knee pain source

When Knee Pain Doesn’t Go Away – Consider your lower back.

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One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the knee pain source.

Is your knee pain actually due to a problem in your knee? Or is the root cause of your knee pain coming from somewhere else in your body?

Rosedale, et al published a study in 2020 that revealed 43% of all isolated extremity pain was coming from the spine. What that means is that you could have nagging knee pain, and no back pain at all, and your knee pain is the result of a lower back problem. I’m not going to get into the technicalities of how this happens. Generally speaking, it’s a mechanical problem in your lower back that causes irritation to nerves or structures that impact your knee – and only your knee.

But how do you know for sure?

One of the biggest clues you’ve missed 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, and stretching. Even physical therapy – but no matter what – your knee pain just won’t go away. It might get better for a short period, but it always comes back. If the lower back is not considered at this point, then it’s typically when knee doctors get involved. This is great if you’ve actually got a knee problem.

Knee pain that doesn’t respond to conservative treatment should be looked at further. But if your knee pain is a symptom of a problem in your lower back, and it’s missed, you risk having an unnecessary knee procedure or surgery that will only cause you more problems later.

Here’s a quick story about someone this happened to…

I spoke to a client the other day – we’ll call him “David”. He had surgery on his knee to clean out some cartilage and wear and tear from arthritis. They recommended this surgery because he had “failed” regular physical therapy treatment. Nothing else seemed to be resolving his knee pain. It was supposed to be a “quick recovery” and take his pain away because they assumed all his problems were due to arthritis. Well, three months later, Davids knee felt (and functioned) worse than pre-surgery. Now he had back pain to go along with it. To fix the new pain he was having they were recommending even more knee surgery. And now they wanted to do an MRI of his back.

How does something like this happen?

The biggest culprit is over-reliance on imaging to form a diagnosis and treatment plan. Leading you to have the wrong idea of your knee pain source.

If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60 to 80% chance they’ll find arthritis and/or meniscus (cartilage) tears. And this will be whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee. They might just blame your knee pain on it without looking at anything else. That’s exactly what happened to David. They blamed knee arthritis for his knee problem when it was actually coming from his lower back.

How do I know?

Luckily for David, he refused the second knee surgery. He went to a mechanical pain expert for diagnosis and treatment, and in 2 months both his knee and back pain were gone.

Do you have knee pain that won’t resolve with typical knee pain treatment? You must consider that it could be coming from your lower back before you undergo any kind of surgery or procedure.

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 leg – there is a good chance your knee pain is a symptom of a mechanical problem in your lower back and you should get it looked at.

Knee Pain

Knee Pain? Top 3 Causes and What You Can Do.

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Knee pain impacts one-third of all Americans, and annoyingly interferes with activities of daily life. Such activities could be as simple as walking, squatting, going up and down stairs, and getting in and out of the car. This is in addition to the multitude of recreational activities knee pain can impact.

It’s the second most common complaint behind back pain when it comes to musculoskeletal problems. It’s one of the most common complaints I still hear about that started or worsened during the pandemic.

But what if there was a way to address some of the most common causes of knee pain on your own – without procedures or surgery?

Here are three of the most common causes of knee pain I see and what you can do to resolve it – naturally:

1. Patellofemoral Knee syndrome

Also known as “runner’s knee”, patellofemoral knee syndrome (PFS) is characterized by pain in the front of your knee. Usually this is just below or behind your knee cap. With PFS, the source of the pain typically comes from unwanted pressure around your knee cap. This will eventually results in inflammation and pain.

It’s very tempting to just get a cortisone shot or take pain pills to quickly reduce the inflammation and relieve your pain. But the problem with this approach is that you’re only putting a bandaid on symptoms. Inflammation is the result of an angry kneecap – not the cause. What you need to figure out is what is causing your knee cap to get angry in the first place.

Typically, PFS is the result of an imbalance somewhere in your body, typically from poor form and movement habits. Over time, this ultimately causes more pressure at your knee cap. If your hips, quads (front of the thigh), and hamstrings (back of the thigh) aren’t balanced and working together, for example, you could end up with problems with the way your knee cap tracks and functions. This will make your knee cap angry and inflamed over time.

When you figure out the true culprit behind the pressure and inflammation at your knee cap, you’ll not only be able to resolve and manage PFS naturally and for the long-term, but you can avoid temporary band-aid treatments.

