Tag Archive for: back pain

low back pain

3 Reasons Your Lower Back Stretches Aren’t Working

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If you suffer from chronic lower back stiffness or pain – and you’ve been diligent with your stretching routine – it might be time to re-evaluate your approach.

Whether it’s your stretching technique, the type of stretch, or even the idea that you might not need to stretch at all, it’s important to understand why your current regimen might not be helping.

Here are three common reasons why your lower back stretches might not be working and how to address them:

1. You’re using the wrong stretching technique.

Research varies on how long to hold a stretch, but many people find that holding a stretch for 30-60 seconds is effective. However, technique is everything. One common mistake is not fully relaxing into the stretch. It won’t be effective if you’re holding tension in your body or gripping your muscles as you stretch. Make sure you’re breathing deeply and easing into each movement. Forcing the stretch or pushing through pain can trigger muscle tension and defeat the purpose.

If you’ve relaxed fully and your stretches still don’t seem to work, consider trying “dynamic” or “moving” stretches. Rather than holding one static position, move gently through a series of stretches, like pelvic tilts or cat-cow stretches. These can help your muscles stay loose without becoming rigid. Adjusting your stretching approach can make a noticeable difference and reveal that your technique might have been the issue.

2. You’re doing the wrong type of stretch.

Determining the right type of stretch can be tricky without professional guidance. There’s a distinction between general stretches meant for relaxation and specific corrective stretches for targeted issues.

For instance, if your lower back tightens up after a long day or due to stress, general stretches like a child’s pose or a seated forward fold may relieve tension. I often use these stretches to keep my own back healthy when I’m on my feet all day helping patients.

However, if you’re already dealing with lower back pain or symptoms like sciatica (pain or tingling running down your leg), generic stretches might not help and could even worsen your condition. In these cases, corrective stretches tailored to your specific problem are necessary. These stretches are usually prescribed by a specialist who considers your body mechanics and underlying issues, recommending the best type and frequency for you.

3. You shouldn’t be stretching your lower back at all.

One surprising reason your lower back stretches might not be helping is that you may not need to stretch it in the first place. Chronic lower back tightness can sometimes indicate a weak core or hip instability.

This is more common than you might think, and if this is your situation, stretching your back repeatedly can lead to more frustration and even worsen the problem. The deep stabilizing muscles in your lower back are closely connected to your core muscles. If your core isn’t functioning properly, your lower back muscles might compensate, leading to persistent tightness and discomfort.

Ever notice your lower back feels sore after a day of ab exercises or after certain workouts? This is a sign that your lower back is overcompensating. Instead of stretching more, it’s time to focus on core strengthening and proper movement techniques. Seek guidance from a specialist to assess and correct your form and make sure your core is doing its job.

In Conclusion…

If your lower back pain or tightness isn’t improving despite regular stretching, it’s possible that your technique needs adjusting, you’re using the wrong type of stretches, or stretching isn’t what your body needs at all. Finding the root cause of your lower back issues is key.

Consulting with a movement or physical therapy specialist can help you identify the best course of action so you can stop wasting time on ineffective stretches and get back to your favorite activities without pain.

Are you local to Portsmouth, NH?

Book a free discovery visit with one of our specialists HERE. Our team will listen to your story and help you make the best decision moving forward – whether that means working with us or finding the right plan for you 🙂

What Your Doctor May be Missing About Your Pain’s True Source

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Pain can be frustrating and overwhelming, especially when it doesn’t go away.

It’s only natural to seek answers – and for many – that means a trip to the doctor. But here’s the thing. Even the best doctors can miss the true source of your pain.

Why?

Because too often they rely on imaging (like MRIs or X-rays) focused on the location of your pain – rather than considering the true source of your pain – and that it could be coming from somewhere else in your body. 

I often see this with pain in areas like the hips, knees, elbows, arms, and legs. Take persistent knee pain, for example. Most doctors will start by ordering an MRI of your knee – which might show things like arthritis or a torn meniscus. But what you may not realize is that these findings are common as we age and often appear in people who don’t have knee pain at all.

