tendinitis and tendinosis

Six Tips for Managing Knee Pain without Medication

/in /by

When you’re suffering from lingering knee pain that just won’t go away, it can deeply affect your day-to-day life.

And when this happens – it’s easy to become desperate and resort to daily medication – or “quick fix” procedures or surgery. But there’s good news – there are plenty of natural, non-medicated ways to manage knee pain successfully and improve how you feel – even if you’ve been dealing with knee pain for years. You don’t always need medication or invasive treatments to find relief – despite what the medical community tells you.

Here are six effective tips to help you manage knee pain naturally:

1. Strengthen Your Hips and Core

Your hips and core play a crucial role in providing stability and support for your knees, as these muscles work together to ensure proper alignment of your entire lower body. When these muscle groups are weak or unbalanced, your knees bear the brunt of poor mechanics during movements like walking, running, and squatting. This leads to unnecessary strain, which can worsen knee pain over time. By strengthening your hips and core, you can improve your overall body mechanics, reduce stress on your knees, and promote long-term joint health. Over time, not only will this help alleviate current knee pain, but it will also significantly reduce the risk of recurrence. Incorporating exercises such as glute bridges, side leg lifts, and planks into your routine can make a noticeable difference in your strength and stability.

2. Improve your Flexibility

Mobility comes before stability when it comes to joint health. Stiff joints force surrounding muscles to overcompensate, which can lead to even more discomfort and inefficiency in movement. Improving your flexibility – particularly in the hips, hamstrings, and quadriceps – helps distribute forces evenly through your body and reduce strain on your knees. Regular stretching, yoga, and specific mobility exercises are great ways to maintain flexibility and keep your knee joints moving freely. A regular mobility practice is essential for reducing chronic knee pain and discomfort, preventing injuries, and enhancing overall athletic performance, balance, and coordination in your daily activities and exercise routines.

3. Don’t Sit too Long

Sitting for extended periods can cause stiffness in your knees and reduce circulation, which can lead to more pain. Additionally, knee pain might stem from your back or hips, even if you don’t feel pain there, and sitting for too long accentuates problems in these areas as well. By standing up and moving regularly throughout the day, you can prevent the muscles around your knees from tightening up and maintain better alignment. Simple actions like standing every 30 minutes, doing some light stretches, or walking around your space can make a big difference. Even if you don’t have knee pain right now – this is a good practice to get into – because it will go a long way in preventing it.

4. Stay Active

Regular, low-impact exercise is one of the best ways to manage knee pain naturally. Activities like swimming, cycling, and walking increase blood flow, which helps reduce inflammation and promotes joint lubrication. Movement also releases endorphins – your body’s natural pain relievers. If arthritis is a concern, consider activities that build strength without overloading the knee, like Pilates or resistance band exercises. Movement is key, but be sure to avoid high-impact exercises that could exacerbate your pain. Focus on activities that maintain flexibility, balance, and muscle endurance for overall joint support in your knee..

5. Wear Supportive Footwear

Footwear is often overlooked when it comes to knee pain, but wearing shoes that provide adequate support and cushioning can make a huge difference. Shoes that don’t support your feet properly can cause poor alignment, which translates to extra stress on your knees. Opt for shoes that prioritize comfort, good arch support, and alignment to help reduce the impact on your knees. If necessary, consider custom orthotics to improve foot and knee mechanics, as well as periodically replacing worn-out shoes to maintain optimal support and prevent further strain.

6. Optimize Your Balance

Good balance is about more than just preventing falls – it helps your knees by reducing strain during movement. When your body is well-balanced, the load is distributed evenly across your muscles and joints. Poor balance, on the other hand, can cause your knees to overcompensate, leading to pain and increased wear and tear. Simple exercises like standing on one leg, using a balance board, or practicing yoga can improve your balance and take the pressure off your knees. Incorporating these exercises into your routine can also enhance coordination, prevent injuries, and promote overall stability for the rest of your body as well.

If you’ve been dealing with knee pain for a while and haven’t incorporated any of these tips yet, now is a great time to start. Try these first before resorting to something invasive – or accepting a life on daily pain medication. Additionally, it’s a good idea to consult with a physical therapy specialist who is an expert in natural treatments for knee pain.

Are you a local to Portsmouth, NH?