2. Iliotibial band syndrome

The causes of iliotibial band syndrome are very similar to that of PFS. Except that your pain and symptoms will be experienced on the side of your knee instead of the front. Your iliotibial band (ITB) is a large band of tissue that runs along the side of your thigh to the bottom of your knee. Your ITB is formed from a muscle in your hip called the tensor fascia latae (TFL). When your TFL gets overworked, your ITB suffers. It will result in what often feels like stabbing pain at the side of your knee.

The most common treatment I see for this is foam rolling and massage. While these are great modalities to relieve your symptoms, they don’t address the root problem. You must figure out why your TFL is being stressed and overworked if you really want to get rid of your pain. Typically, it’s due to weak glute muscles, the deep ones designed to stabilize your pelvis. Your TFL is neighbor to your glutes. So when they decide to be lazy, your TFL loves to help out, and eventually overdoes it. When you can get these two groups of muscles working properly together, you’ll put an end to ITB syndrome.

3. Osteoarthritis

This is a very hot topic and everyone wants to know if they have it. (Spoiler alert – if you’re over the age of 50 – you already do.) Osteoarthritis happens naturally over time and is a normal part of aging. The problem with arthritis is that it only gets paid attention to when you’ve got pain. Then it gets blamed for all your problems. Arthritis certainly plays a role in your mobility and quality of movement. But it’s not the “death sentence” that many make it out to be. Many people find out they have osteoarthritis in their knees and think they have to just “live with it” or get a total knee replacement.

Remember, arthritis is normal and it happens to everyone as they age. What is not normal is for you to think you’re helpless or have to avoid your favorite activities because of it.

Arthritis occurs when the protective cartilage that cushions the ends of your bones wears down over time. There isn’t anything you can do to reverse this process. But, there is plenty you can do to minimize the symptoms you get because of this condition. It all comes down to balanced joints and movement. The more mobility you have, and the more stability you have around your knees, the less symptomatic your arthritis will be.

Some key areas to focus on when you’ve got arthritis in your knees is good core and hip strength. As well as good flexibility in your hips and ankles. If anything is off in these areas, your knees will want to compensate. This could result in compression at your knee joint and aggravation of your arthritic symptoms.

There is no need to rely on pain pills, or believe that procedures and surgery are your only options when it comes to knee pain.

As you can see, three of the most common causes of knee pain are due to – or influenced – by movement problems. Therefore, movement should be your go-to solution – not something you avoid.

If you’re having difficulty using movement as your solution and you want to contact a movement expert who understands mechanical knee pain and can diagnose the root cause of your knee problem – consider speaking to one of my specialists!

In your free Discovery Session we will ask you all about what’s been going on & see if we would be a good fit to help you. Book your free discovery session HERE.

tendinitis and tendinosis

Why Cortisone Shots Often Fail in the Knee

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When you’ve got nagging, persistent knee pain, it’s common for doctors to recommend a cortisone shot in the knee.

A cortisone shot in the knee, also known as corticosteroid injections, or “steroid shots”, works by reducing inflammation in your knee joint in an effort to alleviate pain. Sounds pretty straightforward, right?  Well… not so fast.

Assuming your knee pain is truly due to inflammation, then yes, a cortisone shot can be a successful treatment option. For example, it’s often used as a pain management strategy when you’re awaiting a major joint replacement surgery.

Advanced osteoarthritis is a common cause of knee inflammation.  The only real “cure” for this is joint replacement. Periodic cortisone shots may help give you the pain relief you need to pass the time until surgery. But this is a very specific and not common circumstance.

What we see more often than not is cortisone shots either working temporarily, or not working at all in your knee joint.

Patients are often told they need up to three cortisone shots to see results. There’s a problem with this approach. Every time you get a cortisone shot, you risk damaging the cartilage and tissue in your knee joint. This not only leads to irreversible joint damage, but more persistent pain in your joint that gets harder and harder to fix.

So when it comes to whether or not you should get a cortisone shot in your knee – you really want to make sure that the root source of your problem is inflammation.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the knee pain you are experiencing might be due to inflammation, the underlying cause leading to that inflammation could be something else entirely. Eight percent of the time the knee pain you’re experiencing is due to a mechanical or movement problem.

