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.

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.

Why Strengthening your Core Won’t Cure your Back Pain

/in /by

As a back pain expert, I talk to folks numerous times per day about the best things they can do to get rid of their back pain. The most common topic that comes up? Core Strengthening. Everyone wants to learn how to strengthen their core properly and more effectively – in hopes that it will put an end to their back pain.

Unfortunately, getting rid of back pain is not as simple as strengthening your core.

I wish it was. Don’t get me wrong – strengthening your core does have its role in both helping and preventing back pain – but core strengthening alone is rarely enough. In fact, sometimes, it can even make your back pain worse, especially if introduced too soon

So why isn’t core strengthening enough? Even when your Medical Doctor, Google, and YouTube all seem to allude that it should be?

Because 80% of the time, your back pain is due to something we call “mechanical” – meaning the source is way underneath all of those core muscles. While strengthening your core muscles will often make you feel better, and may even temporarily relieve your back pain, strengthening your core muscles will never address the mechanical problem underneath. And it will continue to rear its ugly head until it’s finally resolved.

So how do you solve mechanical low back pain so that core strengthening can actually do its job?

First… Let’s talk about what mechanical low back pain is… and isn’t.

Mechanical low back pain is caused by poor postural habits and repetitive movements and stress that occur slowly over time – and eventually lead to movement dysfunction within the spine. It arises from things like having a job where you sit for 8 hours a day, 5 days per week. Perhaps you’re a new mom and are constantly bending over to care for your new baby. You love to garden, or you’re an avid golfer, and have been doing these things for years. All of these “lifestyle” habits and requirements can be responsible for mechanical low back pain.

But what back pain is often blamed on are structures. Things like herniated or bulging discs, arthritis, stenosis, and pinched nerves. What you have to understand is that most of these ailments occur normally as you age. The majority of the population over the age of 50 will have one or more of these “abnormalities” show up on an MRI – even when they don’t have any back pain. But when you’ve got a mechanical back pain problem – one where your spine isn’t moving as well or as normally as it should – these structures become susceptible for irritation. So yes, the structures cause the pain, but the underlying mechanical problem is what’s responsible for irritating the structures.

If you’re confused – I don’t blame you. All you need to understand is that strengthening muscles of any kind – including your core muscles – will not resolve a mechanical back pain problem. You have to address the mechanical “fault” with very specialized and corrective movements that are prescribed to you. They aren’t cookie-cutter and you can’t find them on YouTube.

So when should you focus on strengthening your core?

After the mechanical back problem is identified and resolved. You’ll need to work with a mechanical back pain specialist to do this. But once you do – core strengthening plays a critical role in keeping you strong, healthy, and balanced. A good core strengthening regimen helps you prevent the mechanical back problem from coming back.

Moral of this story – if you’ve been at core strengthening for awhile now and disappointed that it hasn’t yet “cured” your back pain – then you must consider that you’re in the 80% and have a mechanical back pain problem. Fix what’s underneath first – and then strengthen away.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Back Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or reserve a seat in her upcoming Masterclass for Back Pain & Sciatica Sufferers – click here.

Woman sleeping facedown on a bed.

Tips and Solutions for Morning Back Pain

/in /by

One of the most common complaints from chronic back pain sufferers is back pain first thing in the morning.

For some folks, it rears its ugly head on occasion and appears out of nowhere – as if they’ve “thrown their back out”. For others, it’s like Groundhog Day – they go to bed feeling great but wake up every morning feeling stiff and achy.

Why does this happen? Shouldn’t your back feel better after a good night’s sleep?

Back pain impacts people in different ways and at different times of the day. When it comes to morning back pain – while the easiest thing to blame is your mattress – some of the more common causes of morning back pain include poor sleeping position, insufficient exercise, and bulging discs. 

Let’s go through each one and talk about tips to help minimize them.

Poor Sleeping Position

The sleeping position that aggravates you is going to depend on the underlying cause of your back pain. Sometimes sleeping on your back with legs elevated is what makes your back feel worse in the morning – even if it feels amazing while you’re in this position. For others, sleeping on their stomach is the thing that wreaks havoc on their spine. The most back-friendly position is to sleep on your side. Side-sleeping allows you to put your spine in a neutral position – which is where you get in the least amount of trouble. It’s really challenging to achieve a neutral spine when you’re on your back or stomach. If it bothers your hips or shoulders to sleep on your side – I recommend placing a pillow under your waist as well as your head – and if needed – also one between your thighs.