The problem is

– once something shows up on your MRI – it grabs your doctor’s attention – and becomes the full focus for treatment (even if it’s not the real problem). 

This misdiagnosing of pain like this is a huge reason why so many people suffer longer than necessary. It also leads to unnecessary surgeries, procedures, and treatments that never address the root cause of the problem. Back to our knee pain example, your doctor might not even consider that your knee pain could be coming from somewhere else (such as your lower back). And if that’s the case – no amount of knee-focused treatment will solve your knee pain – all because we allowed the MRI to make assumptions about the root cause of pain and dictate the treatment plan. 

What most medical doctors miss is this: The way your body moves and reacts to pain is often a much more reliable way to determine its true source than what shows up on an image. I’m not blaming your doctor – it’s just not how they are trained to examine and look at pain. But it is important for you to be aware of this – especially when your pain isn’t going away. You have to at least consider that the root cause was missed and could be coming from elsewhere.

Let me explain a little more.

Over my 22-year career, I’ve worked with people who suffered from persistent tennis elbow for years – despite trying every recommended protocol – only to discover their pain was actually coming from their neck. I’ve met patients who underwent major knee surgery that failed to bring relief – because the problem wasn’t in their knee at all.  I’ve seen patients replace their entire hip – only to find out their real problem was coming from their lower back the entire time.

And this isn’t just my experience. Research backs this up.

A study in the Journal of Manipulative Therapy found that on average, 40% of isolated extremity pain (like your hip, knee, shoulder, elbow, etc) is actually caused by your spine, even when there’s no pain in the spine itself. In these cases, imaging of your knee, shoulder, etc. would only show “normal abnormalities” associated with aging – and not ever show you the true source of your problem – which could be your spine.

So how do you figure out the real cause of your pain?  

The key is with specialized movement testing – designed to take into account your whole body, as well as everyday movement patterns and lifestyle. When you work with a mechanical pain specialist who is trained in this type of movement testing, they don’t just look at static images of your body – they look at how your body functions as a whole.

For example – by moving your spine in specific directions and seeing how that movement affects the pain in your knee, shoulder, or elbow – they can determine whether the spine is the real culprit. 

So if you’ve been struggling with persistent pain anywhere in your body and it’s not going away – you must at least consider that the location of your pain may not be its source. This is particularly common with pain in your extremities. The problem with traditional medical approaches is that they rely heavily on imaging and assume that what you see on an X-ray or MRI is the cause of the pain.

But pain doesn’t work that way. It’s more complex than a picture can reveal, and it often requires a deeper understanding of how your body moves and responds to find the source.  

Pain can be complicated, but finding the source doesn’t have to be. When you consider how your body moves – not just what shows up on an image – you’ll get closer to the answers you need.

Are you in the Portsmouth, NH area?

CLICK HERE to connect with one of our specialists to see if we would be a good fit to help you uncover what may be the real source of your pain.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get access to her free guide: 5 Easy Ways to Get Rid of Back Pain – CLICK HERE – or call 603-380-7902

avoid back pain when raking leaves

6 Tips to Protect your Back when Raking Leaves

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Leaves are everywhere right now in New England, which means for many, the tedious task of raking leaves is right around the corner.

I love Fall – but I don’t love raking leaves.

And raking leaves is even worse when you’re suffering from back pain. The good news is there are many things you can do to protect your back when raking leaves. 

Here are 6 of my most popular tips to protect your back when raking leaves:

1. Warm up before you start.

Just as athletes warm up before a game, so should you before raking. Beginning any physical activity without preparing your body can lead to unwanted strains and injuries. For raking, focus on warm up activities that target your back, shoulders, and legs. Something like a quick walk around the block before you start is an excellent way to warm up. It gets blood flowing to your legs and arms, and the gentle rotational aspect of walking is great for your spine and torso. You could also include some basic stretches into your warmup such as torso twists, shoulder shrugs, and arm circles. This gets some lubrication into your joints and spine to help protect your back once you start raking.