So while the symptoms you’re experiencing could be inflammatory in nature, the root cause of your issue is not. A cortisone shot is not going to help your knee in this case. Or worse, you’ll get temporary relief that fools you into thinking it worked. This only delays treatment that will give you the long-lasting relief you’re looking for.

So how do you know if you have a true inflammatory problem in your knee?

Let me explain.

Let’s say you have some arthritis and general wear and tear in your knee joint. You have good days and bad days. The pain comes and goes. Certain movements and exercises make your knee feel better while others seem to really aggravate it.

This is a pretty classic presentation of a mechanical knee problem. The mechanical issue (aka movement problem) in your knee can irritate certain structures within your knee joint (like a meniscus or ligament) and cause it to be inflamed.

If you go ahead and just inject cortisone into this knee, it might relieve the inflammation for a short time. It won’t help the underlying movement problem. It’s only a matter of time before the cortisone wears off and the structures in your knee feel irritated again. Not only have you masked the problem, but now you risk creating actual damage to those structures from the cortisone. Studies have shown that repeatedly injecting cortisone into your knee (or any joint) can advance the formation of osteoarthritis.

Another interesting statistic is that 41% of knee pain has been shown to be coming from your spine – even when there is no back pain present.

In this case, your knee could really hurt and appear to be inflamed. If a doctor can’t find any real explanation for this from an X-ray or an MRI (because the real problem is coming from your spine), he or she may assume it’s just inflammation from wear and tear and suggest a cortisone shot. This is not going to help your knee. Once again you risk causing real damage to an otherwise healthy knee joint.

These are just a few examples of where cortisone shots are unnecessary and can go wrong when incorrectly prescribed.

Have you recently had a cortisone shot in your knee and it didn’t work? It could  be that you never actually needed it. Or that the symptoms (inflammation) was being addressed instead of the underlying cause.

If you are considering a cortisone shot in your knee, it’s always a good idea to get a second opinion to make certain you really need it. A mechanical pain expert can tell you whether or not your knee pain is truly due to inflammation. If your knee pain is due to a movement problem (80% of time it is) then a proper movement prescription is your answer.

Are you local to Portsmouth, NH and looking for help with your knee pain NOW?

Consider speaking to one of my specialists.

Tell them about your knee pain and they’ll see if we would be a good fit to help you!

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

skiing

Four tips to Protect your Knees and Avoid Injury when Skiing

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Skiing can put a lot of stress on your knee joints and if you’re not careful – lead to pain and injury.

Your knee joint requires both mobility and stability to function well. It’s important for your knee joint to be mobile enough to allow for a full range of motion. But, it also needs to be stable enough to support your body weight and absorb the forces that come with everyday activities. When it comes to skiing, mobility is going to protect your knees when you fall, and stability is going to keep your knees feeling strong as you twist and turn down the slopes. Maintaining a balance between mobility and stability is crucial for knee joint health in general. It certainly is crucial when it comes to skiing.

Here are four tips to help protect your knees and avoid injury when skiing:

1. Warm up before hitting the slopes.

When you take the time to stretch and warm-up your muscles before skiing your knee is not only going to feel better, but be better equipped to handle the stress of the day. Warming up helps to increase blood flow to your muscles and improve your strength, endurance and agility on the slopes.

When warming up, choose exercises that take your knee, hips and ankles through full range of motion. Plus – if skiing is a day trip for you, you’ve likely just sat in the car for an hour or more. Prolonged sitting puts extra stress and compression on your knee joint, especially in the front of your knees. Warming up your knees can help relieve this added stress on your joints before you hit the slopes.

2. Strengthen your upper leg muscles and core

Having good strength of your upper legs and core can help improve both the stability and alignment of your knee joint – which is important during skiing.

Your knee joint is surrounded by a complex network of muscles, ligaments, and tendons. When the muscles around your knee joint are weak, imbalanced, or simply not functioning well – this will cause your knee to move in ways that add extra stress to your joint. Given the stress skiing already adds, you don’t want to make your knee work any harder.

Strengthening your core and upper leg muscles will improve the alignment of your knee during activity, reduce the risk of injury, and improve the overall function of your knee – which can only help you when skiing.

3. Keep your Knees Mobile

Full and free mobility of your knee joint is important. It helps maintain the health of your joint and surrounding tissues.

When your knee (or any) joint doesn’t move well, you will get added stress on your ligaments, cartilage, and tendons. Your knees need to bend all the way so you can squat and pick things up.  They need to straighten all the way to give you stability when needed. When either of these motions are lacking – your knee joint suffers.