Insufficient Exercise

Another common culprit of morning back pain is insufficient exercise. A lack of regular physical activity can lead to weakened muscles and reduced flexibility, both of which can contribute to back pain. When your muscles are not strong enough to support your spine properly, your back is more susceptible to strain and discomfort. Incorporating regular exercise into your routine, especially exercises that strengthen your core and back muscles, can help reduce morning stiffness and pain. Activities such as yoga, Pilates, and even daily stretching can improve muscle tone and flexibility, thereby offering better support to your spine and reducing pain.

Bulging Discs

This is the most common reason I see for morning back pain. Your vertebral disc has three primary functions: 1) to absorb shock; 2) to help hold the vertebrae of your spine together; and 3) they contribute to the mobility in your spine. The interesting thing about vertebral discs is that they are made up primarily of water. Over the course of a normal day – and over the course of life – your discs will compress and decrease their water content. At night, your disc literally re-hydrates and can gain up to 17-25 mm of height.

While this may be beneficial to someone whose arthritis is to blame for their back pain, it is not beneficial for someone suffering from a bulging disc. Remember when I mentioned that your disc is partially responsible for mobility in your spine? When you have a bulging disc – that bulge restricts your mobility. If it fills up with fluid overnight – you’re going to wake up feeling a lot more restricted and in a lot more pain. Unfortunately, there is no quick fix I can reveal for you on this one. The best advice I can give you is that if you’re waking up every morning in a lot of pain and you’re afraid to move – there’s a good chance you’re suffering from bulging discs, and you should see someone who can help you with this.

If you’re waking up every morning with back pain, then hopefully this information helps you have a better understanding as to why it might be happening. Before you consider spending loads of cash on a new mattress – give one or more of these solutions a try and see if it helps. Because the good news is that 80% of the time there is a natural, movement-based solution that can address your back pain successfully. If you’re not having success with eliminating morning back pain on your own – then consider enlisting the help of a physical therapy specialist who is an expert in these kinds of solutions – and who can properly diagnose your back pain.

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 a free copy of her guide to back pain – click here.

Pain when gardening

Pain-Free Gardening: How to Protect Your Back and Love Your Garden

/in /by

Gardening season is finally here – and with all of gardening’s positive benefits – it’s no surprise that gardening is such a huge passion for so many. 

Tending to plants and watching them flourish offers a profound sense of accomplishment. The connection to nature is therapy for your soul. And the meditative practice of gardening reduces stress, gives you a break from the hustle, bustle and stress of daily life, and enhances your mental well being. Plus – let’s not forget all the physical benefits of gardening. Anything that gets you moving, active and mobile I’m a fan of.

But how do you continue to pursue your gardening passion when your back hurts? It’s been a very common concern as of late. The good news is that it’s entirely possible to spend more time loving your garden than tending to your back.

Here are 5 of my top tips to protect your back when gardening:

1. Avoid bending from the waist

A common gardening posture I see is folks standing with straight or slightly bent knees and bending over from their waist – creating an “L-shape” with their body. While this posture is acceptable to do from time to time – it’s not a good idea to do this over and over again while gardening. This particular posture puts a lot of strain on your lower back as well as the backs of your knees. Over time, your lower back muscles will become very sore and tight, which can make them susceptible to injury when you least expect it. What to do instead? Get in the habit of squatting and bending from your knees. If you must do a particular gardening activity for a sustained period – try being on all-fours – and switch your hands periodically. These positions are much better for your back and you’ll be able to sustain the activity for much longer.

2. Take frequent breaks

It’s easy to get lost in the activity of planting and weeding. But even if you’re choosing good postures like I mentioned above – your back still needs a break. Our spines do not enjoy being bent forward for prolonged periods and when you do this for too long without taking a break – it puts a lot of stress on the vertebral discs in your spine and makes them more likely to bulge. I recommend setting a timer and giving yourself a break every 30 min. Simply stand up and get out of the bent over posture. Your back will thank you and you’ll be able to garden for much longer without risk of injuring your spine.

3. Pivot instead of twist

One of the most vulnerable positions for your back is the combination of bending and rotating. And when done repetitively, you’re almost guaranteed an injury to your spine. When you’re doing things like digging or planting – activities that have you bending and twisting – you want to pivot instead. Keep your body in line with the activity you’re doing. Don’t rotate or twist from your waist. How do you do this? Make sure your hips are always in line with the object you are moving and maneuvering. Keep your ribs in line with your pelvis and always move them as a unit. While it’s ok to bend and twist from your waist on occasion – you’ll find yourself in some trouble when you do this over and over again – especially if you have a history of back pain episodes happening to you in the past.

