Tag Archive for: arthritis

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

October 24, 2022/in Knee Pain, Movement/by Carrie Jose

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

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

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

Sounds pretty simple and harmless – right?

Well… it is until it isn’t.

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

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

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

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

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

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

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

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

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

And then there’s the elephant in the room…

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

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

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

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

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

1) Your knee problem is really a knee problem and

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

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

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

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

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

Why your Cortisone Injection Failed You

May 18, 2022/in Chronic Pain, Movement as Medicine/by Carrie Jose

Why your Cortisone Injection Failed You

When you have joint pain that won’t go away, especially after trying lots of physical therapy, your doctor might recommend you get a cortisone shot.

Cortisone shots are often prescribed for things like back pain, bursitis, bulging discs, cartilage tears, osteoarthritis, tendonitis, and many other conditions that are perceived to be inflammatory in nature. While every single one of these conditions can cause things to be inflamed, it doesn’t mean that inflammation is your underlying problem. If something else is causing any of these structures to get irritated and inflamed, then your cortisone injection won’t work. At the very best it will provide you temporary relief, but the problem will ultimately come back in about 6-12 months time.

Cortisone shots also come with many potential problems and side effects. So you really want to be sure that it’s necessary before you get one.

The list includes problems such as: cartilage damage, death of nearby bone, joint infection, nerve damage, temporary facial flushing, temporary flare of pain and inflammation in the joint, temporary increase in blood sugar, tendon weakening or rupture, thinning of nearby bone (osteoporosis), thinning of skin and soft tissue around the injection site, and whitening or lightening of the skin around the injection site. And none of these side effects account for human error with the procedure. If your doctor is “off” with his/her injection – you could end up with unnecessary tissue trauma and pain because your shot wasn’t injected correctly.

So when it comes to cortisone shots, you really want to make sure that 1) the root source of your problem is inflammation and 2) you actually need one.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the actual pain you are experiencing might be due to inflammation, the underlying cause leading to the inflammation could be something else entirely. Cortisone shots are used to address inflammation. But 80% of the time the musculoskeletal pain you’re experiencing is due to a mechanical or movement problem. So while the symptoms you’re experiencing could be due to inflammation, the root cause of your issue could be due to something else. In this case, the cortisone shot will not help – or worse – provide you with temporary relief that leads you to think it did.

Let me explain with a bit of scientific research.

Studies show that 70-80% of people over the age of 50 have a bulging disc on their MRI. 60% have a meniscus tear in their knee. These findings are considered normal as you age. The research also says that not all of these people experience pain. So you can have two people with the exact same MRI findings and one person will be perfectly fine while the other can barely walk. This is how we know that “the finding” (a bulging disc or meniscus tear for example) isn’t necessarily the problem.

**The source of the problem is what is causing that bulge or tear to get annoyed.**

About 80% of the time it’s going to be something like a faulty movement pattern or “mechanical issue,” such as poor mobility or stability, leading to some compensatory movement strategies in your body. When you don’t move well, structures like normally occurring disc bulges and meniscus tears can get irritated.

For example, let’s say you have a bulging disc in your back. If you sit for most of the day, travel a lot for work, or have a job that involves a lot of repetitive lifting, these types of activities are known to really aggravate a bulging disc. If all you do is inject cortisone to calm down the irritation, you won’t be fixing the real problem… which in this case is your daily movement habits. After about 6 months of returning to all these activities again, the pain WILL come back.

The good news is that there are ways to solve this type of problem (and others) naturally, and without a cortisone injection. But the important thing for you to realize here is that if you did get a cortisone shot recently and it appears to have “failed,” the last thing you want to do is get another one or resort to an even more invasive procedure. It’s possible you didn’t need it in the first place, so you want to make sure that is uncovered first.

So, if you’ve recently had a cortisone shot and it didn’t work, it could very well be that you never actually needed it… or that the wrong problem (inflammation) was being addressed instead of the underlying cause.

If you are considering something like a cortisone shot, it’s always a good idea to get a second opinion to make certain you really need it and that it’s the best course of action for your problem. And if you’ve already had one and it didn’t work, don’t worry, odds are good that there is still a solution out there for you… and it doesn’t have to involve more procedures.

It could be as simple as learning how to move better!

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you avoid quick fixes like cortisone shots and get long lasting results.

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.

Getting and Staying Fit when you’re Over 50

June 21, 2021/in Lifestyle, Movement, Posture, Running, Nutrition and Lifestyle/by Carrie Jose

The importance of being healthy and fit has taken center stage these last 18 months, but especially for the over 50 crowd. Most people aged 50+ who want to get and stay fit struggle, because what might work for someone in their 20’s or 30’s just doesn’t make sense for them in their 50’s. As you age, both your needs AND your priorities change.

