Why Your Hamstring Isn’t Healing – 3 Signs It’s Something Else

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Hamstring Pain is common – especially in active adults over 40.

But what’s less commonly talked about is how often a hamstring injury is misdiagnosed. If you’ve been stretching, foam rolling, and rehabbing your “hamstring strain” for weeks or months with little to no improvement – there’s a good chance your pain isn’t coming from your hamstring at all.

That’s because certain types of back problems can mimic hamstring pain almost perfectly. And if you don’t recognize the signs, you may end up chasing the wrong problem for far too long.

So how can you tell when your hamstring isn’t healing because it’s not really your hamstring?

Let’s take a look at what a true hamstring strain typically looks like – and then go over three clear signs that something else is actually going on.

What a true hamstring injury looks like:

A hamstring strain usually happens suddenly – often during an explosive movement like sprinting or lunging. You’ll feel a sharp pain in the back of your thigh, and possibly notice swelling, bruising, or tenderness. In the early stages, walking or bending your knee might be difficult. But with the right combination of rest, movement, and strengthening – most hamstring injuries heal well and don’t linger – especially when properly diagnosed and rehabbed.

If your pain doesn’t follow that pattern – or seems to be sticking around far longer than expected – there’s a good chance your spine is actually to blame.

Here are three key signs your “hamstring strain” might be something else entirely:

1. The pain never really goes away

A true muscle injury will hurt when it’s injured – but it heals. If your pain feels dull, achy, and persistent – especially after long periods of sitting or standing still – that’s a red flag.

This type of pain often stems from nerve irritation in the lower back, not muscle damage in your leg. It’s common for certain spinal problems to refer pain down the back of the thigh, which is why this gets misdiagnosed so often. But unlike a muscle strain, nerve-related pain doesn’t improve with time or basic rehab – and may even get worse with certain types of movement or exercise.

2. You notice tingling, numbness, or odd sensations

Muscles don’t cause tingling. Nerves do. So if your hamstring injury is accompanied by numbness, tingling, or an odd “buzzing” feeling in your butt or leg – it’s almost certainly a nerve issue. The sciatic nerve, which originates in your lower spine, travels right through the area where most people feel hamstring tightness. When that nerve gets irritated, it can create sensations that feel like they are coming from your hamstring – but aren’t.

If you’re experiencing these kinds of nerve symptoms – it’s a strong indicator that your spine (not your hamstring) is the real source of the problem – and it needs to be addressed.

3. Your pain travels below your knee

This one’s especially important. Your hamstrings attach just above and behind the knee – so any pain you feel below your knee can’t be coming from your hamstring.

If your discomfort travels down your calf or even into your heel, the likely culprit is your spine. Research shows that as much as 40% of lower leg pain originates from the lower back – even when there’s no actual back pain. So it’s very possible to have a perfectly healthy hamstring – but still feel pain there due to a nerve referral from your spine.

What to do next

If any of these signs sound familiar – don’t keep treating your hamstring like a muscle strain – it won’t help – and could even worsen your problem. Plus, the longer you focus on the wrong issue, the longer it will take to get better.

Instead, seek out a physical therapy specialist who understands how to properly screen and assess your spine. They’ll be able to figure out if your lingering hamstring pain is related to a problem in your lower back. And once you identify the true root of your pain – you can finally get the treatment you need – and get back to doing the activities you love.

A Physical Therapy Expert’s Guide to Enjoying Fall Activities Pain-Free

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Fall is my favorite season – and I know it is for many of you too.

Crisp air, colorful leaves, pumpkin patches, and cozy outdoor gatherings are some things that come to mind. But there’s also raking leaves, picking apples, chopping wood, and moving heavy things like hay bales or pumpkins. Any of these fall activities can produce unwelcome strain on your body if you’re not careful. 

Here’s a guide to enjoying all that fall has to offer – from a back pain and mechanical pain expert – so you can enjoy fall activities this season while keeping your back and joints pain-free.

1. Rake Leaves with Care

Raking is a quintessential fall activity, but it’s also repetitive and strenuous, which can lead to back pain if done improperly. Here are a few ways to protect yourself:

  • Warm Up First: Just as athletes warm up before a game, you should warm up before raking. Try a brisk 5-10 minute walk around your yard or neighborhood to get your blood flowing, followed by gentle stretches for your back, shoulders, and legs. A few torso twists and arm circles will help loosen up your muscles and prepare them for the repetitive motions of raking.
  • Choose an Ergonomic Rake: Look for a lightweight rake with a long handle that allows you to stand upright. Avoid bending forward too much, and alternate sides regularly to avoid overusing one side of your body.
  • Use Your Legs and Core: When bending to gather or bag leaves, squat using your legs and keep your core engaged. Avoid twisting from your waist, as this puts your spine in a vulnerable position. Instead, pivot your entire body to avoid strain.
  • Take Regular Breaks: Raking for extended periods can tire out your muscles, making you more susceptible to injury. Set a timer for every 20-30 minutes and take a short break to stretch your back and shoulders.