4. Use gardening tools wisely

Gardening tools can be of significant help when it comes to maintaining good posture and avoiding overuse of your muscles and joints. When you have to lift something heavy – especially repeatedly – use a wheelbarrow. This valuable gardening tool will allow you to lift and move heavy things with significantly less strain on your back. If you’ve got to be on your knees or squatting a lot – consider using a gardening bench. This will make it easier to sustain activities that require prolonged bending or kneeling. Lastly, use tools with longer handles to help avoid crouched over postures. If you can maintain a more upright posture while gardening, you’ll be able to tolerate it longer and with less back pain. 

5. Raise your gardens

Let’s face it, gardening involves bending over and lots of it. Activities like this are just not good for your back when done over and over. Consider modifying your garden to include more raised boxes and beds. This is going to make it so much easier to tend to your plants without having to bend over so much. And when you need to create a work surface – make sure that is raised too. Bending forward isn’t “bad” for your spine – but when you bend all the time without giving your back a break – you’re asking for trouble. Modifying your garden to make it more ergonomic can make a huge difference in the health of your spine.

Gardening has so many positive benefits and it’s a true passion for so many folks I speak with. The last thing I want is for back pain to be the thing that stops you from doing something you love. Hopefully these tips give you some important things to consider – and more importantly – help you protect your back so you can focus on loving your garden.

Are you local to Portsmouth, NH?

CLICK HERE to speak with a specialist for free.

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 get a free copy of her guide to back pain – click here or call 603-380-7902

Why Your Nagging Shoulder Blade Pain isn’t Going Away

/in /by

The prevalence of shoulder pain tends to increase and become more severe as we age – especially for folks in their 50’s and beyond.

When people complain of shoulder pain – it can manifest in a lot of different ways. Sometimes pain appears in the front, sometimes on the very top of your shoulder, sometimes deep inside your joint… But probably the most annoying and uncomfortable type of shoulder pain I hear about is the one that occurs deep inside your shoulder blade. 

It’s tough to get to, tough to pinpoint, and even harder to make go away.

It kind of feels like middle back pain – but also feels like shoulder pain – so which is it? And more importantly… Why isn’t it going away?

There are many reasons why we get shoulder pain and there’s a good explanation why it can move around and appear in so many places. It’s the most mobile joint in your body, which lends itself to lots of ways to get injured. And to add even more confusion – 47% of all shoulder pain originates from a source in your spine (neck) – even when you don’t have any neck pain.

Therefore, misdiagnosis of shoulder pain is very common and it’s probably the most common reason I see for that nagging shoulder blade pain not going away – no matter how many times you massage it, stretch it, or “theragun” it.

If you’ve had nagging shoulder blade pain for a while now and it’s not going away – there’s a really good chance it’s not actually a shoulder problem and you’ve been misdiagnosed. 

Let’s look at a few key signs and considerations to help you figure out if that nagging pain in the middle of your shoulder blade has been misdiagnosed:

1. Location of your pain?

When your pain is coming from a source within your shoulder, the pain will be localized to your shoulder joint. “True” shoulder pain is typically felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But the pain will never radiate below your elbow. If the nagging pain in your shoulder blade ever causes pain past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area) – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem. 

2. Do you experience numbness, tingling or burning?

If the nagging pain in your shoulder blade is ever associated with numbness, tingling, or burning – these are signs of nerve irritation, or perhaps nerve compression. If that’s happening – the problem is almost certainly coming from your neck. It’s very common for things like bulging discs to compress nerves, or limit movement, which can irritate nerves in your neck. The nerves in your neck will commonly refer symptoms into your upper shoulder/upper trap area, down your arm, and… you guessed it… right into the middle of your shoulder blade. And remember – you could be experiencing the referred symptoms without much (or any) pain in your neck. If you’ve got symptoms of numbness, burning, or tingling in your arm or shoulder along with nagging shoulder blade pain – and you haven’t yet gotten your neck examined by a mechanical pain specialist – there is a good chance you’ve been misdiagnosed. 