By the time you hit age 50, you may start to suffer from things like arthritis, degenerative and aging joints, and more back and knee pain. And if you aren’t suffering from them yet, you’re worried about when you will. First, let me just tell you that it is 100% possible to get and stay fit after 50. I have the joy of working with folks aged 50+ every day who are the healthiest they’ve ever been in their lives. So what’s their secret?

Here are 5 habits my healthiest clients aged 50+ stick to so they can get and stay fit:

1. Get enough sleep

The myth that you don’t need as much sleep as you get older is false. Most research indicates that even when you’re over 50, you should still be aiming for 7-9 hours of sleep per night. When you don’t get enough sleep, it catches up to you. You lack energy, making you less motivated to exercise and more likely to eat sugary, unhealthy foods. Lack of sleep lowers your immune system, affects your memory and ability to focus, impacts your balance, and increases your chances of developing high blood pressure. In general, lack of sleep is going to significantly impact your ability to eat well and exercise, two essential ingredients for getting and staying fit after age 50.

2. Keep Nutrition Simple

If you’re over age 50, you’ve likely seen every cleanse, crash diet, health shake, weight loss pill, or gimmick known to man. There literally isn’t a trick left in the book you haven’t seen. At age 50+ you also typically aren’t in the mood to be a nutritional extremist either. It’s a good idea to just keep things simple. Focus on eating nutritious whole foods (things that are unprocessed) and drink plenty of water. Start your day with an 8oz glass of water and then aim to drink at least 3 more bottles after that. When you’re planning meals, make your plate up with half vegetables, one quarter protein, and one quarter whole grains. Adding a little bit of healthy fat consisting of plant oils is a good idea too. Good nutritional habits give you the energy and stamina you need to get and stay fit!

3. Lift Weights

I can’t tell you how often I get asked “is it safe to be lifting heavy weights at my age?” People worry that lifting heavy weights could be “bad” for their spine or knees once they’re aged 50+. Lifting weights is not only good for you, but perfectly safe when done correctly. But it’s important that your workout is customized and takes into account any injuries or ailments you may have. Arthritis in your joints, bulging discs, and even meniscus tears are all normal things that occur as you age. They don’t mean you can’t exercise — but you do want to make sure your strength training routine reflects this.

As a physical therapist, the two biggest things I look at when I’m examining someone’s strength routine are form and loading strategies. Good and proper form is critical to protect your joints and back. “Loading” refers to how much weight you lift and how often (reps). This changes as you age because the integrity of your soft tissue (muscles and ligaments) is different. Loading strategies also need to be adapted if you’re injured or in pain. A good strength coach and physical therapist, especially when working together, can make sure that you have a strength training routine that is not only safe but perfect for your age and ability.

4. Strengthen your Core

After age 50 things like balance and reaction times start to become more compromised, and the likelihood of back pain increases. Maintaining good core strength helps with all of this and becomes more important than ever at age 50+. The biggest problem I see with people trying to strengthen their core is that they just don’t know how to do it properly. They may be doing all the right things, but with all the wrong muscles. If you’re new to core strengthening, or perhaps you’ve been doing it awhile but your core strength still isn’t where you want it to be, consider trying Pilates. It’s long been known as the staple of core strengthening because it requires you to perform very controlled and precise movements while focusing on your breath. Having proper control over your breath, body, and movement are the cardinal signs of a truly functioning and strong core.

5. Address Pain

This may seem obvious, but I can’t tell you how many people either ignore or just work around their pain. When you ignore your pain, you risk developing other problems due to your body compensating. These compensation strategies may last you for a short time, but eventually they will catch up to you. When you’re over 50, recovering from injury is harder and takes longer. So although preventing injury is your best strategy, don’t just ignore pain if you’re experiencing it. When you work around pain, it’s impossible to get the most you can out of your workouts and this delays your ability to get and stay fit. If you’re always having to modify exercise or compensate for pain, not only is this frustrating, but you delay getting to the root cause of your problem. Simply put, if you’re experiencing musculoskeletal pain — get it addressed.

We are a team of specialists who are specifically trained to help you address these issues. If you’re interested in an assessment, consultation, or simply want a couple questions answered — sign up for one of our FREE Discovery Sessions! This 30 minute session allows you to talk one-on-one with a movement expert to figure out what you want, need, and how you’re going to get there.

Should Age be a Reason to Avoid Certain Activities?

June 14, 2021/in Movement/by Carrie Jose

We’re continuing with our topic of the month – Getting Fit After 50 – and people have been asking me…

Are there certain types of exercise I should avoid once I hit a certain age?

The short answer is no.

Most of our clients are over the age of 50 and they do everything from surfing, to playing tennis, hockey, running, and even tap dancing!

None of these activities are considered “easy on the joints,” but they do them anyway.

So why is it that some folks see age as just a number – where others use it as a reason to stop doing certain things?