2. Safely Pick Up and Carry Pumpkins

Pumpkin picking is a fall favorite, but carrying heavy or awkwardly shaped pumpkins can strain your back and shoulders if you’re not careful. Here’s how to keep things safe and pain-free:

  • Lift with Your Legs, Not Your Back: When lifting a pumpkin, bend at your knees and use your leg muscles to power the lift. Keep the pumpkin close to your body and avoid twisting as you lift.
  • Use a Cart or Wagon: Many farms and pumpkin patches provide carts—take advantage of them! Use a cart to transport heavier pumpkins and prevent carrying strain.
  • Limit Carrying Distance: If you’re decorating with multiple pumpkins or other fall items, consider limiting the number of trips you make to and from your car or home to avoid repetitive strain.
  • Pro Tip: This advice applies to picking up and carrying anything. Whether it be hay bales, fall decorations, or putting away summer furniture.

3. Use Good Posture when Apple and Pumpkin Picking

Apple orchards and pumpkin patches can be so much fun, but both activities involve a lot of bending, reaching, and lifting. Use these tips to protect your body:

  • Stay Grounded: Instead of overstretching to reach that perfect apple, use a ladder or stool. Overreaching can lead to shoulder and back strains, so play it safe and keep a good base of support as you reach up.
  • Mind Your Posture: When standing or walking for extended periods in the orchard or patch, practice standing tall, with your weight evenly distributed between both feet. This not only helps reduce fatigue but also protects your lower back.
  • Wear Supportive Footwear: If you know you’ll be walking and standing for prolonged periods – you’ll want to have good, supportive shoes. This will go along way in helping your spine and the rest of your joints absorb the load of your body as well as those pumpkins and apples

4. Move Often and Stay Hydrated

All-day outdoor fall activities can wear you out, especially if you’re standing, bending, or lifting frequently. Staying mindful of your body can make a big difference:

  • Take Stretch Breaks: If you’re spending a long day outdoors, make a point to take a stretch break every hour or so. Focus on simple movements that lengthen your spine and open up your chest and shoulders, such as reaching your arms overhead and gently twisting your torso side-to-side.
  • Stay Hydrated: Cooler weather can make you feel less thirsty, but it’s still essential to stay hydrated. Dehydration can lead to muscle stiffness, fatigue, and even unwanted spasms and cramps – increasing the risk of strains.

5. Cool Down After Fall Activities

Once you’ve wrapped up your fall fun, give your body a few minutes to cool down and recover properly. A little bit of post-activity care can go a long way in keeping pain at bay.

  • Gentle Stretching: After raking, decorating, or any heavy lifting, spend five minutes stretching your back, legs, and shoulders. Simple stretches like extending our spine backwards or pulling your knees to your chest can help relieve tension.
  • Mind Your Posture When Resting: After a full day of physical activity, it’s tempting to sink into a couch or recliner, but try to avoid slumping immediately afterward. Instead, sit with a straight back, or go for a light walk. This can help prevent stiffness and reduce the likelihood of soreness.

Enjoy Fall Activities the Pain-Free Way

Fall activities are a great way to enjoy the season and embrace the outdoors, but they don’t have to come with pain and strain. Taking a few preventive measures, such as warming up, being aware of your body, and using proper lifting techniques, can make a significant difference in how you feel afterward. With these tips, you’ll be ready to fully enjoy apple-picking, pumpkin patches, and all the beauty that fall has to offer – with a lot less aches.

That being said, if you try every tip I’ve mentioned and don’t notice any difference in how you feel or tolerate these activities – your problem might need expert help. Reach out so we can help you find a mechanical pain expert in your area who can work with you.

Are you local to Portsmouth, NH? If so, consider speaking to one of my specialists in a Free Discovery Session. This 30-min session is a designed to: 1. Make sure we can help you 2. Make sure you’re a good fit for what we do 3. Make sure we’re a good fit for you. Click here to speak with a specialist.

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, call 603-380-7902, or CLICK HERE to get a free guide for preventing back pain.

tendinosis

Why the Difference between Tendinitis and Tendinosis Matters

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Tendinitis and Tendinosis: Why the Difference between them Matters.

Many patients at our specialized physical therapy practice in Portsmouth, NH, suffer from either Tendinitis or Tendinosis. Tendinitis and Tendinosis sound very similar, and are often used interchangeably but they couldn’t be more different. And neither should their treatment regimen.

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.

Tendons are tight, yet flexible bands of fibrous tissue that connect your muscle to bone. Without tendons, your muscles would be useless. Tendons are extremely organized, and the fibers are designed in a way to withstand and transmit high forces of tension so your muscle can function properly.

With tendinitis, your tendon becomes inflamed and irritated, typically due to repetitive overuse, and it will hurt when you try to move. The most common areas for tendinitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

Tendonitis is an acute condition, and the best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. But this should only be for a short period of time. From there, you want to figure out what caused the tendinitis 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 tendinitis.

When you don’t manage tendinitis 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. An important 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, and could even worsen the condition.

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers and get blood flowing to the tissue (actually create some inflammation). 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”.