If so, CLICK HERE to speak to one of my specialists. They can help you figure out which strategies will successfully get you back to all the activities you love – while avoiding medications and procedures.

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

Hiking with Bidue

Three Lessons Learned from Hiking with my Pup

/in , /by

I have a 10.5-year-old Black Lab/Hound-mix rescue pup (named Bodie) who I bring with me everywhere when I’m allowed. But our favorite place to hang out? Hiking trails.

Bodie and I have been slowly working on finishing our “NH48”. For those of you not familiar – we’re trying to hike all of the NH White Mountain peaks that are over 4000 feet in elevation – and there are 48 of them. This past weekend we hiked Owl’s Head, which was number 31, and the weekend before, we checked off Mount Zealand for number 30. If you’ve ever hiked these peaks, then you already know these two hikes are pretty long – especially as day hikes. Owl’s Head was 17 miles, and Zealand was 12. And we did them back-to-back weekends!

I planned to hike again this weekend, but after watching and learning from Bodie over the years, I’ve realized some powerful lessons that I wanted to share with you that can absolutely be carried over into everyday life.

Here are three Lessons I’ve Learned from Hiking with my Pup:

1. Nature is the ultimate natural remedy for anxiety.

Bodie can be a bit anxious, and when he doesn’t get outdoors enough, it gets worse. Spending extended time in nature is one of the most powerful and natural anxiety remedies I’ve experienced – and I see it in Bodie. After our hikes, he’s much calmer and even barks less at neighborhood dogs. 

Bodie is also my mirror – when I’m anxious and haven’t spent enough time outside – he notices and mirrors my energy. Have you noticed this in your life? If so, try getting out in nature more – it works wonders. Bodie and I keep ourselves pretty active – but there’s just something about hitting those trails that is magical. Bodie reminds me daily to spend quality time moving outdoors.

2. Bodie knows how to listen to his body.

It’s remarkable to watch Bodie on the trails – he knows exactly what his body can handle and when to rest. Can you imagine if we all had that kind of awareness? Life would be so different.

As a PT specialist for over 22 years, I’ve learned how to listen to my body, and it’s one of the most important skills I’ve taught clients over the years. When you truly understand what your body is telling you, you can challenge it without being reckless. This is important because we only improve when we appropriately challenge ourselves.

Shying away from every ache and pain can actually teach your nervous system to fear pain, which does more harm than good.

Watching Bodie, I realize this instinct is built into him. His nervous system is so in tune – it just knows. While we may not have the same instincts,it is possible to improve our relationship with our nervous systems, which will help us do more of the activities we love and prevent injuries. If you struggle with recurring injuries or fear of movement because of pain, I highly recommend working with a movement expert who can help you work through this. Your body awareness will improve and your nervous system will thank you.

3. Recovery is critically underrated.

Bodie is a pro at recovery. After every hike, he takes a day or two to rest – lounging around, sleeping more, and letting his body recover. It’s a reminder that recovery is just as important as the effort we put in. Whether it’s hiking, exercising, or going through daily routines, our bodies need time to repair and strengthen. I take this lesson from Bodie and make sure I’m giving my body the rest it needs.

Recovery is key to maintaining strength, mobility, and long-term health – not to mention injury prevention. 

If you’re struggling with recovery or feel like your body isn’t bouncing back after adequate, it could be a sign of a bigger issue. I recommend working with a movement specialist who can help you. You don’t have to let stubborn aches, pain, or injury linger or keep you from doing what you love.

We’d love to help you figure that out!

Work with someone who specializes in finding natural ways to get rid of pain – and who can help you to keep it gone – so you can keep enjoying all of the activities you love to do. For me and Bodie – that’s hiking.

All you have to do is request a free appointment with one of our specialists to see if we can help and if you’re a good fit for what we do 🙂


Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE or call 603-380-7902.

5 Reasons to Ditch the Pills and Embrace Exercise as Medicine

/in /by

Our bodies are built for movement, yet modern life has us sitting far more than we should.

Compared to our ancestors, we’re moving less and sitting more – sometimes for over half the day. While fitness trackers and smartwatches encourage us to stand and get more steps in, it still doesn’t seem to be enough to counteract the effects of a sedentary lifestyle.