After age 50, the number one reason I see people avoid activities they want to do is because of pain. The second most common reason is because they were told to.

Let’s start with pain.

Having been a physical therapist for twenty years, I know a thing or two about what goes through people’s minds when they are dealing with back or joint pain. In most cases, the pain itself is not the biggest concern. People are willing and able to tolerate a certain amount of pain at the expense of doing what they truly love. We do it all the time in our 20’s or 30’s… and don’t think twice about it.

But as we age – a little bit of fear starts to set in when we’re in pain.

We’ve typically seen or heard horror stories from friends or family who have paid the price for either pushing through – or ignoring pain all together. When we’re younger, we’re more likely to approach pain with a “wait and see” approach. But as we age – pain becomes a bigger concern and we’re more likely to seek professional medical help sooner.

This leads me to the second reason people over 50 will just stop doing certain exercises…

Because they were told to. And often by a well-meaning health care professional.

Let me explain that.

Our medical system is overloaded, and everyone does the best they can to keep up. But if you’re a musculoskeletal health professional who’s NOT up with current medical research – you’re likely to give advice based on “old-school” ways of thinking.

For example, diagnosing all musculoskeletal pain based on X-rays and MRI’s… If your X-ray shows “bone on bone” arthritis – then a joint replacement is assumed to be your only option. If your MRI shows a meniscus tear or bulging disc – then you automatically need arthroscopic surgery.

But the current research disputes this line of thinking…

And says 80% of ALL musculoskeletal problems – even when you’re over 50 – can be solved without surgeries or other procedures.

How your pain behaves is what matters most. Not your age or arthritis. The best way to explain this concept is with a case study!

This client (we’ll call him “Jim”) is 57 years old and was told knee replacement surgery was his only option to resolve the knee pain he was suddenly experiencing.

When he questioned the knee replacement and asked if he could wait, his doctor’s response was that because of his age – and because of the “bone on bone” arthritis that was showing on his X-ray – surgery was his best option. Otherwise, if he wanted to wait, he would need to stop the running and hiking he had been enjoying so much until very recently.

Research studies show that the indication of osteoarthritis on X-ray alone does not mean it’s the cause of your pain.

In other words, it’s entirely possible Jim’s knee pain could be due to something other than his “bone on bone” arthritis.

Did he really need surgery? And did he really need to stop some of his exercises because of arthritis or his age?

Ceasing his activities would have certainly made Jim’s arthritis worse. And if he went through with the knee replacement without being completely sure if arthritis was the main cause of his knee pain – he not only risks unnecessary surgery – but also risks getting set back several months for recovery.

This would delay his ability to get back to running and hiking even further.

Although age is most of the time NOT a factor in your choice of exercise… it is a factor when it comes to how quickly you’re able to recover from surgery.

So here’s what happened.

We prescribed him a corrective movement strategy to see if arthritis was the main factor causing his knee pain. And just like we see over and over again – his knee pain significantly improved after just a few visits!

Research says that if pain responds quickly to a corrective movement done repeatedly – your pain is primarily due to a mechanical origin – and not arthritis. Arthritis doesn’t change that quickly – in fact it doesn’t change at all (unless you get surgery). But mechanical pain does.

Turns out that Jim’s knee pain was due to some mechanical imbalances in his knee joint, and NOT the arthritis. Arthritis was a factor for sure – it made his knee stiff – but it was not the main cause of his knee pain.

If you’re getting older… know that age related changes like arthritis are quite normal and nothing to be afraid of.

And arthritis, along with your age, are certainly not reasons to avoid exercise.

Jim was given medical advice to have a surgery he does NOT need yet based solely on his X-ray and his age. But there are SO many other factors worth considering as well.

Tips to Avoid Injury When You’re Over 50

June 7, 2021/in Arthritis and Joint Pain, Back Pain, Movement as Medicine, Physical Therapy/by Carrie Jose

Most of our clients are aged 50 or above, and staying as active as possible while they age is a big priority for them. As we get older, our bodies do need more care and maintenance to not only age well but avoid injury.

Here are some of my top tips I like to give clients to help them stay 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.” If you want to stay healthy and mobile, you need to keep moving. One of the biggest concerns I hear from folks aged 50+ is whether they should start modifying what they do because of arthritis. Remember, 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, can prevent knee arthritis! The effects of arthritis worsen when you don’t move, which is when I typically see people having problems. Common “injuries” like 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 this — and the better your joints will feel.

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 much 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.

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 helping you prevent falls and avoid injury. 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, Tai Chi, Yoga, and our favorite — Pilates — are also great to promote good balance.

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. In our office, our favorite core-strengthening activity is Pilates. We especially love it for folks aged 50+ because it’s easy on your joints and it helps to promote flexibility at the same time. But what I love most about Pilates is that it teaches you how to strengthen your core properly and safely, two important things at any age, not just when you’re over 50. When you know how to properly engage and use your core, you start to incorporate it more into other exercises. Suddenly walking, running, Yoga, and lifting weights all become that much more effective, and you’re far less likely to get injured doing them.