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

You have to get blood flow to the area and re-organize those fibers so your tendon can work properly again. Passive treatments like ice, rest, and medicine will not help tendinosis.

The only exception is shockwave therapy (also known as Extracorporeal Pulse Activation Technology).

With shockwave therapy, high-energy sound waves stimulate the body’s natural healing mechanisms by increasing blood flow to the injured, affected area. The increased blood flow delivers oxygen and nutrients to the damaged tissue to help accelerate healing and reduce inflammation.

With pain reduced and the healing process promoted, your tendon is now primed for physical rehabilitation and re-organization of the tendons, the next most essential part of getting rid of your tendinosis.

The only way to truly re-organize tendons is to put stress on them so they can “remodel”. To do this, you have to put just the right amount of stress to cause a little bit of pain (inflammation) – but not so much that your tendon gets inflamed again.

This is literally one of the few times where “no pain no gain” actually holds true. A properly trained physical therapist who is well-versed in tendinosis rehabilitation will know how to do this and can guide you through it.

You have to retrain the fibers in your tendon to withstand normal forces again – and this process takes both time and careful loading strategies.

The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love again as if nothing ever happened. You don’t have to accept this as a chronic condition.

If you’re confused on tendinosis and tendinitis after reading this don’t worry – so is half the medical community.

The take home points to remember are that tendinitis involves pain and inflammation. There is no damage to your tendon, and it only lasts about 4-6 weeks.

Treatment for tendinits should involve passive modalities like ice and rest. The focus should be on what caused your tendon to get irritated in the first place. Then, you can get rid of it before it turns into tendinosis.

If the problem in your tendon has gone on longer than 3 months, you must suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon. Passive treatments (with the exception of shockwave therapy) will not work. They could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies, aka strengthening. That will properly re-organize your tendon so that it can be strong and functional again. This is extremely challenging to do on your own.

So it’s a good idea to talk to an expert about this. If you are local to and looking for physical therapy in Portsmouth, NH, reach out to schedule a FREE 30 minute discovery session.

physical therapy

How to Know if You’re Getting Quality Physical Therapy

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How to Know if You’re Getting Quality Physical Therapy

I’ve been a Physical Therapist for just over 20 years and I’ve seen a lot of changes in my field over the course of my career. One of the biggest (and saddest) changes I’ve seen is the overcrowding of physical therapy clinics. This has ultimately impacted the quality of care you receive. Reimbursements from insurance companies have gone down. In turn, traditional physical therapy clinics have been forced to increase their volume of patients.

That means you rarely get to spend time with your therapist anymore. And your treatment sessions may consist of repetitive exercise sets that you typically can do at the gym or on your own, and that aren’t all that prescriptive or effective. If you do manage to get some one-on-one time with your therapist – whether it be for hands-on-care or actual consultation about what’s going on with you – it’s often just a quick 20 min.

The rest of the time, your well-meaning therapist is often held hostage to a computer because of all the documentation requirements placed on them (just to get paid and keep their jobs).

The end result… you spend an hour or two at the clinic each week doing “supervised” exercises that may or may not be addressing your problem. As this model of care is becoming more and more standard, it’s impossible for the quality of your treatment not to suffer. Many folks I speak with say that traditional physical therapy is a “waste of time”.

Why bother going when they can do everything on their own at home?

Worse – when traditional PT does fail – what next? Most people go back to their doctors hoping for a different solution. But in most cases – after the perceived “failure” of PT – the logical next step involves unwanted procedures or surgery.

But what if you don’t need that? What if quality physical therapy could have fixed your problem – but you just didn’t know what that looked like?

Herein lies a major problem in the current management of musculoskeletal conditions such as back, neck, knee and ankle pain. It’s important that you understand what quality physical therapy is and isn’t – so that ultimately you can advocate for the best treatment – and not settle for anything less.

Let’s start with what quality physical therapy is not…

It’s not a bunch of general exercises and ultrasound treatments. It shouldn’t consist of you riding a bike for 10 min, lying on a hot pack with e-stim for 15 min, and then getting some generalized massage before they send you off on your way. And most certainly, quality physical therapy does not feel cookie cutter or like a waste of time.

Quality physical therapy treatment – on the other hand – is customized, specific, and obvious.

When you receive quality physical therapy – it’s about so much more than making you feel good and reducing your present symptoms. Of course that’s a happy byproduct. But quality physical therapy treatment should consist of a proper musculoskeletal diagnosis. This will explain to you exactly why you’re having symptoms.

No more guessing games. And spoiler alert – your physical therapist’s diagnosis – when done properly – is often different and far more specific than your doctor’s. From there – you should have a clear plan to eliminate and/or get your pain back to something manageable. In other words, you should feel so good that you never even would have called your doctor or PT in the first place.

But what’s the most important aspect of your treatment?  What distinguishes quality physical therapy from the regular kind? It’s how things work and function when you’re not at physical therapy.

In other words – do you always feel good when you leave only for the pain to come back the next day?

You should leave every visit with a crystal clear path forward.

