Tag Archive for: back health

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Do Cortisone Shots Work on Herniated Discs?

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Do Cortisone Shots Work on Herniated Discs?

A recent conversation with someone regarding whether or not they should get a cortisone shot in their back to help a herniated disc inspired me to write this article. Why? Because in speaking with her, I realized how misinformed she was about when you should and shouldn’t get a cortisone shot, and what they are and aren’t good for. And I hate to see people getting procedures or injections when they don’t actually need one.

So when is a cortisone shot a good idea?

Cortisone shots work really well when the primary source of your pain in a targeted area is inflammatory or “chemical”. When you’ve got pain that is of chemical origin – then chemical drugs (like a cortisone shot) will work well to get rid of it. So what is “chemical pain” and how is it different? Chemical pain is the result of your body’s natural inflammatory response in response to injury – which produces an influx of chemicals and other nutrients in your blood to heal the injured area. Since this process creates inflammation and swelling – you feel pain. When the inflammatory process is working correctly, these chemicals naturally dissipate as the tissue heals. But on occasion, the process can get out of hand and get dysfunctional. The painful chemicals linger and create an almost constant state of pain that really doesn’t respond to any kind of movement or even rest.  In the case of back pain due to a herniated disc, typically you’ll find that you can relieve it temporarily by changing positions, moving, or going for a walk. But if it’s chemical pain – your back will hurt constantly – it will feel hot and inflamed – and nothing will seem to touch it. While rare, if your herniated disc is causing this type of pain response, then you’ll likely benefit from a cortisone shot. You need to get rid of those chemicals and the cortisone shot will do just that

But most cases of back pain – even those involving a herniated disc – are instead considered “mechanical” in origin.

Mechanical pain is responsible for 70-80% of all musculoskeletal injuries and it has to do with your mobility and movement patterns. Unlike chemical pain – mechanical pain does respond to changes in movement and position. It’s why most people suffering from herniated discs will feel better when they walk, move, or exercise. They can also temporarily relieve their back or leg pain by standing up (for example) after having been sat for a long time. The key recovery tool for mechanical pain is movement – identifying where your mobility restrictions are and where your faulty movement patterns or habits exist. Once you figure this out – the structural component (aka the herniated disc) is irrelevant and you can live with it for years to come without issue. If you’re suffering from back pain or sciatica, and have been told you have a herniated disc, and what I’ve just described is your typical pain pattern – you will likely not benefit from a cortisone shot and instead need a proper movement/mechanical assessment from someone who’s an expert in this sort of thing.

Now here’s where things get confusing…

If you’ve got a herniated disc – it has the ability to irritate the structures surrounding it – everything from muscles to nerves. I’ve seen people aggravate a herniated disc by simply sneezing or coughing. When your herniated disc gets “angry” and irritates the surrounding structures, you will experience localized inflammation. But it’s different from the dysfunctional inflammatory pattern I described previously. It’s still possible to make this inflammation go away on its own – without drugs – because it’s not in a permanent “chemical” state. But when you’ve got a highly sensitive and painful herniated disc it’s very tempting to get a cortisone shot to relieve the pain.

But here’s why I urge you to think twice… The cortisone shot may provide you with temporary relief – but it will be a bandaid.

Because at the end of the day – the cortisone shot will not address the root cause – the underlying mechanical problem that is causing that herniated disc to keep getting angry. What you risk is that during those periods of “pain relief” – you continue to do things that make that herniated disc worse – because you can’t feel what’s going on. If you keep masking the pain pattern with cortisone shots, and keep unknowingly making your herniated disc worse, you may get to the point where you can’t fix it naturally anymore and will be looking at a surgical fix instead.

Ok – so that was a lot of information and scientific terms thrown at you. But at the end of the day – here’s what I want you to remember and think about if you’re considering getting a cortisone shot for your herniated disc… 

If you can influence your back pain with any sort of movement or activity – then it’s not the type of pain that warrants a cortisone shot. Cortisone shots do nothing to affect a structure (aka herniated disc) – they only eliminate chemicals that are causing pain. And the short-term pain relief from the cortisone shot will not outweigh the potential long-term and harmful consequences you could experience by not addressing the root cause. But if you’re experiencing the sort of back pain that is hot, inflammatory, and not responsive at all to movement, activity, or positional changes – then you’ve got a situation where a cortisone shot might be beneficial – and could get you over the hump that is needed for movement and activity to actually help.