5. Educate Yourself

Knowledge is power, and lack of it, is one of the biggest reasons I see people decreasing their activity levels when there is no reason to. People think that things like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities. But that’s not necessarily true! Most of the things I just mentioned are normal occurrences as we age, and having them show up on an x-ray or MRI is not a reason to change something you’ve been successfully doing for years. Plus, regular movement and exercise 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. Whatever you do, try to avoid Dr. Google. It can send you down a rabbit hole and not all the advice you read will apply directly to you.

Five Reasons People over 40 are doing Pilates

May 2, 2021/in Pilates/by Carrie Jose

Recently, Pilates has been gaining popularity with folks over age 40. Why? Well, let’s take a look at the history.

It was first created by Joseph Pilates almost 100 years ago, who suffered from asthma, rickets, and rheumatic fever. When traditional exercise systems failed him, he turned to anatomy books and became obsessed with the human body. Refusing to let his body ailments define him, he eventually developed his own system of exercising, now known as the Pilates method. But the original name for his method was “Contrology,” because the focus of his exercises were to have full control of your movement and to feel empowered in your body.

I’ve been incorporating Pilates into my physical therapy practice for the last 11 years – and it’s been transformational for my clients.

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength. It helps our clients connect to their bodies in a way they haven’t been able to achieve with traditional strengthening methods. Most of my clients are over the age of 40, and they love Pilates because it helps them have more energy, better balance, and improved strength and mobility. It allows them to participate in all the activities they love with more ease, and significantly decreases their likelihood of injury.

If you’re over 40, and aren’t yet doing Pilates, here are five reasons to get started:

1. Pilates helps prevent back pain.

Once you hit 40, your risk of back injury starts to climb. We see a lot of folks in our office who’ve tried traditional physical therapists, chiropractors, and so many kinds of core strengthening programs – but still have recurring back pain. Getting rid of back pain in the short-term is easy, but keeping it gone is the challenge.

We specialize in keeping pain gone, and Pilates helps us do that. Our Pilates instructors work closely with our PT team and get enhanced training on how to navigate back pain. We also keep our classes small so that we can pay close attention to everyone. This is key if you’re recovering from an injury and want to consider Pilates. Beware of classes that are overcrowded and not individualized. More than 5-6 people per class could be dangerous if you’re dealing with back pain. It’s impossible for your instructor to keep a close eye on you or give you individualized modifications.

2. Pilates strengthens your whole body, not just your core.

One of the keys to lifelong fitness is what I call “balanced strength.” In other words, each part of your body works together to produce the right amount of force, at the right time. I see lots of “strong” people in my office, but they can’t do the activities they love, because their muscles aren’t working together. Pilates emphasizes full body strength that is coordinated. Coordinated strength is essential to a balanced body.

3. Pilates improves your flexibility.

Do you stretch your hamstrings every day but they never seem to improve? It could be because you’re not stretching the right way. The great thing about Pilates is that it improves your flexibility in a way that strengthens at the same time. The “old school” way of stretching was to find the most uncomfortable position for your muscle and just hold it for 30 seconds. Research has shown this is not effective. The best way to stretch is to keep moving and do it dynamically. In Pilates, we do just that! One of the central concepts to Pilates is “lengthening.” This helps you stretch your muscles in a way that results in long lasting, sustainable improvements.

4. Pilates minimizes stress to your joints.

As we age, it’s normal to have arthritis. But it doesn’t have to be the death sentence to activity that most people think. The key to combating arthritis is maintaining a mobile and well balanced joint. When you optimize everything that surrounds your arthritic joints, your symptoms decrease. Pilates helps with all this – without causing any additional stress. Since Pilates is based on the idea of constant opposition – lengthening while strengthening – you end up with a joint that is happy and balanced. This helps to minimize the impacts of arthritis and even prevent the rate of degeneration as you age.

5. Pilates trains your nervous system.

Since Pilates emphasizes small, precise movements – it’s very good for your nervous system and coordination. We refer to this as motor control. Having good motor control is key for controlled, coordinated movement. A strong muscle that isn’t coordinated to “turn on” when it’s needed is almost useless. It’s why strong, healthy people still get back pain. Your core could be strong – but if it isn’t trained to function properly and when it’s supposed to – it won’t help you prevent back pain. When done properly, and with a qualified instructor, Pilates is one of the best exercise methods I’ve found to train your nervous system and improve motor control – which is key for injury prevention.

Could your Knee Pain be Caused by your Lower Back?

April 26, 2021/in Back Pain, Chronic Pain, Knee Pain/by Carrie Jose

Is your knee pain actually due to a problem in your knee – or could it be caused by your lower back?