2. Choose the Right Rake.

With any repetitive activity such as raking – good ergonomics is essential. Ergonomics refers to how safe and efficient you are in your working environment. Bad ergonomics will typically cost you unnecessary energy and labor – and can often result in an injury. When it comes to raking, choose a rake with a handle that is long enough so that you can maintain upright posture while using it, and go for one that is light in weight yet still durable. A good, ergonomic rake might require a bit more investment than you were intending, but it will be worth it in the long run because ultimately, a back injury will cost you much more. And knowing how to protect your back from injury is priceless.

3. Bend with your legs and hips  

When performing repetitive activities or lifting something heavy, one of the most vulnerable postures for your back to be in is the combined position of flexed (bent forward) and rotated. To protect your back and avoid injury, you want to use your legs and hips to bend and lift. If you’ve got the right rake, it will be easy to maintain an upright posture while raking. And then when it’s time to scoop up the leaves and deposit them, you’ll want to squat using your hips and knees, and pivot with your trunk and pelvis. Avoid lifting with a curved back and twisting from your waist or spine. Maintaining these habits on a regular basis (not just when raking) will help you protect your back from strain or injury that could otherwise be very easily avoided.

4. Take regular breaks

Continuous and repetitive raking can tire out your muscles and make them more susceptible to injury. Plus, when you get into the monotony of raking, the mindlessness of the activity makes it easy to not pay attention to things like maintaining good posture and using good body mechanics. An easy way to combat this is by taking regular breaks. I recommend at least once every 30 min. Set an alarm on your phone or watch to remind you – and when it goes off – stop what you’re doing, put the rake down, and give yourself a quick upright back stretch. This very simple and easy strategy will go a long way in protecting your back when raking leaves.

5. Engage your Core

You don’t need six-pack abs to protect your back while raking leaves, but simply being mindful of your core can be super helpful and certainly won’t hurt you. Most back injuries occur when you least expect it – and when you aren’t paying attention. When you’re raking leaves, or any other mindless, repetitive activity for that matter, make an effort to think about gently drawing in your lower abdominals while you perform the activity. It’s a subtle move, and you should be able to easily breathe and talk while doing it. If you struggle to breathe and talk normally – you’re overdoing it.  This simple act of engaging your core will help keep your spine more supported and stable while raking and it will help protect your back.

6. Keep Moving Afterwards

What you do after raking is equally as important as what you do during to help protect your back from pain and injury. One of the biggest mistakes people make after a repetitive or strenuous activity (like raking) is to slump on the couch or recliner and “rest”. This is one of the worst things you can do to your spine because it’s more pliable and vulnerable right after strenuous activity. And when you put your spine in a relaxed, flexed position while it’s vulnerable – you’re just asking for an injury. You won’t notice it while you’re resting – but you might feel a tweak or strain when you go to stand up – or even up to several hours later.

Do yourself a favor and perform some gentle stretching after raking, or go for another walk to help relax your back. And be mindful of your resting postures for a few hours after raking.

This is an easy way to protect your back during raking season.

Hopefully these tips give you a few things to think about before you go raking all those leaves in your yard – but most importantly – help you protect your back and avoid unwanted back pain this fall season.

Are you a local in Portsmouth, NH?

CLICK HERE to connect with one of our specialists who can help you manage back pain from raking leaves so you can enjoy the fall season to the fullest!

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get her free guide for preventing back pain, CLICK HERE or call 603-380-7902.

Back Pain MRI

The Hidden Risks of Relying on Back MRIs

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If you’ve ever experienced acute or chronic back pain, or perhaps you’re suffering right now, you’ve likely wanted to “see inside” to know what’s going on.

You’re not alone.

Many people share this desire, and most medical doctors agree with this approach. But what if I told you that getting a back MRI too soon could actually lead you to more (and often unnecessary) injections, procedures, and even surgery?