It’s critical that you know how to keep your pain gone after your physical therapy is finished as well as prevent it from coming back. Generalized, non-prescriptive exercises won’t be enough to accomplish this. You need very specific and purposeful treatment – and in a nutshell – that’s what quality physical therapy looks like. And you know what – it works.

When done correctly – 80% of all musculoskeletal problems can be resolved naturally and without procedures or surgery – even without pain pills for that matter. I love my chosen field and I continue to have faith in my colleagues. Quality physical therapy does still exist – you just may have to go hunting for it.

Sadly, the insurance-based model of physical therapy reimbursement has made it harder to deliver quality physical therapy for clinics. You may need to be prepared to pay out of pocket for some or all of your treatment in order to receive the quality physical therapy you deserve.

It’s worth the extra cost. Especially when you consider the alternative and risk of a failed procedure or surgery. That can have a much bigger “cost” at the end of the day.

Trust me – I’ve seen it.

Are you local to Portsmouth, NH?

If you’re dealing with pain – book a Free Discovery Visit with one of my Specialists. We will ask you what’s been going on -and determine if we would be the right fit to work with you.

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

Medicare cuts

Medicare cuts coming in Jan. Why you should pay attention.

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On Nov 1st, the Federal government issued a final ruling that’s going to result in Medicare cuts of 4.5%. In an already dysfunctional and overcrowded healthcare system – this is going to be a problem for you (the consumer) – and here’s why…

Healthcare is ultimately a business. And its goal is to make a profit. Revenue and profit come from things like procedures, tests, images, and surgery – not from disease prevention and keeping people healthy.

What does that mean for you?

Health care specialities such as orthopedic surgery, neurology, and gastroenterology (for example) – those that are procedurally-driven – generate higher revenues and get paid more for their services.

On the flip side – disciplines like primary care physicians, rehab therapies (like physical therapy), and endocrinologists (those that manage chronic conditions like diabetes and osteoporosis) – get paid less.

The consequence is that the disciplines who actually need more time with you- so they can get to know you and your lifestyle – because that’s what is required to give you a good strategy for disease and injury prevention- are forced to do more work for less.

Eventually, something has to give…

Family medicine doctors have to see patients every 10 minutes and that’s if you can even get in to see them in a timely fashion. Physical therapists have to see multiple patients per hour, resulting in 12-16 patients per day.

These caseloads and demands are not supportive of a health care practitioner truly getting to know you as a person, what your concerns are, or what your particular lifestyle and burdens are. (A recent commentary by Shirlene Obuobi, MD in the Washington Post illustrates this dilemma quite well.)

These are all critically important factors if you want to get effective treatment and advice that’s going to match your needs and deliver the outcome you want.

The consequence is sub-par preventative care. And you risk unnecessarily getting shuffled off to the “specialist” who uses fancy tests and procedures (instead of getting to know you and asking questions) to make (often costly) decisions about your health.

Now, my intention here is not to paint specialists who use procedures and tests as their norm of examination as the “bad guys”.

The problem is you, the patient, is getting pawned off on them too soon because the people who are meant to protect you and help you defend against disease and injury are getting crushed (and not valued) by the health insurance companies.

Medicare tends to be the leader and everyone else follows suit. If these 2023 cuts go through, commercial insurers will be next.

So what can you do?

First, you must do everything in your power to become educated about health and wellness. Then, you can prevent disease and injuries on your own.

This may require hiring certain, key, preventative health care professionals to guide you – such as getting your own dietician, your own physical therapist, and your own mental health professional. Ironically, we already do this without even thinking about it when it comes to our dental care.

Why wouldn’t we want to do this with other aspects – like digestive, mental, and musculoskeletal health?

Health insurance companies add red-tape when it comes to accessing these services. An example is requiring a referral. Referrals that our already overburdened primary care physicians don’t have time to give. This leads me to my second recommendation. Start thinking outside the box. Be willing and able to invest in the health care you both desire and need.

Going outside of insurance and paying out of pocket for preventative care services is not as expensive as you think. Your options could open up exponentially. Especially if you budget and plan for it. At some point, it’s not going to be in your favor to rely on your health insurance to fund all your healthcare needs anymore. It’s clear they’re not interested. Instead, look at your finances and start budgeting.

One of the best ways to do this is to open up a health savings account. If your health plan doesn’t allow for that, then open up a separate savings account to save on your own. More and more practitioners are ditching insurance – if not leaving their respective professions altogether. Do you want to stay out of the hospital? Or big corporate health care systems and see someone private who has the time to care about you? You will have to pay. Personally, I believe this is the way to go but I understand it’s not for everyone.

However, with some planning and foresight, it could be.

I hope things do eventually change for the long-term. Stay educated, take control over the administration and funding of your health care in the short term. This is a far better alternative than heading to Washington and fighting Congress on your own.

Are you local to Portsmouth, NH? CLICK HERE to request a Free Discovery Session with us – we’ll ask you what’s been going on – and see if we’re the right fit to help you.