Physical inactivity has now become a major health issue, and the consequences are clear: less movement leads to more musculoskeletal issues and chronic pain (among other things). And the unfortunate reality is that most folks turn to pain medication for relief, despite research increasingly pointing to regular exercise being just as effective and far healthier.

Here are 5 reasons to ditch the pills – and embrace exercise instead – as a powerful form of medicine to manage musculoskeletal pain naturally.

1. Exercise Mediates Pain

The way we perceive pain is complex. Many assume it’s a direct response to physical damage or injury – but it’s not that simple. The perception of pain involves numerous physiological and psychological factors that the brain must interpret. Depending on your general health, past experiences, and mental health condition, this can vary quite drastically from person to person. In other words – it’s your brain that decides how much or how little pain you experience.

Because of this complexity, external factors like exercise (and also pain medication) can alter how we perceive these signals. When we exercise, our bodies exhibit an increased tolerance towards pain, and a lower perception of pain intensity. This phenomenon is called “exercise-induced hypoalgesia” – and it works by closing down the gateways that allow pain signals to enter the brain. Certain medications can do this too, but when you exercise, you’re doing it naturally. 

2. Exercise Helps Inflammation

Inflammation is a normal part of your body’s healing process, and it occurs when inflammatory cells travel to a place of injury. However, if inflammatory cells stick around too long, it can result in chronic pain and irritation. This is where exercise can really help. 

When you exercise, your body experiences minor physiological stress, which triggers your body’s natural inflammatory reaction. During the inflammatory process, certain proteins called anti-inflammatory cytokines are produced. These protein chemicals help to modulate the body’s inflammatory response – ultimately reducing the level of inflammation associated with your pain. Inflammation can be both good and bad. When you exercise, you are creating “good” inflammation, which will naturally help to ease your pain.

3. Exercise Stimulates Endorphins

Ever wonder why a quick walk outside or a strenuous gym workout magically makes you feel better? It’s not your imagination. It’s something called endorphins – neurotransmitters released by your brain to alleviate pain and promote pleasure.

Endorphins are considered your body’s natural “opioids” because they interact with the same pain-inhibiting receptors in your brain that drugs like morphine do. But unlike morphine, endorphins are triggered naturally and don’t come with harmful side effects like addiction, drowsiness, or mental fog. Exercise stimulates the production of endorphins, boosting your mood, reducing stress, and giving you access to your very own stash of natural, healthy painkillers.

4. Exercise Improves your Mental Health 

Exercise and mental health share a powerful connection. It’s virtually impossible to influence one without the other.

Regular exercise stimulates the production of various mood-boosting chemicals, including endorphins (that we just spoke about) along with serotonin and norepinephrine. Aside from helping to control pain, endorphins are also considered a “feel-good hormone”. They trigger feelings of positivity that, once again, are similar to morphine. Serotonin and norepinephrine are instrumental in alleviating symptoms of depression and anxiety. Therefore – when you exercise – it’s virtually impossible not to feel better. And since we know that pain is controlled by your brain – anything that improves mental health is going to contribute positively to your relationship with pain.

5. Exercise as a Prescription

OK – so we’ve discussed the multitude of positive effects that exercise has on pain perception, inflammation, and mental health. But what if you’re currently suffering from an injury? Is it possible to still use exercise as a pain reliever? The short answer is yes. But it’s challenging to do on your own. You can’t just google “best exercises for back pain” and expect good results.

When it comes to using movement or exercise to rehab an already existing injury – it needs to be carefully prescribed. 

For all the reasons already discussed, physical activity will still help you modulate pain – but you must consider the role exercise is going to have on any potential tissue damage. With weakened or damaged tissue, exercise is still an effective pain reliever, but it has to be prescribed or you risk worsening your injury.

For these reasons, I always recommend working with a movement expert who truly understands the nature of musculoskeletal pain and tissue healing. If you start a general exercise routine because you want to feel better  – I applaud you – just make sure you’re getting your desired result. But if you start exercising to help with pain and don’t experience any noticeable improvement – or you catch yourself modifying to work around your pain – then it’s time to enlist the help of an expert. Otherwise, you risk ending up on pain pills, which is exactly what we want to avoid.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE.

Why Walking is Essential for Your Health After 50

/in /by

Walking is one of the most underestimated, yet accessible and beneficial forms of exercise for folks over 50.

As we age – the saying “use it or lose it” gets closer to home – and maintaining an active lifestyle becomes even more crucial. 