One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the source. And often times that source can be your lower back.

One of the biggest clues that 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… but no matter what, your knee pain just won’t seem to go away. This is often when knee doctors start to get involved, which is great if you actually have a knee problem. Knee pain that doesn’t respond to conservative treatment should be looked at further. It’s possible that you might need some kind of procedure or surgical intervention.

**But what if your knee pain is a symptom of something else?**

If so, and you don’t get it properly checked, then you risk having unnecessary knee surgery.

I just spoke to someone who this happened to. She had knee surgery to “clean out” some wear and tear from arthritis after trying several months of physical therapy. She was told it would be a “quick recovery” and that her pain would be significantly reduced. Well, three months later, her knee is feeling worse than pre-surgery. And to fix the NEW pain she has, they tell her she will need even more surgery! She came to us for a second opinion, and the very first thing we did was screen her lower back to see if it might be the cause of her knee pain. Turns out it was! This woman’s knee pain was never actually coming from her knee, and she ended up having unnecessary surgery because the root cause – her lower back – was missed.

How does a misdiagnosis like this even happen?

One of the biggest culprits is imaging. If you’re over age 40, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears. Studies have shown that arthritic changes and meniscus tears are a normal part of aging, so they will show up on your images even if you don’t have any knee pain. This is why you should never dictate your treatment plan, and certainly not surgery, based on an MRI or X-ray alone.

Here are a few clues to help you figure out if your knee pain could be coming from your back.

First, pay attention to how and when your knee pain started. If you’ve had a fall or some kind of trauma to your knee, and you experience knee pain or swelling shortly after, then odds are very good you have an isolated knee problem. With isolated knee injuries, you often know exactly when and how you hurt your knee. It may have been associated with a pop or specific strain of some kind. But if your knee pain comes on slowly or out of nowhere, then you must consider that the source of the problem could be elsewhere.

Another clue is how your pain behaves. When your lower back is the source, often you’ll have difficulty pinpointing exactly where your knee pain is. It may feel dull or even numb. It might move around, or perhaps travel up or down your leg. One day your knee will feel great, and other days it could feel excruciating. When someone comes into our office with pain like this, we ALWAYS check their lower back first. Knee pain that moves around a lot, or that comes and goes frequently, can quite often be due to a back problem.

If you’ve been suffering from knee pain for awhile, it’s worth considering that the root source of your problem could be your lower back.

Before you think about getting images of your knee, or undergoing some kind of surgery or procedure, you’ll want to make certain that your knee problem is indeed a knee problem.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. To get a free copy of her free guide: 7 Ways to Stop Knee Pain – click here.

Arthroscopic Knee Surgery – Does it Even Work?

April 21, 2021/in Arthritis and Joint Pain, Knee Pain, Knee Pain, Movement/by Carrie Jose

While researching for my latest article in the Portsmouth Herald, I came across an interesting study titled: “Arthroscopy for degenerative knees – a difficult habit to break.”

The title of this study is telling.

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

Furthermore, studies now indicate that people who get arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that could have been avoided.

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

Sounds pretty simple and harmless – right?

But over the years, research has shown that this procedure is really not necessary in most cases.

Most people can get pain relief and restore function in their knees without ever getting surgery.

One of the earliest studies from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have shown similar results. Even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment like physical therapy.

Despite all this research, surgeons are still performing these procedures more than ever.

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management and not giving therapy enough time to work.

In our office, we often see people after they’ve tried regular physical therapy first. Since we have a more specialized approach, and we’re able to spend more time with our clients, we tend to get better results and can help clients avoid surgery all together.

But not all physical therapy clinics are afforded that luxury. In those cases, people are led to believe that the physical therapy “didn’t work,” and they get scheduled for surgery.

But what’s the big deal really?

If outcomes are the same regardless of whether you get surgery or not – why not just get it? It’s quicker, and far more convenient than going to weekly therapy appointments…

But despite the term “minimally invasive,” it’s still surgery.

You will have bleeding, swelling, and recovery time. There is trauma that is caused to the soft tissue in and around your knee that has to heal. There’s also the risk of infection, which comes with a whole set of different complications.

And then of course there’s the elephant in the room that nobody likes to talk about…

I’ve seen many of these arthroscopic surgeries performed that had clients feeling WORSE than before surgery. Because it turns out the procedure wasn’t even necessary. Luckily, we’re still able to rehabilitate them. But it’s completely demoralizing and discouraging for our clients.

In general, despite how small the procedure may seem, you want to avoid surgery whenever possible.

Although small, the risks that can happen with surgery simply aren’t worth it – especially when you can get the same results from natural, conservative treatment.

For some, arthroscopic knee surgery really is necessary. But for most, it can be avoided.

If you’re currently suffering from knee pain and want to learn more about what you can do to avoid surgery and heal your knee pain naturally and on your own – DOWNLOAD our Free Guide: 7 Ways to Get rid of Knee Pain Naturally.