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

How Stress Leads to Pain

How Stress Leads to Pain

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How Stress Leads to Pain

People are dealing with more stress than ever right now and it’s impacting people in different ways. Many folks I speak with have been experiencing a rollercoaster of emotions — and their bodies are reflecting that. Keep reading to learn how stress leads to pain.

Stress impacts everything from your gut, to your immune system, to your mental health, to your musculoskeletal system.

When it comes to musculoskeletal pain – common areas in your body that easily get impacted include your shoulders, jaw, head, and lower back.

Stress is your human response to physical, emotional, or mental changes in your body or living environment.

According to internal medicine physician Richard Lang, MD, PhD from the Cleveland Clinic: “Stress doesn’t necessarily cause certain conditions, but it can make the symptoms of those conditions worse.” It’s easy to fall into a vicious cycle. Your physical symptoms worsen. Your stress increases – and so on and so on. 

We know without a doubt that stress impacts our bodies – but exactly how or why this happens is an interesting phenomenon that is still being researched.

But for now – here are some of the working theories on how stress leads to physical pain.

Social conditioning 

Many of us are taught from a young age that expressing emotions, particularly negative emotions, is “bad” or “unacceptable.” The result is that you may have learned to hold stress inside your body when faced with a stressful situation. Researchers who study this believe that the muscle tension we develop is the result of “unspoken social beliefs” that we adopted as children in order to feel accepted or liked. This pattern carries into adulthood and becomes embedded into our subconscious systems, i.e. our nervous system. Later on, when faced with any type of stress, our muscles react based on how we’ve taught them. If you grew up learning to bury emotions and tension somewhere in your body as a response to stress, it’s easy to continue that pattern into adulthood.

Trauma

When we think of trauma – we often associate it with one big event or injury. Like an accident, major fall, or perhaps a violent crime or incident. This type of trauma typically results in obvious physical damage such as broken bones, bruises, or soft tissue and organ injuries. But trauma can also be more emotional in nature and less obvious. Emotional “micro-traumas” typically occur over the course of a lifetime and go unrealized for years. And regardless of the type of trauma or its perceived severity, your body reacts and “remembers” the emotional impact. But these memories are rarely conscious. Similar to what happens with social conditioning, if you’re faced with a stressful situation later in life that reminds your brain of a previous trauma, your body may still react like it did when the actual trauma occurred, except you won’t consciously know it.

For some folks, until they’re able to associate their physical symptoms with the deep, often emotional trauma that happened much earlier in life. They may continue to suffer or worse, resort to lifelong medications to manage their pain. Have you suffered from chronic pain and been told there is no “logical” evidence or reason for it? It’s possible it could be related to undiagnosed trauma. Find a therapist (psychology today is a great resource) who’s been specifically trained in this to help you.

Environmental Stressors and Habits 

Your environment and daily habits can have a huge impact on how your body feels from day to day. They can also influence both physical and emotional stress. For example, if you’ve been reading my articles for awhile, you know that sitting too much is a number one cause of back and neck pain. Sitting too much could be the result of your job – or stress.

When you’re stressed, you tend to be less motivated and you may opt for unhealthy coping mechanisms, such as more TV and more couch time. You’ll be less reluctant to exercise or go for a walk. How you set up your environment can play a big role in combating stress at home. If you’re working from home – choose a set up where you can stand at your computer for part of the day. Reduce the physical stress that sitting has on your body. Get the TV out of your bedroom. You’re more likely to get a good night’s sleep and less likely to turn the news on first thing in the morning.  This can be a source of stress in and of itself. The take home point is that life is hard enough. So set yourself up for success by creating an environment that encourages good daily habits.

Regardless of how or why stress impacts your body, there is one thing I know for certain, movement helps.

Start there and see what happens. Regular, every day movement helps you both physically and mentally and I have yet to see any negative consequences from a daily movement or exercise habit. If musculoskeletal pain is currently keeping you from daily movement – then talk to an expert who can help. 

Request to talk to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery visit with one of my specialists.

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

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3 Reasons You Need PT After Minimally Invasive Spine Surgery

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Minimally invasive spine surgery (MISS) started to take off in the 1990’s. It has since become far more common for spinal conditions. Some being degenerative disc disease, herniated discs, spinal stenosis, scoliosis, spinal infections, spondylolisthesis, compression fractures, and spinal tumors.

Minimally Invasive Spine Surgery is a far better alternative to open-spine surgery.

You can expect less anesthesia and less blood loss during surgery. Along with a reduced risk of infection, less pain after surgery, less pain medication needed, smaller scars, shorter hospital stays, faster recovery time, and quicker return to daily activities and work.

But don’t confuse the term “minimally invasive” with minimal risk.

With MISS – you’re still at risk for many of the same consequences of open-spine surgery should things go wrong. Therefore, you want to make sure you really need spine surgery before you go “under the knife” – even if it’s a tiny one.

There are some risks of MISS:

  • Bad reactions to anesthesia
  • Pneumonia after surgery
  • Blood clots in your legs that could travel to your lungs
  • Infection (although this is significantly minimized with MISS)
  • Blood loss during surgery requiring a transfusion
  • Injury to the nerves of your spinal cord

While rare, these are very real risks and they do happen. Risks like this don’t occur with conservative treatment – such as specialized physical therapy.