3. Does posture affect your pain?

Do you notice that your shoulder blade pain changes depending on your posture? This is another tell tale sign that your shoulder blade pain is likely coming from your neck. Our heads are inclined to remain upright on top of our shoulders to look ahead at what’s in front of us. So when you slouch your middle back – your neck will always compensate so your head can look forward. Ever hear of the term “forward head posture”? That’s what we call the compensation your neck makes for curved, slouchy posture in your middle back. And in forward head posture, you will stretch out and eventually irritate the nerves in your lower neck. The nerves in your lower neck – particularly the areas of your C6 and C7 vertebrae – refer right into the middle of your shoulder blade. So if you notice the pain easing when you sit upright or lie down, and increasing with long car rides or sitting at a computer (when your back tends to be slouched) – there’s a very good chance the pain in your shoulder blade is coming from your neck.

The good news is that even if you’ve been misdiagnosed for some time, nagging pain in your shoulder blade is typically a mechanical problem and can be fixed naturally with a corrective movement prescription, postural training and education, and strengthening the areas around your neck and middle back. You don’t need to resort to injections or pain killers. Do me a favor though – don’t try and fix this problem yourself or by looking up exercises on YouTube. We call it a movement prescription for a reason – and it should be prescribed to you by a physical therapy specialist who has a deep understanding of the intricacies of mechanical pain and how it all works. If you want help finding someone like this in your area – get in touch – I’m happy to help.

Headache sufferer

5 Signs your Headaches are coming from your Neck

/in /by

Headaches impact approximately 47% of the population and are one of the most common disorders of the nervous system. If you suffer from headaches regularly, then you already know how disruptive they can be on your work life, social life, daily activities, and just overall energy and well-being. 

But what makes headache management particularly challenging is how often they are misdiagnosed. The most common types of headache disorders are what’s known as primary headache disorders – and those include migraines, cluster headaches, and tension-type headaches. But you could also be suffering from a secondary headache disorder – which is caused by some other illness or physical issue. One of the most common forms of secondary headache is something called a “cervicogenic headache” – meaning it comes from your neck. They can be quite debilitating and are commonly confused with migraines – but there are some key signs to look for that make them different. 

Let’s look at 4 signs that might indicate your headache is coming from your neck:

1. Headaches worsen with certain neck movements

If you find that certain movements or positions of your neck exacerbate your headaches – it could be a sign that your headaches are coming from your neck. Sometimes it’s very specific movements that trigger a headache – such as tilting your head forward or backward – or turning it from side to side. But other times it’s less obvious and related to more prolonged postures. For example, I’ve had patients experience headaches from sitting at a bar for several hours and turning their head to a certain side to talk to their friend. Pay attention to whether certain neck movements or positions create discomfort in your neck that either precedes or worsens your headache. It could mean that your headache is coming from a source in your neck.

2. Your Neck is Stiff

Another telltale sign of neck-related headaches is limited mobility or range of motion of your cervical spine (neck). If you find yourself struggling to turn your head fully, or you experience pain and stiffness when attempting to do so, it could indicate an underlying issue in your neck that is causing your headache. A common saying in my office is “mobility before stability”. If the joints in your neck don’t move fully and freely, the structures around those joints (muscles and nerves) can become angry and irritated – and this could be the source of your headaches.

3. Tenderness in your neck muscles

If you routinely have sensitivity and tenderness in the muscles of your neck – it could indicate an underlying neck problem. If you notice that your headaches seem to get triggered whenever the tension or tenderness in your neck muscles worsens – then there’s a good chance your headaches are coming from your neck. The muscles of your neck can get tense and irritated for a number of reasons – most commonly because of poor posture or because they are being overused in some capacity. Since your neck muscles have direct and intricate attachments to the base of your skull – they can be a common cause of your headaches.

4. Location of your Pain

A headache that stems from the base of your skull and stays on one side of your head – often radiating into your temple or behind your eye – is a common sign that your headache is coming from your neck. If you tend to get associated shoulder or arm pain at the same time as your headache – it’s another indicator your headache could be cervicogenic. That’s because the nerves in your neck extend into these areas and are capable of radiating pain into these locations. If you suffer from chronic headaches, pay attention to where the pain is coming from or where it’s radiation. If it’s extending beyond your head – there’s a good chance your headaches are coming from your neck.

5. Massage and Chiropractic Manipulations Help.

If you find temporary relief from your headaches any time you get a massage or see a chiropractor, it’s almost certain your headaches are cervicogenic. While it’s great you’ve found pain relief – the problem with relying on these modalities is that they are completely “passive” – meaning – you don’t have an active role in the process of relieving your headaches. Passive modalities work great when paired with specialized, corrective exercises you can do on your own that are designed to prolong the effects of these treatments. But when passive treatments are used in isolation – the headache relief tends to be short-lived. The take home point here is that if you find treatments like massage and chiropractic treatment help – your headaches are almost certainly coming from your neck.