Five Reasons to Include Pilates in Your Life

February 21, 2021/in Movement, Pilates/by Carrie Jose

Pilates has been around for about 100 years, yet so many people have NOT heard of this incredible exercise method. It was first created by Joseph Pilates and initially gained popularity among the dance community as a way to recover from and prevent injuries.

But you don’t have to be a dancer to practice Pilates or enjoy the benefits. It’s become very mainstream over the years and for good reason.

I’ve been incorporating Pilates into my physical therapy practice for the last 11 years and it’s been transformational.

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength. It helps our clients connect to their bodies in a way they haven’t been able to achieve with traditional strengthening methods. Most of my clients are well into their 50’s and 60’s, and they love Pilates because it helps them have more energy, better balance, and improved strength and mobility. It allows them to participate in all the activities they love with more ease – and most importantly – significantly decreases the likelihood of injury.

But not all Pilates classes are created equal. And it’s important you choose your Pilates studio based on what your most important needs are.

Here are five reasons to consider adding Pilates to your life – and things to watch out for when choosing a program:

1. Pilates helps prevent back pain.

Once you hit 40, your risk of back injury starts to climb. We see a lot of folks in our office who’ve tried traditional physical therapists or chiropractors, and so many different kinds of core strengthening programs, but still have recurring back pain. They’ve been successful in getting rid of their pain in the short term, but they aren’t able to keep it gone for the long term.

Keeping pain GONE is what we specialize in – and one of the ways we do that is with Pilates. But “general/cookie-cutter” Pilates isn’t always enough.

For example, our Pilates instructors work closely with our PT team and get enhanced training on how to navigate back pain, and we keep our classes small so that we can pay close attention to everyone. If you’re recovering from an injury, or vulnerable to back pain, you’ll want to beware of classes that are overcrowded and not individualized. More than 5-6 people in a class when you’re trying to recover from back pain could be dangerous and increase your likelihood of re-injuring yourself. It’s impossible for your instructor to keep a close eye on you or give you individualized modifications when there are too many people in class.

2. Pilates strengthens your whole body, not just your core.

One of the keys to lifelong fitness is what I call “balanced strength.” In other words, each part of your body works together to produce the right amount of force, at the right time. I see lots of “strong” people in my office, but they can’t do the activities they love, because their muscles aren’t working together in the right way at the right time. This can result in compensatory patterns over time – that may predispose you to injury.

Pilates emphasizes full body strength that is coordinated. Coordinated strength is essential if you want balanced strength – which will give you the best shot at avoiding injury.

3. Pilates improves your flexibility.

Do you stretch your hamstrings every day but they never seem to improve?

It could be because you’re not stretching the right way – OR – it could be that you shouldn’t be stretching them at all! (Conversation for another day…)

Either way, the great thing about Pilates is that it improves your flexibility in a way that strengthens at the same time. The “old school” way of stretching was to find the most uncomfortable position for your muscle and just hold it for 30 seconds. Research has shown this is not effective in most cases. The best way to stretch is to do it dynamically with movement. In Pilates, you never stop moving, and one of the central concepts to the practice is “lengthening”. Basically, you use the concept of self-induced opposition to strengthen and stretch at the same time – this is how you end up with flexibility that lasts.

4. Pilates minimizes stress on your joints.

Aging is a real thing and along with it comes arthritis. But it’s not a death sentence like most people are led to believe. The key to combating arthritis is maintaining a mobile and well balanced joint. When you optimize everything that surrounds your arthritic joints, your symptoms decrease.

Pilates helps with all this – without causing any additional stress.

Since Pilates is based on the idea of constant opposition – lengthening while strengthening – you end up with a joint that is happy and balanced when you incorporate a regular practice of Pilates into your life. It helps to minimize the impacts of arthritis and even prevent the rate of degeneration.

5. Pilates trains your nervous system.

Say what? Is this even something I should care about?

Yes it is — and it’s almost ALWAYS a missing link I find for people who’ve been at a certain activity for a really long time, and then suddenly start having pain.

If you don’t train your nervous system, it gets lazy, and compensation patterns develop. When one part of your body is compensating for another, it ultimately leads to imbalance. The right type of Pilates will help with this.

Notice I said “right type.”

If you’re looking to just work out and have fun, then almost any Pilates will do. But if you’re wanting to truly correct your body’s imbalances and train your nervous system, Pilates is still your ticket but it needs to be with a qualified instructor.

If you’re not yet incorporating Pilates into your everyday routine… what are you waiting for!?

It’s my go-to exercise system for folks over the age of 40 and it’s my favorite way to help people keep their back pain gone.