The good news is that a regular routine of walking offers a simple and low-impact way to not only maintain an active lifestyle – but combat the “use it or lose it” syndrome. A regular walking routine not only supports cardiovascular health, strengthens muscles and bones, and aids in weight management – but also boosts mental well-being and enhances balance and coordination. It’s not a surprise to me that more and more adults over 50 are lacing up their walking shoes and hitting the pavement… yet so many are still skeptical and/or disregard this great form of exercise.

Regardless of where you stand on walking for health… Here are 7 reasons to do it (especially if you’re over 50):

1. Enhances Cardiovascular Health

Cardiovascular disease remains the leading cause of death among older adults. A regular walking routine can significantly improve heart health by boosting blood circulation, reducing bad cholesterol levels, and increasing good cholesterol levels. The rhythmic nature of walking ensures that your heart pumps at a steady rate, which is beneficial for overall cardiovascular health.

2. Strengthens Muscles and Bones

Aging naturally leads to the loss of bone density and muscle mass. However, regular walking can counteract this process. As a weight-bearing activity, walking strengthens bones and reduces the risk of osteoporosis and fractures. It also engages multiple muscle groups simultaneously, helping them stay active and strong.

3. Boosts Mental Health

Walking isn’t just a physical activity – it’s also great for mental health. Walking has been shown to reduce symptoms of depression and anxiety significantly. It provides an opportunity to clear your mind, reflect, and even meditate. Walking with friends or loved ones adds a social aspect, which can be incredibly beneficial for your mood and mental well-being. For an extra mental boost, try walking in nature—the fresh air and tranquil environment can be rejuvenating for both mind and soul.

4. Aids in Weight Management

As you age, your metabolism naturally slows down, making weight management more challenging. Regular walking helps burn calories, maintain a healthy weight, and prevent chronic diseases like diabetes and heart disease. Being at a healthy weight also means increased energy levels, easier mobility, and less stress on your joints.

5. Improves Joint Health

Many people fear arthritis and avoid activities that might exacerbate it. However – despite some medical opinions – movement is one of the best remedies for arthritis. And walking is particularly beneficial for arthritis. It helps lubricate the joints, especially the knees and hips, and keeps the surrounding muscles and soft tissues loose and flexible. Regular walking is super beneficial for managing arthritis effectively.

6. Enhances Balance and Coordination

Falls are a significant concern as we age due to decreased bone density and the subsequent naturally occurring increased risk of fractures. Maintaining balance and coordination is easier than trying to regain them after they’ve diminished. Walking requires the coordination of several muscle groups – plus enhances the body’s ability to stabilize itself quickly – thereby reducing the risk of falls.

7. Low-Impact and Adaptable

One of the greatest advantages of walking for those over 50 is its low-impact nature. Unlike high-impact exercises such as jogging – walking is gentle on the joints and can be easily adapted to fit your fitness level. Whether you prefer a leisurely stroll around the neighborhood or a brisk hike in the park – walking can be tailored to meet your individual needs and goals.

If you’re over 50… and you haven’t yet incorporated a regular walking routine into your lifestyle…

What are you waiting for? It’s one of the most simple yet effective ways to stay active, healthy, and mobile after the age of 50. But if an injury or pain is holding you back from starting or continuing a regular walking routine – it’s time to consult a movement expert. 

Eighty percent of all musculoskeletal pain and injury is related to a movement problem that can be resolved naturally, and without procedures or surgery. But you can’t truly figure this out without consulting a movement expert, or physical therapy specialist who specializes in mechanical pain. Reach out if you need help finding one in your area.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE.

Avoiding Movement

How Fear Can Worsen Your Injury: The Hidden Dangers of Avoiding Movement

/in /by

Fear is a natural, protective response to injury.

But sometimes it can do more harm than good if you’re not careful. Reason being… When we experience pain or injury of any kind – while the pain can range from mild to excruciating – the real “pain” comes from not knowing what you just did. 

Was it anything serious? Will it go away on its own? What should I do?

All these questions compound the unknown which tends to manifest itself as some version of fear and trepidation. And the degree at which this occurs is highly variable among individuals. On one end of the spectrum – the fear of making an injury worse can lead to behaviors that hinder recovery. But on the opposite end – the fear of not doing enough and being cavalier about “no pain no gain” could also impede your recovery.