At the end of the day, before you consider any kind of injection or procedure, be sure you’re well-informed and have asked all the questions necessary to be sure that a natural alternative is not still available and worth trying.

If you are local to Portsmouth, NH – consider speaking to one of my specialists. We will ask you all about what’s been going on and see if we would be the best fit to help you. Click here to request 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 request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Tips to Fix Morning Back Pain

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Morning Back Pain? Things you can do.

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

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

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

Back pain impacts people in different ways. Both the location of your pain as well as the time of day you feel your worst can be indicators of where your back pain is coming from and what’s going on.

Some of the most common causes of morning back pain include:

  1. Poor sleeping position
  2. A crappy mattress
  3. Bulging discs

Let’s go through each one and talk about tips to help morning back pain.

1. Poor sleeping position

The sleeping position that aggravates you is going to depend on the underlying cause of your back pain. Sometimes sleeping on your back with legs elevated is what makes your back feel worse in the morning – even if it feels amazing while you’re in this position.  For others, sleeping on their stomach is the thing that wreaks havoc on their spine. 

The most back-friendly position is to sleep on your side. Side-sleeping allows you to put your spine in a neutral position – which is where you get in the least amount of trouble.

It’s really challenging to achieve a neutral spine when you’re on your back or stomach.  If it bothers your hips or shoulders to sleep on your side – I recommend placing a pillow under your waist as well as your head – and if needed – also one between your thighs.

2. A Crappy Mattress

Over the course of my career, I’ve probably been asked at least 1000 times what the best mattress is to sleep on. The answer is “it depends”. Your most important concern should be to find a mattress that you feel comfortable on and that gives you the best night’s sleep. This is different for everyone. Some prefer soft and plush, while others prefer firm and supportive.

But here’s the thing – if you don’t have an underlying back problem then the surface you sleep on will be irrelevant. In most cases, I find that when a mattress aggravates your back, it’s a sign that you’ve got a back problem brewing that needs some attention.

That being said – for those that do suffer from generalized, chronic back pain – a firmer, more supportive mattress is going to be your best bet.

3. Bulging Discs

This is the most common reason I see for morning back pain.

Your vertebral disc has three primary functions:

  1. Absorb shock
  2. Help hold the vertebrae of your spine together
  3. Contribute to the mobility in your spine

The interesting thing about vertebral discs is that they are made up primarily of water.

Over the course of a normal day – and over the course of life – your discs will compress and decrease their water content. At night, your disc literally re-hydrates and can gain up to 17-25 mm of height. While this may be beneficial to someone who’s arthritis is to blame for their back pain, it is not beneficial for someone suffering from a bulging disc.

Remember when I mentioned that your disc is partially responsible for mobility in your spine? When you have a building disc – that bulge restricts your mobility. If it fills up with fluid overnight – you’re going to wake up feeling a lot more restricted and in a lot more pain.

Unfortunately, there is no quick fix I can reveal for you on this one. The best advice I can give you is that if you’re waking up every morning in a lot of pain and you’re afraid to move – there’s a good chance you’re suffering from bulging discs, and you should see someone who can help you with this.

If you’re waking up every morning with back pain…

then hopefully this information helps you have a better understanding as to why it might be happening. Although a crappy mattress could be the reason, I caution you not to default to that. More often than not, there’s an underlying problem in your back that needs to be addressed.

But the good news is that 80% of the time there is a natural, movement-based solution that can address your back pain successfully without relying on pills or procedures.

Are you experiencing back pain and looking to get help without pills or procedures?

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 with one of my specialists.

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 Easing Back Pain and Stiffness – click here.