5 Tips for Staying Active and Mobile as you Age

January 25, 2021/in Arthritis and Joint Pain, Movement, Nutrition, Posture, Running, Nutrition and Lifestyle, Strength and Mobility/by Carrie Jose

Most of our clients are in their 50’s, 60’s and 70’s, and they want to stay as active as possible as they age. However, as we get older, our bodies do need more care and maintenance to age well and avoid injury. Here are some tips we like to give our clients to help them stay active and mobile, prevent injuries, and continue doing everything they love!

1. Keep Moving

I always tell my clients: “You don’t get stiff because you get old, you get old because you get stiff.”

If you want to stay healthy and mobile, you need to keep moving. One of the biggest questions I hear from folks aged 50+ is what to keep doing or stop doing because of arthritis. Remember, arthritis is normal as you age and it’s rarely a reason to stop doing certain exercises. Research has shown that activities like running, when done consistently and with proper form, can actually prevent knee arthritis! A similar and equally effective exercise is walking. Consistent walks will build up your strength and endurance, something that declines as you age, and it helps your balance and coordination. If you walk outside, you can get some fresh air and Vitamin D, which is highly beneficial for a strong immune system – something we all need right now.

2. Maintain a Healthy Diet

Tafeltennis Betting Sites Vergeleken: Winstwijzer’s Vergelijking van de Beste Opties

De wereld van het tafeltennissen is een opwindende en dynamische sport die miljoenen fans over de hele wereld aantrekt. Of je nu een doorgewinterde speler bent of gewoon geïnteresseerd in de spanning van de competitie, het wedden op tafeltennis kan een extra dimensie van opwinding en betrokkenheid toevoegen aan je ervaring. Maar met de vele online wedplatformen die beschikbaar zijn, kan het een uitdaging zijn om de juiste keuze te maken.

Gelukkig heeft Winstwijzer, een toonaangevend platform voor sportweddenschappen, een diepgaande vergelijking gemaakt van de beste tafeltennis weddenopties. In deze uitgebreide gids nemen we je mee op een reis door de wereld van het tafeltenniswedden, waarbij we de belangrijkste factoren belichten die je moet overwegen bij het kiezen van een betrouwbare en gebruiksvriendelijke wedsite. Of je nu op zoek bent naar de beste odds, uitgebreide live streaming, of een breed scala aan weddenschapsmogelijkheden, deze gids heeft alles wat je nodig hebt om een weloverwogen keuze te maken.

Betrouwbaarheid en Veiligheid

Als het gaat om tafeltennis betting sites, is het van cruciaal belang om een betrouwbare en veilige website te kiezen. Bij Winstwijzer hebben we een grondige vergelijking gemaakt van de beste opties op de markt. We hebben gelet op factoren zoals bonussen, inzetlimieten, live streaming, mobiele apps en klantenservice.

Eén van de topkeuzes is zonder twijfel Bet365, een gerenommeerde bookmaker met een uitstekende tafeltennis betting sectie. Ze bieden competitieve odds, live streaming van grote evenementen en een gebruiksvriendelijke interface. Een andere sterke optie is 888sport, bekend om hun gulle welkomstbonus en uitgebreide tafeltennis betting markten.

Bet365
888sport
Unibet
Betway

Unibet en Betway verdienen ook een vermelding dankzij hun aantrekkelijke promoties, snelle uitbetalingen en uitstekende mobiele apps. Ongeacht welke tafeltennis betting site je kiest, zorg ervoor dat je de voorwaarden en bonusregels zorgvuldig doorneemt voordat je inzet.

Bonussen en Promoties

Tafeltennis is een populaire sport die steeds meer aandacht krijgt van gokkers. Met de groeiende belangstelling voor deze snelle en opwindende sport, is het aantal online tafeltennis weddenschap sites ook toegenomen. Bij Winstwijzer begrijpen we dat het vinden van de juiste site een uitdaging kan zijn, daarom hebben we de beste opties voor u vergeleken.

Onze experts hebben talloze factoren in overweging genomen, zoals de beschikbare wedopties, odds, bonussen en promoties, gebruiksvriendelijkheid van de site en mobiele compatibiliteit. We hebben ook gekeken naar de reputatie van de bookmakers, hun licenties en beveiligingsmaatregelen om ervoor te zorgen dat uw geld en persoonlijke gegevens veilig zijn. Bovendien hebben we de klantenservice en uitbetalingssnelheden geëvalueerd, zodat u een probleemloze ervaring kunt hebben.

Betcity: Een uitstekende keuze voor tafeltennis fans met een breed scala aan wedopties en aantrekkelijke odds.
Bet365: Een gevestigde naam in de gokwereld met een gebruiksvriendelijke site en een uitstekende mobiele app.
22Bet: Een opkomende ster met een sterke focus op tafeltennis en regelmatige promoties voor trouwe spelers.