It’s why I’m a huge advocate of folks not undergoing surgery until all conservative approaches have been exhausted. Or if you’ve got what we call a progressive neurological deficit occurring. Such as quick deterioration in your muscle strength, ability to walk, or ability to control your bowel/bladder.

All that being said – assuming you really do need surgery and will benefit from MISS – you still need physical therapy.

I’m amazed at how many surgeons no longer prescribe rehab after a minimally invasive procedure. Just because recovery time is reduced – doesn’t mean you don’t need a specialist to help you recover properly.

Here are 3 reasons you need PT after minimally invasive spine surgery:

1. Proper scar management

Minimally invasive procedures already do a great job of reducing scar formation. The incisions are smaller and less invasive, but there is still an incision. And the incision with MISS is deep because you have to get to the layers of the spinal nerves, vertebrae, and discs. Because the scars are small, people mistakenly assume they will heal without issue. The truth is they might. But the odds of your scar healing properly are much better with professional scar management. Scar mobilization should begin about 2 wks after MISS.

A specially trained physical therapist will not only help you manage your scar healing, but teach you how to do it on your own. You’ll improve blood flow to the area of the incision (which promotes healing), increase soft tissue mobility, and help reduce any swelling that formed in the area.

2. Restore pre-existing impairments

Odds are pretty good you didn’t end up with spontaneous MISS. You likely had a long road leading to your surgery. It’s critical you go back and address all of the problems that occurred prior to your procedure.

This includes everything from muscle weakness, to poor compensatory movement strategies your body adapted to deal with pain, immobility that occurred either because of pain or to protect you from pain, and residual numbness and/or radiating pain that is still in your legs. MISS might do a great job of quickly getting rid of your back pain, but something led to that pain to begin with.

The absence of pain does not equal the absence of a problem. Now is the perfect time to work with a specialist who will help you not only optimize your recovery from MISS – but make sure the problems/impairments that led you to the operating table to begin with don’t come back.

3. Restore deep core strength

Chronic pain tends to inhibit the ability for muscles to work properly. If you’ve been suffering from back pain for awhile – odds are pretty good your deep core strength is not where it needs to be.

Plus, good core strength is critical for the prevention of future back problems (yes – you can still get back pain after back surgery). Ideally, now that your minimally invasive procedure has either eliminated or significantly reduced your back pain, it’s more critical than ever to work with a specialist who can help you restore your deep core strength. They’ll know how to do it safely and effectively – to not only help you recover from your MISS faster – but keep the original problem from coming back – because it can.

If you’re considering any type of surgery – but especially back surgery – I always advocate getting a second opinion first – even if the procedure is minimally invasive. Eighty percent of the time – back problems can be resolved without surgical procedures.

CLICK HERE to get a second opinion from one of my specialists.

If you truly want to avoid surgery – and we think we can help you do that – we’ll let you know and get you scheduled with us as quickly as possible.

However, if you’ve recently undergone MISS, ask your doctor to refer you to physical therapy. Many surgeons won’t. It’s going to help you recover optimally and faster – and will set you up for the best possible future success when it comes to back problems.

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 her guide to back pain, email her at [email protected] or call 603-605-0402

Physical Therapist

Piriformis syndrome and Sciatica – PT not working?

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I recently polled my readers regarding their most important concerns when it comes to their musculoskeletal health. In other words, what questions were they desperately seeking answers for related to back, neck, knee, hip, shoulder, or ankle pain?

Here is a great question I received from John:

“I’m getting Physical Therapy for lower back pain and sciatica that is said to be from my piriformis. My PT treatment has consisted of various exercises and some massage. Eight sessions in and no change at all. I’m still having pain when sitting or walking a distance. What now?  Do I need an Ultrasound or MRI to see if there is any damage or tear to my piriformis?”

First, John, I’m so sorry to hear you’re still having pain and not seeing any change after a good amount of physical therapy. When it comes to back pain and sciatica, it’s critical that you receive a thorough mechanical and movement examination by your PT before any treatment begins. This should involve repeated testing and retesting of movement and range of motion to determine:

1) where your pain is coming from and

2) what movement patterns trigger and relieve your symptoms

Without this first critical step, you risk missing the root cause of your pain and treating just symptoms. This type of testing is also essential to determine if physical therapy can even resolve your problem. If your physical therapist simply read the prescription from your doctor and dove into generalized treatment protocols – there’s your first problem right there – and it could explain why after 8 sessions you’re seeing no change in your condition.

In your case, it sounds like the massage is intended to treat your symptoms – perhaps your tight, tender piriformis that is believed to be causing your back pain and sciatica. This is perfectly appropriate, however, it’s important to incorporate targeted, therapeutic movement to make the most of what your manual therapy (massage) just did.

In other words, movement is the real “medicine”. Manual therapy is designed to enhance blood flow to and prepare your soft tissue (muscles and ligaments) to be better equipped to tolerate and perform the movement/exercise that is going to have a long-lasting effect.