 

 

Three Easy Tips to Keep your Back from “Going Out”

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Three Easy Tips to Keep your Back from “Going Out”

Most people – four out of five to be exact! – will experience a debilitating back pain episode at one point during their lives, and typically we put more effort into caring for our backs during those times than when we’re feeling good. But it’s critical that we take good care of our backs all the time, not just when we’re in pain!

1. Stand Up & Take a Load Off

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

The solution? Limit your sitting to half-hour periods with a few minutes of standing in between, and you’ll reduce the uni-directional forces on your spine. In other words, if you sit for a long time at work or at home, stand up and walk around a little bit every thirty minutes. Aside from participating in regular strengthening exercise, like Pilates, this is the easiest way for the average person to prevent back injury (and heal your back faster if you already have an injury).

2. Watch for Curves

We have natural curves in our spine that help us handle stress and loads.  Whether sitting or standing, it’s important to maintain these curves.  When standing, our spinal curves occur more naturally and are usually easier to maintain.  When we sit, the protective curves in our spine are harder to maintain and often disappear.  And while a healthy core and strong back muscles are important to back health, they won’t protect your back if you sit for long periods, or when the curve in your lumbar area disappears while you’re sitting.

Fortunately, the solution is as simple as rolling up a towel and placing it between your chair or car seat and the small of your back (just above the belt line). Using a purpose-designed lumbar roll is my favorite choice, and what I use for low-back support. You can use a lumbar roll in your office chair, car, and on the plane if you’re flying! If you want to learn where you can get on of your own contact us about them here. Or  see in more detail how to use them in our free e-book!

3. Extend instead of Bend

The human spine (and entire body) craves balance, which means both extension and flexion.  But we spend the majority of our time in flexion, bending over to put shoes and socks on, brushing our teeth, driving, sitting at work and then driving home. At home we bend forward to cook, sit some more as we eat and then curl up on our couch or an easy chair. As long as we’re not gymnasts or circus performers, it’s safe to say we could all use a little more extension in our day.

A really good exercise is to stand and place your hands on your lower back for support and then arch back as far as you can go.  Repeat this 10 times, at least once per day.  This is also a great activity to do when you are interrupting your sitting during the day.  If you’ve never arched you back like this before, it may feel stiff or even hurt a little at first. But, with a gradual increase in frequency, it will feel less stiff and more natural over the course of a few days.  If it doesn’t, or becomes troublesome for you, stop and consult with a qualified physical therapist who specializes in back pain.

If you like these tips and want to learn even more ways to prevent debilitating back pain episodes, check out our FREE back pain report right here!

It reveals five easy ways (plus two bonus tips!) that are PROVEN to help you ease back pain quickly – without pain medication, frequent doctor’s visits, or surgery. And don’t forget to check out our Pilates programs if you’re looking for a way to exercise that will target – and resolve – back pain!

Should You Heat or Ice an Injury?

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Earlier this week, we put on a free Zoom workshop all about preventing and overcoming knee pain – and one of the questions that came up was if you should apply heat or ice when something is hurting. This is a VERY common question in our office, so we wanted to share the same advice we give to clients right here!

When to apply ice:

Generally speaking, the best time to apply ice is within 24 to 48 hours immediately following an injury. Application of ice during this stage has been shown to reduce the formation of edema and “secondary injury.” After that, it really becomes a personal choice. If you’re in pain, and ice makes you feel better, go for it! Some research has claimed that icing an injury after 48 hours is “bad” for you. But if you really dig into the research, it’s inconclusive on this topic. What I tell my clients is that if something feels irritated or inflamed – go for ice. It’s a much better and more natural alternative to pain pills!

When to apply heat:

Once you’re into the chronic stages of injury or pain, I’m generally a fan of heat. But the term “heat” is relative – and doesn’t necessarily refer to the application of a heating pad only. In fact, research has shown that heating pads are not able to penetrate deeply enough to actually have an effect on the injured muscle or soft tissue. But it does feel good… which can be beneficial in and of itself because when you “feel” better – your nervous system relaxes. If the superficial heat can relax the nervous system enough so that you can actually tolerate the movements or exercises that WILL actually heal you – then I can see a benefit.