Live Streaming en In-Play Weddenschappen

Tafeltennis is een populaire sport die steeds meer aandacht krijgt van gokkers. Met de groeiende populariteit van deze sport zijn er ook steeds meer online wedkantoren die wedopties aanbieden op tafeltennis. Winstwijzer heeft een grondige vergelijking gemaakt van de beste tafeltennis betting sites, zodat jij als gokker de juiste keuze kunt maken.

Bij het vergelijken van de verschillende sites heeft Winstwijzer gekeken naar factoren zoals bonussen en promoties, odds en wedopties, live streaming, mobiele apps en gebruiksvriendelijkheid. Daarnaast zijn ook de reputatie, veiligheid en klantenservice van de bookmakers meegenomen in de beoordeling. Met deze uitgebreide vergelijking kun je eenvoudig de tafeltennis betting site vinden die het beste bij jouw wensen en voorkeuren past.

Mobiele Apps en Gebruiksvriendelijkheid

Tafeltennis is een razendpopulaire sport die wereldwijd miljoenen fans heeft. Het is dan ook geen verrassing dat er een groeiende vraag is naar betrouwbare tafeltennis betting sites waar sportweddenschappen kunnen worden geplaatst. Winstwijzer, een toonaangevende gids voor online gokken, heeft een grondige vergelijking gemaakt van de beste opties voor tafeltennis betting. Zij hebben diverse factoren in overweging genomen, waaronder de beschikbare wedopties, odds, bonussen, gebruiksvriendelijkheid en veiligheid.

Bij het evalueren van de tafeltennis betting sites heeft Winstwijzer gekeken naar:

De verscheidenheid aan wedopties, van wedden op individuele wedstrijden tot toernooien en meer
De competitiviteit van de odds, zodat spelers de beste waarde voor hun inzetten krijgen
Aantrekkelijke welkomstbonussen en promoties voor nieuwe en bestaande spelers
Een gebruiksvriendelijke interface en mobiele compatibiliteit voor gemakkelijk wedden
Veilige en betrouwbare betalingsmethoden en strikte licenties voor een veilige speelomgeving

Met deze criteria in gedachten heeft Winstwijzer de beste tafeltennis betting sites geselecteerd voor Nederlandse spelers, zodat ze met vertrouwen hun weddenschappen kunnen plaatsen.

Samenvattend kunnen we stellen dat de wereld van tafeltennis betting sites een breed scala aan opties biedt voor zowel recreatieve als serieuze gokkers. Door de uitgebreide vergelijking van Winstwijzer te bestuderen, krijgt u een duidelijk beeld van de sterke punten, bonussen en bijzonderheden van elke site. Of u nu op zoek bent naar de beste odds, live streaming, mobiele apps of aantrekkelijke welkomstbonussen, er is voor ieder wat wils. Neem de tijd om uw behoeften en voorkeuren te bepalen en maak vervolgens een weloverwogen keuze uit de top tafeltennis betting sites om uw gokervaring naar een hoger niveau te tillen.

What you eat directly affects your ability to keep moving. If you’re not keeping your bones and heart healthy, you’re not going to be able to exercise! 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, which is a big concern for our clients with osteoporosis.

When it comes to taking care of your heart, your diet can have a huge impact. According to Health magazine, “The risk of a heart attack climbs for men after age 45 and for women after age 55.” So as you enter middle-age, be sure to increase the presence of foods in your diet like unsalted nuts, unprocessed oatmeal, raisins, blueberries, and even dark chocolate (over 70% cacao) to help keep your heart healthy! If you have any comorbidities such as diabetes or kidney problems, be sure to check with your doctor or dietician before making any drastic changes to your diet.

3. Work on your Balance

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. In our office, our favorite core-strengthening activity is Pilates. We especially love it for folks aged 50+ because it’s easy on your joints and it helps to promote flexibility at the same time. We use specialized machines that are beneficial for folks recovering from an injury, and we’ve got Zoom classes requiring no equipment at all that people can do from home. Yet another reason to love Pilates is that it doesn’t just work your core, but your entire body. You can even do portions of Pilates in standing, which helps your balance and coordination! If you’ve never tried Pilates before, we’d love to help you get started.

5. Educate Yourself

Knowledge is power, and a lack of knowledge is one of the biggest reasons I see people decreasing their activity levels unnecessarily. People think that issues like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities altogether. But that’s not necessarily true! Most of the things I just mentioned are normal occurrences as we age, and having them show up on an x-ray or MRI is not a reason to change an activity you’ve been doing successfully for years. Plus, regular movement and exercise actually helps these problems.

If you have 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 any worse. Whatever you do, try to avoid Dr. Google. It can send you down a rabbit hole and not all the advice you read will apply directly to you. If you’re dealing with pain that is keeping you from your favorite activities, reach out to experts like us. We offer a FREE 30 minute Discovery Session just so you can ask questions, get honest answers, and figure out if we’re the right fit for your lifestyle.