If the massage and exercise are not done in a specific and targeted way – they aren’t going to have their intended effect. It’s possible this could be happening to you. If you’re not totally clear on what your exercise is for and what the intended effect is – chances are high your exercises haven’t been prescribed to you properly. If you suspect this to be the case, it’s worth your while to try for a different, perhaps more specialized physical therapist before you go jumping into diagnostic tests that could lead you down a rabbit hole of unnecessary procedures or surgery.

Now, let’s assume for a moment that you did receive targeted and high-quality physical therapy treatment and it’s simply not working. This does happen from time to time – but it should only be approximately 20% of the time for the majority of musculoskeletal problems such as back pain and sciatica. And in my opinion, it should be caught well before 8 sessions. In my experience, it takes about 5-6 (quality) PT sessions to figure out if a problem can be resolved with movement and natural means. If not, then a referral to another specialty is necessary.

Are you there yet? I can’t be certain.

But to answer your question about whether or not you need an MRI or Ultrasound… 

If quality, targeted physical therapy has been truly exhausted then yes – either of these diagnostic tests would be the next step in providing valuable information as to what more might be going on.

Ultrasound is a non-invasive diagnostic tool designed to visualize both organs and soft tissue. It could be a good option for examining your piriformis if you are certain that is where your problem is coming from. But piriformis syndrome only accounts for about 30% of all sciatica cases. And typically a tear in your piriformis will not cause pain to radiate down your leg. Most of the time, sciatica is caused by nerve impingement occuring in your lumbar spine (low back). If conservative treatment, like physical therapy, has been fully explored – an MRI could be helpful to see how badly a nerve is being pinched or irritated and whether or not a procedure or surgery is warranted. But in general, the research has shown time and time again that spine surgery is really only successful when you’ve got serious and progressive neurological deficits and symptoms.

In other words, you might have symptoms like foot drop, and your leg is getting weaker and numb by the minute. Otherwise, physical therapy – although it may be slower to work – has equal if not better results compared to surgery and it’s a lot safer.

The caveat, however, is you need to find a good physical therapist.

I hope this helps answer your question. Most importantly – don’t give up hope!

For the next few months I’ll be answering questions like these each week in my articles. If you’ve got your own questions regarding musculoskeletal aches or pains that you want answers for, reach out via the information below.

Local to Portsmouth and feeling frustrated with your current physical therapy treatment just like John?

Reach out – we’d be happy to provide a second opinion. CLICK HERE to request a Free Discovery call with one of my specialists.

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

golf injuries

Common Golf Injuries and How to Avoid Them

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Most golfers I know won’t let anything stop them from being out on the course – especially here in New England where the golf season is not very long.

But let’s face it, when something hurts, playing 9-holes is just not as fun.

Jack Nicklaus had it right when he said, “Professional golfers condition to play golf; amateur golfers play golf to condition.” That explains why 62 percent of amateurs will sustain a significant golf injury, typically because they’re out of shape, have poor swing mechanics, or don’t adequately warm up.

Here are three common golf injuries and things you can do to avoid them.

Elbow Tendonitis

Tendonitis is characterized as the painful inflammation of a tendon. It’s caused by repetitive movements that overload the tendon, eventually causing it to feel strained and overworked. When it occurs on the inside of your elbow, which is something that happens a lot with golfers, it’s called “golfer’s elbow.” The treatment is ice and rest initially (which means you don’t get to play golf for a while) followed by progressive and proper loading of the tendon to get it back to a healthy state. This whole process, if done properly, takes time… and it can certainly ruin your golf season if it’s not caught early.

What causes elbow tendonitis? We know that technically, it’s inflammation of tendons in your elbow. But what leads to that in the first place? Often weakness in your mid-back and shoulders along with mobility restrictions in your wrists. Your elbow is significantly influenced by what happens above and below it. If your mid-back and shoulder area are weak, the rest of your arm won’t feel supported and your elbow can get overworked. If your wrist is tight and immobile, your elbow will be forced to move more than it should, especially through a golf swing. This will cause extra stress on your tendons and eventually result in tendonitis. The best way to prevent this from happening is to make sure you’ve got adequate mobility in your wrists, and good strength in your mid back and shoulders.

Back Pain

One of the most common ways to hurt your back is with repetitive flexion (bending) and rotation (twisting). Well, what does a round of golf consist of over and over? Repetitive bending and twisting! Every time you swing that golf club, you’re putting your spine through one of its most stressful positions. And if it’s not prepared — it’s going to get injured.

One of the best ways to prepare your spine for a long and healthy golf season is to avoid a lot of sitting and keep it mobile. Sitting for prolonged periods makes your back more susceptible to injury in general, but especially if you’re going to be doing a lot of bending and twisting. Interrupting your sitting frequently during the day is a very easy way to minimize its harmful effects. 

If you lack adequate mobility in your spine, it will feel strained every time you try and swing your club. When you overstress a joint that is stiff, the muscles around it tend to tighten up and spasm in response. It’s important that you take time to optimize and maintain your best spinal mobility for golf season. This will significantly help to decrease the stress that occurs in your spine when you swing in one direction repetitively, and ultimately help you prevent a back injury.