The good news is that with the right knowledge, tools, and team of experts – you can “train your nervous system” to interpret pain appropriately and avoid the hidden dangers of not moving enough. If fear is caused by the unknown of what’s happening when you feel pain or have been injured – then a better understanding of pain (what it is, what it’s telling you, and how it behaves) and how your body naturally heals from injury is going to help lessen that. I always say: “Movement is medicine – but knowledge is power”

So… as I’ve alluded to… one of the most common misconceptions about injury recovery is the need for prolonged rest.

When we get injured, our instinct is to “protect” the affected area, which typically translates to avoiding movement altogether. While this may seem a prudent strategy, it can actually delay your body’s natural healing process. 

Let me explain…

Yes, an initial resting period makes sense in some cases, especially after an acute injury where you’ve experienced some form of trauma to your tissues. But as soon as that initial inflammatory period ends – you’ve got to start moving. This is crucial for the proper healing of tissues that have been damaged from an injury. Plus – a lot of injuries don’t occur traumatically. They happen slowly over time. This type of pain requires a totally different approach to healing.

In either case – resting for too long and not moving enough can lead to all sorts of problems such as muscle atrophy, joint stiffness, and reduced overall function. Plus – you’re teaching your nervous system that it’s “safer” to not move – which can cause problematic adaptations over time if you’re not careful. In other words, you need movement, and even a little bit of pain to occur for proper recovery from an injury. But you’ve got to balance this. Too much too soon could re-injury you – while not doing enough will put your body and nervous system into “protective mode” – making it harder to incorporate necessary and healthy movement later on.

So how do you balance this process? How do you know if the pain you’re feeling during movement is good or bad?

Understanding how pain behaves is key. Generally speaking, pain during movement that doesn’t last is considered “safe”. We call this hurting versus harming. It’s generally ok to hurt, but never ok to harm. As your mind and body experience this phenomena together – you’re effectively coaching your nervous system to not react to the sensation of “hurting” in such a sensitive way. The more you move, and the more your nervous system realizes the painful feeling is not resulting in harm or more injury, the more that hurt sensation fades. Your nervous system no longer interprets it as pain. This is a normal and healthy response to pain when dealing with any injury – but especially those that are chronic and didn’t come on so suddenly.

The danger you run into when you never allow hurt to happen and avoid any amount of pain altogether – is that you encourage fear to run the show. Your nervous system never “learns” what good pain is vs bad pain – and it starts to get confused. Before you know it, any kind of sensation is perceived as pain (danger) by your nervous system – which only serves to fuel the fear of movement even more. It becomes a vicious cycle that is hard to break.

If you’re confused right now I don’t blame you.

This can be a nuanced and complicated concept to understand – and it’s why I don’t recommend going at it alone. Working with a movement expert who truly understands the process of healing and how your nervous system plays into all this will help take the guesswork out of all this and build confidence in this process.

Movement really is medicine and it’s a powerful one – when you’ve got the knowledge to use it properly.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To book a free discovery visit with one of our specialists CLICK HERE.

Back Pain

Could Back Trouble Be the Root of Your Knee Pain?

/in /by

One of the most important things to get right when it comes to successfully resolving knee pain is to make sure you’ve correctly identified the root cause.

Sometimes, your knee pain is due to a problem within your knee joint – such as with arthritis or torn cartilage. But other times (and more often than you think) – the source of your knee pain can be coming from elsewhere – such as your lower back. 

Did you know that 25% of the time, your knee pain is due to a problem within your back – even when you don’t have any back pain?

One of the tell-tale signs you’ve misidentified the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, stretching – even physical therapy – but no matter what – your knee pain just won’t seem to go away. If the root source of your knee pain is within the knee joint – and you address your joint with any combination of the above mentioned interventions – it will help.  

But how do you figure out if the root cause of your knee pain is in your lower back? 

Pay attention to how your knee pain behaves. When your lower back is the source, you’ll typically have difficulty pinpointing exactly where your knee pain is. It may feel dull, achy, or even numb at times. It might move around, or perhaps travel up or down your thigh. One day your knee might feel great, and you’ll think the problem is finally gone – while other days it could feel excruciating. When your knee pain is more vague and moves around a lot, or it comes and goes throughout the day for no apparent reason, there is a good chance that your back is the root source. With true knee pain, you can usually point to where it hurts and describe pretty well when and where it will bother you.