When it comes to skiing, if your ligaments and surrounding tissues are already stressed due to lack of mobility in everyday movement – they will certainly not be happy when you add the stress of skiing. Having a good mobility routine for your knees as a preventative activity is important. It’s going to really pay off when you go to hit the slopes each ski season.

4. Talk to a mechanical pain expert

70% of all knee pain is going to be mechanical in nature. Everything I’ve already described above is going to help you deal with mechanical movement faults that might be happening in your knee joint. But occasionally, despite all your best efforts, you need help from someone who specializes in mechanical joint pain.

Mechanical joint pain responds very well to what we call “corrective movements”. When you know what specific movement your joint needs to feel better, it literally acts like a prescription medication. You can use that movement any time you want to help relieve knee pain on your own. This is particularly advantageous when you’ve gone a little overboard on the slopes. You can “fix” your knee and be ready for the next day.

If you’ve already tried many of the strategies I mentioned, and continue to have knee pain when you ski, it might be worth visiting a mechanical pain expert to help set you on a customized path to preventing knee pain and avoiding an injury that requires more invasive intervention down the line.

It’s more fun to focus on the ski day ahead than worry about whether or not your knee joints can handle it.

I hope these tips help you to not only enjoy what’s left of ski season – but help you have healthier knees in general to keep enjoying all of the activities you love.

Local to Portsmouth, NH and need help with your knee pain NOW?

CLICK HERE to request a Free Discovery Session with one of my Specialists. They’ll ask you all about what’s been going on – and figure out if we would be a good fit to help.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth. To get a FREE copy of her guide to knee pain – CLICK HERE

Herniated Disc

3 Reasons You’re at Risk of a Herniated Disc

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A herniated disc can occur in any part of our spine. However, we often see it happening in the lower back.

This condition has also been known as a bulging, protruding, or ruptured disc. 80% of people will experience lower back pain at one point in their life – and for some this may be from a herniated disc.

Anyone can develop a herniated disc, but certain factors may increase that risk.

Here are three reasons you might be at a greater risk of developing a herniated disc:

1. You’re sitting For Long Periods

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

The solution?

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

2. You’re bending too much

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

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

To combat this, we need to make a concerted effort to extend instead of bend. A really simple exercise you can do every day is to stand and extend your spine. Place your hands on your lower back for support and then arch back as far as you can go. Repeat this 10 times, at least once per day. If you’ve never arched your back like this before, it may feel stiff or even hurt a little at first. But with a gradual increase in frequency, it will feel less stiff and more natural over the course of a few days.

3. Your Age

Age is one of the most significant risk factors for developing back problems.

As we age, our muscles naturally weaken, including those in our back. This can make it harder for us to support our spine and maintain good posture.

Making sure that you are maintaining a proper nutritional diet is very important. It will aid in avoiding injuries like a herniated disc. When our bodies are supplied with the vitamins and minerals they need – your bones and supportive structures are supported to work at their best.

As we get older, we may become less active, which can lead to unwanted weight gain and weaker muscles. This can cause a strain on our back and increase the chances of having a herniated disc. It is generally recommended to be active for around 150 minutes per week. Staying mobile and strong will delay the wear and tear on our bodies as we age.

The good news is – the majority of herniated discs can be completely resolved without surgery.

Are you local to Portsmouth, NH and looking to get help with your pain NOW? CLICK HERE to request a Free Discovery Session with one of my Specialists. They’ll ask you all about what’s been going on – and figure out if we would be a good fit to help.

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

Back Pain

Hip pain not going away? Three Reasons Why.

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Hip pain is not nearly as common as knee or back pain, but it still impacts much of the population and it can be quite debilitating – especially when it doesn’t go away.

People routinely report hip pain in the side of their hip and in their groin. They may even complain that it radiates into their back and down their thigh. When this goes unresolved, it impacts your ability to walk, play golf, squat, bear weight on one leg, and even sleep through the night.

The big question, though, is why does it go away from some and persist for others?

If your hip pain isn’t going away – here are three reasons why:

1. You need a hip replacement

This is probably the most legitimate reason your hip pain isn’t going away. Your hip joint has become so arthritic and worn down that it’s time to get a new one.

