pain is also normal. It’s an important signal that alerts us to take action. It doesn’t always equal damage. Be sure to educate yourself about these topics and ask more questions if you’re told to stop an activity “just because”, or that surgery is your only option because of an image.

Do you avoid exercise because of back, knee, hip, shoulder, or ankle pain?

 Let us help you get back to it! Request a FREE Discovery Call with my team. It’s a no obligation call to figure out 1) if we can help you and 2) are you a good fit for what we do.

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 her Knee Pain Free Report CLICK HERE  or to get in touch email her at [email protected] .

Avoid Pills. Use Movement as Medicine Instead

/in , /by

Avoid Pills. Use Movement as Medicine Instead

In the 1990’s, it started becoming widely accepted to prescribe opioids for people recovering from surgery or injury. As well as those suffering with moderate-to-severe musculoskeletal pain (such as back pain and osteoarthritis). Although effective for managing pain, we would soon find out how highly addictive these drugs are. Statistics show that one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. And once addicted, it’s very hard to stop. Keep reading to lear why movement as medicine is a better option.

The Centers for Disease Control and Prevention (CDC) found in their 2018 Annual Survey Report of Drug-Related Risks and Outcomes that in 2016, more than 11.5 million Americans reported misusing prescription opioids. And despite efforts to curb these statistics, this number started to creep up again during the pandemic.

In response, the medical community established more strict control around the prescription of opioids. Many are avoiding prescribing them all together. For patients with severe back pain and arthritis, for example, injections and minor procedures have become far more common and recommended.

While this approach prevents you from becoming addicted to opioids, there are still inherent risks any time you have an injection or undergo a procedure.

So what’s the alternative?

Prescriptive movement strategies are the alternative. Specialized, custom-fit “exercises” that are designed to have a very specific (and noticeable) effect on your pain.

But what’s the difference between generalized exercises that make you feel good vs prescriptive movements that also make you feel good?

Well, the distinguishing factor is both in:

1) how your pain responds to the movement while you’re doing it, and more importantly

2) how it behaves afterward. Lots of exercises feel good while doing them, but not all exercises give you the long-lasting effect you’re truly looking for.

For example, let’s say you’ve got back pain. Perhaps stretching your back a certain way makes you feel good and temporarily eases your pain. But an hour or two later, or the moment you perform an activity that typically aggravates your back, your pain comes right back. The stretch makes you feel better, but it doesn’t do a good enough job to make you stay better.

Over time, you might find that your back pain comes and goes often. Although this stretch always helps, nothing really takes away your problem completely. Instead, you get stuck in that vicious cycle of stopping all activities every time you hurt your back. Or worse – start avoiding certain activities altogether for fear of hurting your back. This is no way to live and it’s not an example of a good prescriptive movement strategy.

So what would a prescriptive movement as medicine strategy look like?

Let’s take the same example above. But this time – you find that a particular stretch not only makes your back pain go away in the moment, but it stays gone the more you do it. Whenever your back pain returns, you can reliably use this stretch to take your back pain away every time. This is an example of a prescriptive movement strategy. You know exactly what to do, how often to do it, when to do it. And it works without fail every time. Plus, once you know what your prescriptive movement is, you can use it to prevent pain as well.

The good news is that 70-80% of all musculoskeletal pain responds to a prescriptive movement strategy. It works in all joints and muscles. You just have to work with someone who knows how to help you find it and then use it over the course of time. I can’t tell you how often I meet people who have the right movement, they just weren’t applying it correctly to get the long-term relief they were looking for.

Too good to be true?

It’s not – I promise. The problem is there’s a lot of mis-information out there and not every health care or fitness professional is trained in discovering the prescriptive movement that you need – or teaching you how to use it properly. The second problem – to be frank – is that hospitals make a lot of money from procedures and surgeries. There’s no real incentive for them to support conservative, natural treatments that you can do on your own at home.

With procedures and surgery, the results are faster, which makes for happier patients (in the short term). But studies show that 2-3 years out from surgery your results are no better or worse than if you were properly prescribed movement as your treatment. And after 10 years, those who’ve managed to avoid surgery for the same problem, actually have much better outcomes than those who went under the knife.

The greatest benefit of taking the time to go slow at first, and find a prescriptive movement strategy that works, is that you’ll have this movement “medicine” at your disposal at all times. It’s always in your “medicine cabinet” and you never need a prescription or pharmacy to refill it.

Hopefully I’ve got you thinking. And encouraged you, at the very least, to explore whether or not movement really can be your medicine. If you’re already tried and failed at this, it’s quite possible you just didn’t have the right approach.

Consider talking to someone from my team if you’re serious about getting help.

We’re trained to help you find YOUR prescriptive movement as medicine strategy and are up to date on the latest research.

CLICK HERE to request a Free Discovery Call with my team to see if you’re a good fit for what we do.

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 her guide to back pain CLICK HERE or to get in touch, email her at [email protected].