So how does a misdiagnosis like this even happen?

One of the biggest culprits is imaging. If you’re over age 40, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears. Studies have shown that arthritic changes and meniscus tears are a normal part of aging, so they will show up on your images whether you have any knee pain or not. While I have many stories about people getting the root cause of their knee pain wrong – one in particular stands out in my mind that I want to share with you. 

I remember a 56 year old tennis player who had knee surgery to “clean out” some wear and tear from arthritis and a meniscus tear. This was after trying several months of physical therapy that had “failed”. She was told the procedure was routine and that her recovery would be quick. Sadly, after three months, she was still limping around and her knee was feeling worse than pre-surgery. The pain had moved, it spread more to her thigh now and it ached a lot more at night and when she wasn’t moving around. She could play tennis, but her knee felt more tired now and her leg would just ache. When she came to me for a second opinion, the very first thing I did was screen her lower back for problems. She thought this was weird at first because she had never had any real back pain. But it turns out that when we started moving her back around and testing it – her knee pain reacted to this. The root cause of her knee pain was actually in her spine. So it made sense all the physical therapy she had for her knee, and the knee surgery didn’t work.

If you’ve been suffering from knee pain for a while, and typical treatments don’t seem to be working, it’s worth considering that the root source of your problem could be your lower back. 

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your thigh – it’s worth getting your lower back checked by a mechanical pain specialist before give up all together – and especially before jumping into any surgery or procedure on your knee.

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



6 Tips for Healthy and Mobile Knees this Summer

/in /by

When you’ve got persistent, nagging knee pain, it can significantly impact your quality of life, and put a real damper on your summer. The good news is there are many things you can do naturally and on your own to help keep your knees healthy, especially with the increased activity that often comes with summer. 

Here are six of my top tips to ensure your knees stay strong and pain-free during your summer adventures:

1. Strengthen Your Hips and Core

Your hips and core provide essential support and stability to your entire body, but especially your lower limbs and knees. Strengthening these important muscle groups is key for not only relieving knee pain – but preventing it as well. Weakness or imbalance in your hips and core can lead to poor alignment and compensatory stress on your knees during movements like walking, running, or squatting. So when you focus on strengthening your hips and core – you’ll improve your overall biomechanics – and reduce the wear and tear by minimizing the load placed through your knees during summer activities.

2. Get (and Stay) Mobile

One saying you’ll hear me repeat over and over is: “mobility before stability.” When you’ve got stiffness in your joints, the surrounding muscles will try to compensate. Muscles don’t work as well when the joint they are in charge of moving doesn’t have full and free mobility. I see this a lot in people suffering from knee pain.

Good and optimized joint mobility will enhance your body’s ability to move efficiently and with proper body mechanics, thus, reducing the strain on your knees. By increasing (and maintaining) your flexibility and range of motion, your body will move more freely and distribute forces more evenly throughout your joints and muscles (including your knees).

3. Don’t Sit so Much

Knee pain can come directly from your knee, but also from your spine (even when you don’t have any back pain). Interrupting your sitting throughout the day (I recommend once every 30 min) addresses both potential causes. For knees in particular, prolonged periods of sitting can cause stiffness and lead to poor blood circulation in and around your knee joint. That’s why sometimes after sitting for a while, you can experience sharp stabbing pain in your knee when you go to move.

Sitting for extended periods can also lead to tightness in the hip flexors and hamstrings, which can negatively impact knee alignment and function. When you take regular breaks to stand, stretch, and move around – you relieve knee pressure, maintain good joint mobility, and prevent muscle imbalances that (when left unaddressed) can gradually creep up and ruin your summer.  

4. Keep Moving

Regular movement and exercise helps to stimulate blood flow. If you’ve got inflammation in your knees causing pain, good blood flow helps to actually reduce inflammation by delivering essential nutrients and oxygen while also removing waste products. If your knees are on the arthritic side, engaging in low-impact exercises like walking, swimming, cycling, or Pilates can help build strength and endurance around your knees without putting excessive stress on your joints.

Regular movement also helps lubricate your knee joints, which can reduce friction and discomfort during summer activities. Perhaps the biggest benefit of regular exercise and movement is the release of endorphins, which are your body’s natural painkillers that can help alleviate discomfort in any joint, not just your knees.