But here’s the thing to keep in mind, whether or not you need a hip replacement should not be decided by your X-ray – it should be decided by your symptoms. Far too many people rely on the “bone-on-bone” diagnosis from imaging to be the determining factor. But there are hundreds of people walking around with fully functioning hips that have bone-on-bone and don’t need joint replacements yet.

When you need a new hip, the presentation is typically constant, unrelenting pain along with severely restricted mobility. In these instances, getting a new hip is going to be life changing and it should have a significant impact on your hip pain.

2. You’ve been mis-diagnosed

This is the most common reason why hip pain doesn’t go away. Just about everyone I see in my office with hip pain tells me they’ve been diagnosed with “hip bursitis”, when in reality, only 15% of women and 8% of women have true hip bursitis.

Hip bursitis occurs when you have inflammation of the bursa on the side of your hip. It’s typically caused by blunt trauma to your hip, or overuse/imbalance of the musculature there. It’s actually extremely easy to resolve so if your hip pain is persisting, this is likely not the reason.

The other common mis-diagnosis I see is that your hip problem is actually coming from your lower back. If you’ve got radiating pain into your thigh, you must always rule out that it’s not coming from your spine. Because if it is – and you don’t address it – your pain will never go away.

3. You’ve got the wrong treatment approach

If you don’t need a hip replacement, and you’ve got the right diagnosis, your hip pain should go away. If not, then we need to consider the treatment approach.

The most common mistake I see with hip pain treatment is implementing strengthening and stabilization exercises way too soon. The hip joint is one of the most mobile joints in our bodies. Because of that, it can be hard to detect when you’ve got some restrictions there. Having optimized mobility in your hip joint is paramount.

Without good, adequate mobility, your muscles will struggle to function as well as they could, and this can impact strength. I have a saying in my office: “mobility before stability”. And it’s for a good reason. If you don’t check mobility first, you risk strengthening and stabilizing around a joint that isn’t moving as well as it could. This could be a reason why your pain isn’t going away.

If you’ve got hip pain that isn’t going away, I hope this article has given you some food for thought.

Approximately 70-80% of all musculoskeletal problems, including hip pain, can be resolved naturally and without relying on pills, procedures, or surgery.

If you’re not having success with getting rid of your hip pain, then it’s important to question what you’re doing and consider that something has been missed. You deserve to live an active and mobile lifestyle doing all the activities you love.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists. Tell them about your hip pain and they’ll get you on a treatment plan right away – at the very least you’ll leave with some helpful tips moving forward.

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

Staying Active

5 Tips to Stay Active and Avoid Injury in Your 50’s

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I work with a lot of clients in their 50’s and beyond. Staying active over 50 is a big priority for them as they age. An injury can significantly derail this plan, especially as we age, since recovery just isn’t as easy.

Here are five of my top tips when speaking to folks over the age of 50 for staying active and mobile, avoid injuries, and continue doing everything they love:

1. Keep Moving

You’ll often hear me say: “You don’t get stiff because you get old, you get old because you get stiff”.One of the best ways to stay active and mobile as you age is to keep moving. Well what if you have something like arthritis? Remember that arthritis is normal. It happens to everyone as they age and it’s rarely a reason to stop doing your favorite activities.

In fact, research has shown that activities like running, when done consistently and with proper form, actually prevents knee arthritis. Arthritis worsens when you don’t move. And common “injuries” such as meniscal tears and bulging discs are more likely to occur in arthritic joints. But the more active you stay, the less likely you are to be impacted by ailments such as these, and the better your joints will feel. Happy joints will motivate you into staying active.

2. Maintain a Healthy Diet

Both osteoporosis and heart health become bigger concerns as we age, and what you eat can have a direct and positive influence. With osteoporosis, your risk of injury, especially from a fall, becomes greater. Greens like kale, spinach, and arugula are awesome for your bones, along with citrus fruits, fish, and nuts. These foods help your bones stay strong and durable.

According to Health magazine, “The risk of a heart attack climbs for men after age 45 and for women after age 55.” As you enter middle-age, increasing the presence of foods like unsalted nuts, unprocessed oatmeal, raisins, blueberries, and even dark chocolate (over 70% cacao) can help keep your heart healthy. Before making any drastic changes to your diet, especially if you’ve got comorbidities such as diabetes or kidney disease, you’ll want to check with your doctor or dietician. But otherwise, paying attention to your diet can have a big impact on how healthy you keep your heart and bones, which will motivate you in staying active and mobile.