The BEST way to provide “heat” as a way to promote healing to an injury is through movement – but you need the right prescription. The mistakes I often see, especially around 2-4 weeks post injury, is that people aren’t moving enough (if at all), or they are overloading the tissue and moving too much.

Movement truly is medicine, and it’s one of the best and most natural ways to properly heal from an injury – but you MUST get the prescription right.

So there you have it. You can’t really go wrong with either modality. The general rule is that if it’s an acute injury – ice up to 48 hours. For anything else, we typically recommend heat.

If you’re presently healing from an injury and not satisfied with your progress – perhaps you’re just missing the correct prescription. If you’re wondering what that magical movement is, or you’re wondering if the current movement you’re doing is safe, get in touch!

Speaking of movement as a way to heal…

Our Pilates 101: Get Your Back to Health is back!

This is our signature program and it’s designed to help those dealing with lingering back problems learn to move and heal the RIGHT way – from the inside out with proper core strengthening. It’s also ideal for those that had recent back surgery and you’ve already been through your initial stages of general physical therapy.

Interested in learning more or getting on the VIP waitlist for the program? Click here!

Would a Tech-Detox be Good for your Health?

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Technology is a huge part of all of our lives, and there’s nothing wrong with that. We rely on digital technology to do our jobs, communicate with friends and family, find answers to our most pressing questions, and so much more. If you’re reading this right now, it’s because you have access to the internet via your computer, phone, or other device.A 2016 report published by CNN tells us that on average, Americans spend over 50 hours per week online. This “world at your fingertips” has so many great assets, and yet it can be damaging to your health if you never take a break.

Too much screen time can disrupt normal sleep patterns and cause insomnia, lead to increased feelings of isolation, and decrease your attention span over time. And from a physical therapist’s standpoint, walking around looking down at your phone or sitting hunched at your computer for hours on end is terrible for your spine!

There’s no need to give up technology altogether – smartphones and other devices are an important part of the world we live in. However, research shows it can be incredibly beneficial to engage in a sort of “detox” from your gadgets and take a break! This doesn’t have to be as extreme as locking up your phone for a week or quitting social media altogether. You can take small strides towards freeing up those hours that you would otherwise spend online. For example, you can turn your phone off in the evenings, for instance at 5 or 6:00, so that you are not staring at a screen for several hours before bed. This allows your brain to produce its natural levels of melatonin, which your body needs to both fall and stay asleep! Another option would be to delete certain apps off of your phone. Is Facebook a big time suck for you? Try eliminating it from your mobile devices so that you can only access it from a computer. That way, you can prevent distraction when you’re out and about this summer. You can also delete those games that you play out of boredom or habit- which will free up your storage as well as your time! It’s hard to put away the phone altogether, because many of us rely on it for things like its camera function and music. If you’re carrying your phone with you constantly, try putting it on airplane mode. You won’t get texts or social media alerts, but you’ll still have access to your camera, music, calendar, and clock (including timers, alarms, and the stopwatch). You’ll be less distracted, but still get to enjoy the versatile functionality of your smartphone.

If you spend a lot of time during the day on the computer for your job, or have other commitments that require screen time, consider incorporating timed breaks into your day every 25 minutes to stretch and/or walk around. Easy everyday movement and mobility exercises really help to invigorate the body, and taking these breaks will ease tension in your back. You can read more about how prolonged sitting is tough on your back here. If your job requires constant sitting, try to stay up and moving when you get home. It’s easy to flop onto the couch after a long day, but consider stretching or doing a simple in-home workout while watching TV. Or instead of devoting hours strictly to TV watching altogether, you can catch up on your shows while making dinner or folding laundry, for example. Pairing a mobile activity with a passive activity like watching TV will not only make you more productive, but it will also save your back from the pressure and imbalance of prolonged sitting!

Do you have a tech-detox tip to share? Let us know on Facebook! We love to hear your thoughts, and invite you to get in touch if you have any questions about your back pain, mobility, or activity level.