5. Wear Sensible Footwear

The right (or wrong) footwear can greatly impact how your knees feel when walking, running, or standing. Proper footwear provides the necessary support and cushioning to reduce knee strain. And depending on the mechanics of your feet and ankles, the right footwear can help improve overall alignment and stability. 

In the summer, people love wearing sandals and flip flops. However, if you’re prone to knee problems, you may want to reconsider this choice or only wear them for short periods when you won’t be standing or walking for long. Flip flops, in particular, offer little support and can exacerbate knee pain. By choosing shoes that prioritize comfort, support, and proper alignment, you can effectively reduce knee pain and enhance overall joint health for a happy and active summer.

6. Work on Your Balance

Good balance is crucial for stability, control during movement, and reducing fall risk, especially in summer activities like paddleboarding, pickleball, and walking on the beach. When you work on your balance, it helps reduce knee strain by ensuring your postural muscles, feet, and ankles work together to distribute forces evenly. Without this coordination, your knees overcompensate and suffer. When you make a conscious effort to improve and maintain balance – it will help to decrease the stress on your knees by getting other joints and muscle groups to “join the party.”

If you’ve been suffering from knee pain for a while and you’re worried about it ruining your summer – get started on any of these six tips and see if they help. Now, if knee pain is getting in the way of you being able to incorporate any of these tips, then it’s time to consider expert help and speak with a physical therapy specialist.

The right therapist will help you identify the root cause of your knee pain and come up with a treatment plan that not only gets rid of your knee pain, but teaches you how to keep it gone – naturally and on your own. 

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 download her Free Report on Knee Pain – CLICK HERE.

Knee Pain

Lingering Knee Pain? Here are Four Hidden Culprits

/in /by

Approximately 25% of adults suffer from chronic knee pain without any clear reason why.

For some, aging and arthritis are to blame, and it’s something to just “live” with. For others, they’re told it’s due to “wear and tear.” Yet despite one or more surgeries to “clean out the knee,” the pain lingers and persists. 

So why do some people age, develop arthritis, and put lots of wear and tear on their knees without any issues, while others suffer from chronic knee pain?

The answers may surprise you. 

Here are four hidden culprits that contribute to lingering knee pain that are often missed or overlooked:

1. It’s Actually Your Back

Did you know that 40% of the time, an extremity problem (such as in the knee or shoulder) originates from the spine, even when you don’t experience neck or back pain? It’s more common than you think for knee pain to be caused by issues in your lower back. When this is missed, it can lead to knee pain that never seems to resolve. True knee problems typically present with symptoms that are specific and localized to the knee joint. However, if your pain moves around your knee or travels up and down your leg, there’s a good chance it’s actually coming from your back. If you’ve been treating your knee for months or years without success, consider that the problem might be your back, especially if cortisone injections and various knee procedures have had little effect.

2. You Have a Weak Core

Most people associate core strength with preventing and resolving back pain, but it’s also crucial for good knee health. Your abdominals, low back muscles, hips, and glutes make up your “powerhouse,” or core, which greatly influences how well your lower extremities function. If your core is weak, your legs will have to work harder and overcompensate, often leading to knee pain. Although knees require some stability to function well, they aren’t designed to be stabilizing joints – that’s the role of your hips and ankles. If your core, particularly your hips and glutes, is weak and your knees start compensating as stabilizers, this could be why they keep hurting. If you haven’t had your core strength properly assessed, now might be the time – this could be the culprit.

3. Instability in Your Ankles

If your ankles aren’t strong enough to stabilize your foot and lower leg, your knees will compensate, which can lead to knee pain. When a joint lacks strength or stability, it will often stiffen up to compensate. If your ankles lack range of motion and are weak, your knees will bear the burden. This is particularly evident during activities such as running, hiking, or playing sports like pickleball or tennis. Good ankle mobility and stability are essential for these activities, or else your knees will suffer. If you have lingering knee pain and haven’t examined your ankles, it might be time to do so – they could be the overlooked issue.