3. Work on Your Balance

Balance is one of the first things to go as a person gets older, and it’s one of the most crucial factors in fall prevention. Slips and falls due to poor balance can lead to broken bones and fractures, which become more common and harder to recover from as you age. But if you’re intentional about improving your balance when you exercise, it’s not too late to improve it.

While there are many great balance-exercises you can do at home, I always recommend incorporating balance strategies with movement and activity. Because rarely do we fall when just standing still. Try standing on one leg when you brush your teeth, place one foot up on a stool when washing dishes, walk around on your toes and heels during commercials. These are really easy strategies to incorporate into your daily living. And of course, activities like walking regularly, Thai Chi and Yoga are also great to promote good balance – while also keeping you active.

4. Strengthen Your Core

Having a strong core is beneficial at any age, but especially as you get older. Strong abs, hips and buttocks (all part of your core) help you to sit and stand more upright, prevent back and neck pain, and will help you feel stronger and more confident in just about everything that you do.

One word of caution, however, when it comes to core training is to pay special attention to your form and posture. Ironic, right? Since core training is supposed to help those things… But I can’t tell you how often I see folks (especially over 50) begin a new core training program and then call us 4-6 weeks later because they’ve suddenly hurt their back.

If you’re over the age of 50 – and you haven’t exercised in a while – I highly recommend engaging the help of a qualified professional who can guide you through exercises that are appropriate for your fitness level as well as keep a close eye on your form and technique when crunching those abs and working those planks.

5. Educate Yourself

Knowledge is power, and lack of it, is one of the biggest reasons I see people decreasing their activity levels as they age and getting injured.

People think that ailments like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities. Not true. Most of the things I just mentioned are normal occurrences as we age, and having them show up on an Xray or MRI is not a reason to change something you’ve been successfully doing for years.

Staying active and mobile actually helps these problems. If you’ve got pain, that’s a different story.

Talk to an expert who can help you figure out what’s going on, so that you can quickly get back to your activities and not make your pain worse.

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

Tendonisis

Tendonitis vs. Tendinosis – The BIG difference and why it matters

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If you’ve ever suffered from tendonitis or tendinosis – then you know that it can last anywhere from a few weeks to several months!

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon. Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably, they couldn’t be more different. When tendonitis isn’t caught early enough or treated properly it can turn into tendinosis. The treatment for acute tendonitis is very different from chronic tendinosis.

Let me explain…

Tendonitis is an acute condition. The best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

When you don’t manage tendonitis properly, and it goes on longer than a few months, it can result in tendinosis. Tendinosis is a very different condition where the fibers in your tendon actually start to break down. The first thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you. I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again.

Passive treatments like ice, rest, and medicine will not help tendinosis. They might help to relieve any pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area. In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis. Making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right? Well technically it is, but the biggest problem is that this process takes time – up to 9 months in many cases. And most patients I come across simply don’t have the patience for this. Or they simply aren’t told about it.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time. You have to put just the right amount of stress to cause a little bit of pain. However, not so much stress that your tendon gets inflamed again. A properly trained physical therapist that is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time. The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry. So is half the medical community.

The take home points to remember are these:

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks. Treatment for this should involve passive modalities like ice and rest. The focus should be on what causes the tendon to get irritated innitially.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies. These will properly re-organize the tendon so that it can be strong again! This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

Luckily – we’ve introduced a brand new treatment modality in our office. It accelerates the healing of soft tissue and tendon injuries.

It’s called Shockwave Therapy and we are currently accepting new patients for this service. If you’re already a client – you will get this service at no charge. Just ask your specialist next time you’re in and see if you’d be a good fit for this treatment.

But if you’re not a current client – and are currently suffering from something like plantar fasciitis, tendonitis, or some other soft tissue strain or injury – you could be perfect for this treatment! Studies have shown about 70% reduction in symptoms in as little as 6 sessions.

While this won’t completely “fix” your tendon or soft tissue problem – it can have a significant reduction on your pain which will allow you to more easily do the work that WILL fix your problem.

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

Sciatica

Suffering from Sciatica? The Do’s and Dont’s

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Four out of five people will experience a debilitating back pain and Sciatica episode at one point during their lives. Sometimes this looks like severe back pain that lasts a few days and eventually goes away on its own.