What if I told you that 80% of all types of back pain, even debilitating sciatica, can be resolved naturally? 

This isn’t just my opinion. The research shows that getting an MRI for back pain too early may actually lead to more invasive treatments – like injections, procedures, or surgeries – which can do more harm than good in the long run. Moreover, relying on MRI results alone to determine your treatment plan often steers people away from natural, non-invasive treatments that could effectively manage, or even resolve your pain, for the long-term instead of short-term.

What the research says:

A 2023 study published in The Journal of Orthopaedic Research found that patients who received early MRIs within the first six weeks of back pain – without any red flag symptoms – were significantly more likely to undergo surgical procedures and use opioid medications. These patients also reported poorer pain outcomes and a higher incidence of disability at their one-year follow-up compared to those who delayed imaging. This growing body of evidence suggests that premature MRI scans not only lead to more aggressive treatments but also contribute to a more negative outlook on recovery, potentially worsening overall outcomes.

So, when is an MRI necessary?

An MRI is crucial when you have alarming symptoms, often referred to as “red flags.” These include signs of cancer, infection, inflammatory diseases, potential fractures, or severe neurological deficits. Healthcare professionals, including physical therapy specialists, are trained to identify these red flags, but it’s important to note that they occur in only about 5-10% of all back pain cases. To put this in perspective, in my two decades of treating patients with back pain, only three have presented with such serious symptoms. In which case, I knew to immediately refer them for an MRI.

Now, I’m not telling you this to minimize the severity of back pain. But instead, to highlight that most people do not need an MRI of their back to receive an accurate diagnosis and effective treatment. If you undergo an MRI without a clear need, you have a greater risk for undergoing unnecessary procedures or surgeries, and a greater potential for opioid prescriptions – none of which have great long-term outcomes compared to a natural treatment approach.

Let me explain:

When you get an MRI of your back, the issue is that it reveals everything – bulging discs, arthritis, stenosis, and degenerative discs – all of which are common findings and a normal part of aging (though medical doctors don’t always tell you that). After a certain age, typically in your mid-40s to early 50s, these conditions are present in almost everyone, regardless of whether they have back pain. Research supports this. For instance, a 2015 study by Brinjikji et al. found that 50% of people in their 40’s had disc bulges, and 88% of people in their 60’s had disc degeneration – and none of them were experiencing back pain. Because these findings haven’t been effectively normalized, they’re often mistakenly blamed for back pain when seen on an MRI. Why?

Because most people only get an MRI when they have back pain.

However, research like this shows that you can’t reliably correlate MRI findings with the actual cause of your pain. More and more studies continue to indicate that people with and without back pain can have nearly identical MRI results. As Martin Underwood, MD, co-author of the Lancet series and professor at Warwick Medical School, stated: “If you start treating disc degeneration just because it appears on an MRI, the likelihood is that, for most people, it isn’t contributing to their back pain at all.“

Feeling confused? You’re not alone.

The reality is that 70-80% of all back problems, including sciatica, are what we call “mechanical” in nature. This means your pain will fluctuate – you’ll have good days and bad days – and movement has the ability to bring you both relief and make your condition worse. Frustrating – right? Or maybe it’s comforting because this sounds just like what you’re experiencing?

Regardless – here’s the thing – mechanical back pain can’t be accurately diagnosed with an MRI.

Instead, it’s accurately identified through specialized repeated movement testing (by a mechanical pain specialist) to determine what triggers and alleviates your pain. From there, corrective movement strategies can be prescribed to eliminate your pain and prevent it from returning. While this approach may take longer, it offers much better long-term results than any procedure or surgery. If you undergo an MRI for what is most likely mechanical pain, you risk receiving unnecessary treatments that could worsen your condition. It’s important to remember that back surgery is irreversible, and complications from surgery can be challenging to manage.

You owe it to yourself to explore all conservative treatment options first.