If you suffer from debilitating headaches and haven’t yet gotten your neck thoroughly checked out as a source – you should. Because when your headaches originate from a source in your neck, it’s entirely possible to learn how to treat it and manage it naturally and on your own. But you’ll need to work with a specialist who understands cervicogenic headaches as well as the associated mechanical joint components influencing them.

Are you local to Portsmouth, NH? CLICK HERE to speak with one of my specialists for free.

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Are Cortisone Shots the Best Option for Chronic Shoulder Pain?

/in /by
Nagging shoulder pain can be extremely annoying.

But when it starts to interfere with things you love to do – you can’t help but wonder – is it time to get a cortisone shot? 

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast. Just because cortisone shots for shoulders are routine, popular, and often effective at getting rid of pain – it doesn’t mean they are the best or right thing to do.

What is a cortisone shot and how does it work?

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action. But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom? This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – you put yourself at risk for irreversible damage to your joints and tendons if you keep getting cortisone shots when you don’t actually need them. 

So how do you know if a cortisone shot is best for your shoulder pain?

Step one is making sure you’ve correctly identified the root source of your shoulder pain. Is it a chemical source – where the inflammatory process to heal something injured within your shoulder has gone haywire? Or is it a mechanical source – meaning the source of your pain is due to poor movement habits and imbalances in your body.  The difference matters – and will determine whether or not a cortisone shot is, indeed, the best option for your chronic shoulder pain.  Let’s look at the differences between the two sources of pain to help you figure out when a cortisone shot is best for your shoulder pain – versus when you should hold off.

“Chemical pain”

Chemical pain is normal (until it isn’t) – and it’s the result of your body’s natural inflammatory response to injury. When your body is trying to heal from an acute injury or tissue damage, a complex chemical reaction occurs between your blood and other cells that involves the releasing of chemicals to “flush out” the injured area and start the healing process. A good example of this is when you fall and sprain something. The sprain causes tissue damage – so your body creates inflammation to heal it. Normally this process has a start and an end. As your pain subsides, so does this chemical process called inflammation. But sometimes this inflammatory process can get out of control for various reasons. And the accumulation of toxic chemicals sticks around (they don’t ever flush out or go away). The result is constant irritation to your nerve endings and surrounding tissues. You’ll experience constant, dull pain (even at rest) that will appear extremely sensitive to any and all movements. There will be no reliability as to what makes your shoulder feel better – or worse. As you’ll read below – the presentation of shoulder pain due to an underlying chemical cause behaves quite differently from shoulder pain due to a mechanical cause. When it’s chemical – a cortisone shot is often necessary – and the best option for your shoulder pain 

“Mechanical pain”

Mechanical pain is responsible for 80% of all shoulder pain. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. You’ll find, for example, that your shoulder pain eases with exercise, movement, and certain positions – while other times it seems to have a mind of its own and will hurt constantly. But typically, you’ll have some sense about things you can do to ease and/or aggravate your shoulder pain. And this is what makes mechanical pain so confusing  – because when you’ve aggravated it – your shoulder will feel inflamed. But the presentation is different from that I’ve just described above, namely, your pain comes and goes. This type of inflammation is a symptom – and not the root cause of your shoulder pain. A cortisone shot may work temporarily to abolish this type of shoulder pain, but it’s going to keep coming back until you address the root mechanical reason that is causing the shoulder inflammation. What you risk here is getting repeated cortisone shots in your shoulder because you think they are working – when they are only serving as bandaids. 

The verdict?

For chemical pain, a cortisone shot is likely the best option for getting rid of your shoulder pain. But for mechanical pain – it’s not. For shoulder pain that is mechanical, you fix it naturally, with specialized and corrective movement strategies. The tricky part here is distinguishing between primary inflammation that’s gone haywire versus secondary inflammation that is responding to activities, overdoing it, or simply the way you move. Don’t try to figure it out yourself – let a mechanical pain expert do that for you.

Are you local to Portsmouth, NH?

Consider speaking 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 get in touch, or reserve a seat in her upcoming free Masterclass for headaches, neck & shoulder pain – email info@cjphysicaltherapy.com or call 603-380-7902