But for some – especially those that have experienced more than one debilitating back pain episode over the course of their lifetime – they experience searing pain down their leg that may or may not persist over a period of time.

When you experience back pain followed by radiating leg pain – this is known as “sciatica”.

Sometimes the pain will only go to your knee, or be a dull ache in the side of your hip and leg. But other times it can manifest all the way down to your foot and be accompanied by numbness, tingling and a loss of strength.

The good news is that there is plenty you can do on your own to help yourself recover from sciatica naturally. But there’s just as much you can do – unknowingly – to make your situation worse.

Here are some Do’s and Don’ts when it comes to sciatica.

The Dont’s:

1. Avoid resting in bed or on the couch.

While it may feel better in the moment – lying in bed or on the couch will ultimately aggravate your sciatica. Sciatica is caused by pinching or irritation of the nerves in your lower back. When you lie in a slouched posture (such as in bed or on the couch) you will put unwanted pressure on these nerves, thus aggravating your symptoms.

The trickiest part about this is that you typically won’t notice the aggravation when you’re resting. You’ll notice it after the fact when you stand up or try to move around, and mistakenly assume the movement is what’s aggravating you instead of the relaxed posture you were just in.

2. Avoid child’s pose and stretching forward.

This is another big misconception about sciatica because it tends to feel really good when you’re “in the moment” and stretching your back forward. Not always, but often, sciatica is caused by a bulging or herniated disc that is pinching your nerve.

The position of bending forward does temporarily relieve pressure on your nerves – which is why it feels good at first – but it doesn’t last.

Stretching forward also opens up the space between your vertebrae. This can influence the protrusion (bulging) of your disc. If you allow your disc bulge to protrude more onto that nerve – your nerve will become more angry and aggravated – as will your sciatica.

3. Don’t let your MRI decide treatment.

As I mentioned in our first two examples, sciatica often involves bulging discs and irritated nerves. And an MRI will typically confirm this. But here’s the thing – tons of people out there have bulging discs showing up on their MRI’s and no symptoms at all.

What matters is whether or not your bulging disc is interacting negatively with your nerve – and that is typically influenced by poor movement strategies.In other words, if you learn how to move better, you can actually make your bulging disc inconsequential and your sciatica will dissipate.

So you should never let your MRI, alone, determine your treatment protocol when you’re suffering from sciatica. What’s more important is how your sciatica symptoms behave during movement. Research has shown this to be more reliable than imaging alone because it tells us in real time what’s happening to your nerves.

The Do’s:

1. Keep moving.

While it may seem counterintuitive to move when you’ve got pain running down your leg – it’s one of the best things you can do.

Try to stand and walk upright as much as you can and pay close attention to what happens in your leg. If the symptoms in your leg start to subside, then you’ll know that your body is enjoying that particular movement and that it’s helping your sciatica.

But here’s the catch – make sure the relief lasts. Lasting relief (vs temporary) is what we’re looking for and it tells us if the movement you’re doing is a good thing for your sciatica.

2. Watch your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. Remember that sciatica typically involves a pinched or irritated nerve – and irritated nerves are highly sensitive to postural changes in your lower back (especially slouched postures).

Whether you’re standing, sitting, or lying down – be sure to maintain a small curve in your lower back to minimize your slouch. This helps to keep pressure off your discs and already aggravated nerves.

3. Talk to a Movement Specialist.

While it’s entirely possible to rid yourself of debilitating sciatica without pain pills, procedures, or surgery, you’ll find it easier to do so under the guidance of a movement specialist who specializes in understanding back pain and sciatica.

Yes – you can get an MRI and go see a surgeon – but they aren’t movement specialists. They are surgical specialists. In order to get rid of your sciatica the natural way (with corrective movement strategies) – you need to work with someone who’s an expert in this.

Have you been dealing with back pain or sciatica? Or do you know someone who is?

If you”re local Portsmouth, NH, and you want help NOW for your back pain – Request a Free Discovery Session from one of my specialists. They’ll tell you if we can help and get you set up on a treatment plan right away!

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

Back Surgery

Back Surgery: Why it fails and do you need it

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Approximately 500,000 Americans undergo back surgery to relieve their pain every year, and according to the Agency for Healthcare Research and Quality (AHTQ), this costs approximately $11 billion annually.