If you’re currently dealing with back pain or sciatica – or have been dealing with it for years – I understand how frustrating that can be. Consider consulting a mechanical back pain specialist who can help you pinpoint the true cause of your back pain and address it with corrective movement strategies instead of relying on an MRI. Give yourself the opportunity to resolve your back pain naturally, without resorting to invasive procedures or surgery.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media group. To get in touch, or request a seat in her upcoming Masterclass: “Put an end to back pain naturally – without procedures or surgery – CLICK HERE.

Sciatica

Why Cortisone Shots Don’t Work for Sciatica

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If you’ve ever suffered from sciatica – then you don’t need me to tell you how debilitating the condition can be.

From shooting and searing pain into your buttocks that can run all the way down to your foot – to numbness, tingling and loss of strength… sciatica has the ability to significantly impact your quality of life. What’s worse? It typically comes out of nowhere – making this condition even more frustrating to deal with.

It’s no wonder that a majority of people resort to “quick fixes” like cortisone shots – in hopes it will put an end to their back pain and sciatica suffering. According to the American Academy of Family Physicians (AAFP), epidural steroid injections (a type of cortisone shot) are among the most common interventions for chronic low back pain and sciatica. In a study published in The Spine Journal in 2015 – it was reported that approximately 50% of patients with sciatica opted for cortisone shots for pain relief as part of their treatment plan. 

But just because cortisone shots for sciatica are popular and considered “standard” – it doesn’t mean they are best practice.

First of all – even if a cortisone shot “works” (almost 50% of the time they don’t) – the results are typically temporary.  Only 20-30% of patients have been able to report sustained relief past a few month’s time. Everyone else reports anywhere from a few weeks to 3 months relief. The problem with the majority of people only experiencing temporary relief from cortisone shots in their spine – is that  you risk “chasing the pain” with more cortisone shots (or prescription meds), acceptance of your condition and continued suffering (I call it “bad back syndrome”), or opting for spine surgery, that in most cases, is totally preventable.

OK – statistics aside – why exactly don’t cortisone shots work for sciatica?

The reason cortisone shots don’t work is because they are attacking symptoms instead of the root cause of your sciatica. Cortisone shots are great when you have an out of control inflammatory reaction to an injury. This presentation is distinct and rare. We call it “chemical  pain” and it’s essentially the result of your body’s natural inflammatory process going a bit haywire.

What makes chemical pain distinct from mechanical pain (which accounts for 80% of all sciatica/low back pain) is that most “mechanical” sciatica will come and go throughout the day – and will be better or worse during certain activities and positions. For a simple example – your sciatica may “scream” at you if you’ve been sitting for too long – but will ease up and feel better if you stand up and stretch. This is a classic presentation of mechanical sciatica.

Chemical pain does not behave like that. It literally hurts all the time and the only thing to relieve it is drugs.

And even that is temporary – thus – justifying the more invasive cortisone shot when accurately diagnosed. The tricky thing about mechanical sciatica/low back pain is that it occurs slowly over time and is the result of abnormal stress and strain on your discs and spinal nerves. It’s a “lifestyle” and movement condition at its root – not an inflammatory condition. While the cortisone shot may succeed in temporarily getting rid of the inflammation – it won’t ever get rid of the mechanical cause – which means you’re more likely to prolong the true problem over time. A cortisone shot, at its best, puts a bandaid on your sciatica. And this is the number one reason why so many people end up in a vicious cycle of treatments, and end up getting both unnecessary and preventable spine surgery.

So what should you do for your sciatica instead of a cortisone shot?

First, trust the research and evidence – which says there’s an 80% chance your sciatica has a mechanical root cause – and that the inflammation you’re experiencing is instead – a symptom. Research aside, I can vouch for this over the 22 years I’ve been helping people get rid of sciatica naturally. 