4. You Lack “Hyper” Mobility

Early in my career, “hyper” mobility was often considered a bad thing. However, research and experience have shown that a joint that moves fully and freely functions better and allows the surrounding muscles to work optimally. Many people mistakenly focus on muscular strength as the solution to pain when they should be looking deeper. For knees, you need a bit of “hyper-extension” or more-than-straight flexibility. Most practitioners focus only on how well a knee bends. But it’s just as important to pay attention to how well a knee extends – and just getting to “straight” is often not good enough. I see this a lot with folks who’ve had surgery. If full knee extension (including hyperextension) wasn’t restored properly during your post-op rehab, knee pain will persist, or show up months to years later and you’ll have no idea why. Ensure you have full knee extension that includes a bit of hyperextension and that it matches your other knee – this could be why your knee pain isn’t going away.

Knee pain can be tricky to figure out, especially if it’s chronic. The key to successfully getting rid of knee pain starts with correctly identifying the cause. From my experience, arthritis, age, and wear and tear serve as “excuses” when a practitioner doesn’t know where to look. If you’re suffering from chronic knee pain and haven’t explored any of these four possible hidden culprits – talk to a specialist who understands how to look at the bigger picture. The true cause of your lingering knee pain might be elsewhere.

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

Why Surgery should be your Last Resort for Knee Pain

/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. Furthermore, the science tells us that people who do undergo arthroscopic knee surgery are more likely to have knee arthritis that advances rapidly – resulting in a total knee replacement that quite possibly could have been avoided.

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

Sounds pretty simple and harmless – right?

Well… it is until it isn’t. 

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

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

An early research study from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

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

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

And then there’s the elephant in the room…

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

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

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

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

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

Plantar Fasciitis

Enjoy Flip-Flop Season: Strategies to Prevent and Treat Foot Pain

/in /by

Flip-flop season is officially here – but unfortunately – that also means we are about to see an influx of foot pain – otherwise known as “plantar fasciitis”.

Here’s a question someone asked me just the other day… “I’ve been wearing my flip-flops for the past week and notice that the pain in my arch and heel has acted up. Is there anything I can do? Or do I need to just not wear flip-flops anymore?”
While wearing more supportive shoes would certainly help, staying on top of your plantar fasciitis and/or preventing it altogether means flip-flops don’t have to be an issue, and you can continue enjoying them all season long.

First – What is Plantar Fasciitis?

Quite simply, it’s inflammation of your plantar fascia—the tissue that makes up the arch (bottom) of your foot. Your plantar fascia runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot, enabling you to propel yourself during walking and running. When you land on your foot, your arch falls or flattens—this is called pronation. In response, your foot then stiffens or supinates, providing the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked, leading to what we call “plantar fasciitis”.

How Do Flip-Flops Contribute?

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

What Can You Do?

The best way to prevent and treat plantar fasciitis is to not neglect your feet. Consistent mobility exercises for your toes and ankles are key, as is conditioning for the strength and stability of your arch. Balance exercises, toe exercises, and plyometric (jumping) exercises are all important. Additionally, make it a point to walk around without shoes as often as possible. Incorporating pelvic floor and core training exercises is also beneficial because the function of your deep core has an impact on your foot mechanics.

When Your Pain is Too Severe

If your plantar fasciitis is too painful, jumping into exercises may not help and could even aggravate it more. One effective treatment modality for particularly painful cases is something called Shockwave Therapy (Extracorporeal Pulse Activation Technology or EPAT). During a shockwave treatment, high-pressure sound waves are delivered directly to the affected tissue, bringing blood flow and accelerated healing to the injured and inflamed area (in this case, your plantar fascia and surrounding muscles). The treatment is non-invasive and penetrates deeply. Pain reduction can be seen in as little as one shockwave session, but research shows it to be most effective after a minimum of six. Shockwave therapy can significantly reduce pain and swelling from plantar fasciitis in the short term, allowing you to tolerate the exercises required to keep your plantar fasciitis at bay in the long term.

When addressed correctly, plantar fasciitis doesn’t have to be chronic, and it doesn’t have to dictate your footwear selection. If you’ve tried various treatments already for your plantar fasciitis without success, consider working with an expert who can accurately identify where your plantar fasciitis is coming from. They can also help you decide if incorporating something like shockwave therapy – in addition to the necessary exercises – is what’s needed to finally resolve your plantar fasciitis and get back to enjoying your flip-flops again.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or inquire further about Shockwave Therapy – CLICK HERE.