But what if I told you that only 5% of people undergoing back surgery actually need it – and worse – for many folks the pain ends up coming back. The American Society of Anesthesiologists estimates that 20-40% of back surgeries fail. If you’ve had repeated back surgery your risk of failure increases. Failed back surgery is so common that it’s gotten its own name – “Failed Back Surgery Syndrome” – which occurs when you experience continued pain in your neck, back, or limbs following any spine surgery meant to reduce pain.

So why then do we continue spending so much money on back surgery when the majority of people don’t actually need it – and when half the surgeries fail?

Back pain can be excruciating, debilitating, and have a significant impact on your quality of life and happiness.

If you’re in this situation, and told by a well-respected surgeon that surgery is your best option of taking your pain away and getting you back to living your life again, odds are good you will take that opportunity. And most of the time – surgery does take your pain away – initially that is.

But what surgeons don’t tell you is that your pain has a high likelihood of returning.

If you’ve had one “successful surgery” – you assume the next will go the same. But as mentioned above – the more back surgeries you have – the more likely they are to fail – and the vicious cycle begins.

So when should you get back surgery?

If you’ve had an accident or trauma that has resulted in major damage to your spine – you need surgery.

If you have urgent compromise to one of your spinal nerves you also need surgery. But let me preface “urgent”.

Your symptoms will be progressive and severe.

Signs might include problems with your bowel and bladder, sudden and worsening foot drop (loss of strength and ability to lift your foot and toes), walking will be difficult and progressively worsen, and nothing will take your pain away – medication and rest will barely touch your symptoms.

These cases are rare – but do require surgery to quickly decompress your nerve before permanent damage ensues.

But 70-80% of the time, back pain is what we call non-specific or mechanical.

And surgery is not recommended – and rarely works for this type or back pain.

Mechanical back pain can be acute and last for a few days, or can be chronic and come and go. You might have nerve pain with numbness and shooting pain down your leg, but it won’t be urgent like the situation described previously. The pain you feel is typically caused by irritation to soft tissue structures, discs, muscles, and joints. But the root cause of this irritation is from something different – and that is what we need to care about.

It’s why 50% of back surgeries fail.

Let me explain…

When you get an MRI to see “what’s causing” your back pain – it will typically show some form of bulging disc, degenerative discs, or lumbar stenosis. You will likely be told that these findings are what’s causing compression and irritation to your nerves.

They might try injections and medication first, but when that doesn’t work, they’ll recommend surgery. But here’s the catch. These findings show up in 60-80% of all MRI’s when you’re over the age of 50. But not everyone with these “abnormalities” has back pain.

In other words, you can have two people of the same age, with equal-looking MRI’s, and one will have pain while the other doesn’t.

How does that happen?

What research has shown over the years is that what shows up in your images rarely correlates with what’s causing your back pain.It’s why so many back surgeries fail – because we are messing with “abnormal” findings that are in fact – quite normal for your age. So if the structures aren’t the problem – then what is?

Most back pain comes from poor movement habits and lifestyle.

Over time, repeated, unbalanced movements will exacerbate or cause irritation to these structures that are considered “findings”. But you can’t fix your back problem by only addressing where the symptoms are.

You have to address the root cause. This is typically some combination of restoring full and free mobility in your spinal joints and balancing out flexibility and strength. When you move correctly – these structures are no longer bothered – and neither is your back.

I know what you’re thinking – this sounds way too simple and perhaps you’ve already tried physical therapy or something similar and it didn’t work. Sadly, not everyone understands – or even agrees – with the concept of mechanical back pain in the way I’ve just explained it.

But trust me, when you find someone who does, you’ll be amazed at how easy it is to fix your own back. You can then keep the pain gone – without ever having to see the inside an operating room.

Back surgery can be costly – both to your bank account and mental well being.

That’s a lot of money to risk when there’s only a 50% chance of the surgery working. There’s an even better chance that your pain will come back. If there’s a complication of any kind, then you’re looking at more surgeries. This is an almost certain loss in quality of life.

It’s worth it to do your due diligence. Find a movement specialist who understands mechanical back pain and can keep you out of the operating room.

If you’re dealing with back pain now and want to learn more…

We will be talking all about this and more in our upcoming Masterclass for Back Pain & Sciatica Sufferers.

The Masterclass is free – and happening on January 24th from 6-7 pm via zoom. Reserve your seat HERE – spaces are limited – and there’s a limited number of spots left.