Knee pain

Between walking 18 holes, and the repetitive twisting that happens at your knee when you swing a golf club, there’s the potential for lots of stress (and injury) through your knee joints. If you lack adequate mobility or stability in and around your knees, you’re going to have problems. Much like the elbow, the most common source of knee pain I see in my golfers comes from the joints above and below, and not from the knee itself. To keep your knees mobile and healthy and prevent them from getting overstressed during golf season, it’s important that you take measures to optimize the strength in your core and hips, as well as stability in your feel and ankles. 

The power in your golf swing should come from your hips and core, not from your knees (or back). If they aren’t very strong, your knees will want to try and help, and they are not designed for this. Your knees need to be loose and free during a golf swing. If not, the muscles and ligaments around your knee joint will take on unwanted stress. 

Another cause of unwanted stress to your knee joint is lack of support from your feet and ankles.

Your knees need a stable foundation if they want to bend and twist without stress. If stability below is lacking, your knees will tighten up in an effort to compensate. Moral of the story: make sure you’ve got mobile knees, a strong core and hips, plus stable feet and ankles, so that knee pain doesn’t derail your golf season.

Hopefully these tips help you understand why golf injuries happen and most importantly, how to prevent them. If you’re feeling stuck and looking for individualized expert help – request a FREE Discovery Session. We look forward to speaking with you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Common Pickleball Injuries and what to do

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If you haven’t heard of pickleball yet, odds are good you will very soon. Pickleball is quickly becoming one of the most popular recreational sports in the US, especially in the over 50 crowd, and especially in Portsmouth and all around the Seacoast of New Hampshire. It’s essentially a cross between tennis, racket ball, and ping pong. The court is smaller than in tennis and the net is set lower. People love pickleball because it’s a great way to not only get exercise – but to socialize and meet new friends.

But like any other sport, injuries happen. And because injuries become more significant and harder to rehabilitate as you get older – it’s important to have an awareness about the common injuries that tend to occur in pickleball players and what you can do to prevent them.

Here are four of the most common injuries I see in Pickleball and what you can do:

 

1. Rotator cuff strains

Your rotator cuff is a group of muscles in your shoulder that play a critical role in both stability and mobility of your shoulder joint. Because pickleball involves repetitive swinging – your shoulder is at risk for overuse injuries and strains. To help minimize the risk of rotator cuff injury, it’s important to ensure that you have good mobility in your shoulder joint, and good mid-back or scapular strength. Your scapula is also called your shoulder blade – if your scapular muscles are weak – then your rotator cuff might be tasked with extra work or strain. The more mobile your shoulder is, and the more balanced the strength around your shoulder joint is, the more effective your rotator cuff will be when playing a repetitive sport like pickleball.

2. “Pickleball” elbow

This is pretty much identical to tennis elbow – known medically as lateral epicondylitis. It causes pain and tenderness on the side of your elbow or forearm – and happens due to overuse of your forearm muscles – typically due to poor mechanics above, below, or in the elbow itself. To prevent this, you want to make sure the areas above and below your elbow joint are strong and stable. Your shoulder needs to be both strong and mobile for when you swing – otherwise your elbow will compensate and try to help out. Your wrist needs to be stable when holding the racket – or your elbow will need to kick in and try to help. The ligaments and muscles around your elbow aren’t designed to do the job of both your shoulder and your wrist – so if you don’t give these areas some love – you could end up with pickleball elbow.

3. Ankle sprains

Because there is a lot of pivoting and starting/stopping directions during pickleball – it’s easy to sprain your ankle if you’re not careful. Most ankle sprains occur from rolling on the outside of your ankle. This results in bruising, pain and swelling of the ligaments along the side of your ankle. While this injury does heal over time, it can often result in chronic weakening or scarring of those ligaments as well as tightness in your ankle joint – which only makes you susceptible to future ankle sprains. It’s best to make sure you have a good warm-up before you play. One that conditions your ankle and feet for quick stepping and flexibility. You also want to make sure you have strong hip muscles. If your side hip muscles aren’t strong and helping you stay stable in your pelvis – your ankle will take the brunt – and you’ll be more likely to sprain it.

4. Achilles tendonitis

Your Achilles tendon is a very strong, thick tendon that connects your calf muscle to your heel. It’s responsible for generating a lot of power to help you spring off your foot and jump. Its power is generated from its ability to stretch and then contract. Therefore, your ankle needs to have good mobility in order for your Achilles tendon to do its job. If your ankle is stiff and tight, you could be at risk for developing Achilles tendonitis. One other consideration is the strength of your glutes (or butt). Calf muscles love to compensate for weak gluteal muscles. If that happens over and over, they become tight and can put extra strain on your Achilles tendon – since they are connected. So make sure your butt is strong and your ankle is mobile in order to help prevent this common pickleball injury.

If you’re a pickleball lover – or perhaps wanting to get into this popular sport for the first time – I hope these tips help you to become more aware of what you can do to protect yourself from injury.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.