Second, medical doctors (unfortunately) are not trained in recognizing, diagnosing, or even treating mechanical pain. You need a mechanical pain specialist to help diagnose and get rid of mechanical sciatica – if you want it done the right way and for the long term. Plus – the best thing about working with a properly trained mechanical pain expert first – is that it’s fool-proof. If it’s not a mechanical cause – and it indeed is an inflammatory process “gone wrong” inside your spine – they will rule it out quickly – and refer you for a cortisone shot (appropriately).

So here’s the good news…

There’s an 80% chance your back pain or sciatica is a mechanical problem at its source. Which means that when working with the right medical professional(s) – you can successfully get rid of it naturally – and avoid cortisone shots altogether. I’m a huge advocate of natural, DIY treatment approaches whenever possible – because although small – there are real risks associated with invasive procedures like cortisone/epidural injections. And when those adverse reactions occur – they are often irreversible. 

Why not give yourself the shot at a natural approach to your sciatica before diving into an invasive one?

I’m not talking YouTube exercises and Google – I’m talking actually mechanical pain specialists. I know a lot of them. So if you’re struggling to find one in your area – please reach out. I’d love to help.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media group. To get in touch, or grab a seat in her upcoming Masterclass: “Put an end to back pain naturally – without surgery, procedures, or pills – CLICK HERE.

Avoiding Movement

How Fear Can Worsen Your Injury: The Hidden Dangers of Avoiding Movement

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Fear is a natural, protective response to injury.

But sometimes it can do more harm than good if you’re not careful. Reason being… When we experience pain or injury of any kind – while the pain can range from mild to excruciating – the real “pain” comes from not knowing what you just did. 

Was it anything serious? Will it go away on its own? What should I do?

All these questions compound the unknown which tends to manifest itself as some version of fear and trepidation. And the degree at which this occurs is highly variable among individuals. On one end of the spectrum – the fear of making an injury worse can lead to behaviors that hinder recovery. But on the opposite end – the fear of not doing enough and being cavalier about “no pain no gain” could also impede your recovery.

The good news is that with the right knowledge, tools, and team of experts – you can “train your nervous system” to interpret pain appropriately and avoid the hidden dangers of not moving enough. If fear is caused by the unknown of what’s happening when you feel pain or have been injured – then a better understanding of pain (what it is, what it’s telling you, and how it behaves) and how your body naturally heals from injury is going to help lessen that. I always say: “Movement is medicine – but knowledge is power”

So… as I’ve alluded to… one of the most common misconceptions about injury recovery is the need for prolonged rest.

When we get injured, our instinct is to “protect” the affected area, which typically translates to avoiding movement altogether. While this may seem a prudent strategy, it can actually delay your body’s natural healing process. 

Let me explain…

Yes, an initial resting period makes sense in some cases, especially after an acute injury where you’ve experienced some form of trauma to your tissues. But as soon as that initial inflammatory period ends – you’ve got to start moving. This is crucial for the proper healing of tissues that have been damaged from an injury. Plus – a lot of injuries don’t occur traumatically. They happen slowly over time. This type of pain requires a totally different approach to healing.

In either case – resting for too long and not moving enough can lead to all sorts of problems such as muscle atrophy, joint stiffness, and reduced overall function. Plus – you’re teaching your nervous system that it’s “safer” to not move – which can cause problematic adaptations over time if you’re not careful. In other words, you need movement, and even a little bit of pain to occur for proper recovery from an injury. But you’ve got to balance this. Too much too soon could re-injury you – while not doing enough will put your body and nervous system into “protective mode” – making it harder to incorporate necessary and healthy movement later on.

So how do you balance this process? How do you know if the pain you’re feeling during movement is good or bad?

Understanding how pain behaves is key. Generally speaking, pain during movement that doesn’t last is considered “safe”. We call this hurting versus harming. It’s generally ok to hurt, but never ok to harm. As your mind and body experience this phenomena together – you’re effectively coaching your nervous system to not react to the sensation of “hurting” in such a sensitive way. The more you move, and the more your nervous system realizes the painful feeling is not resulting in harm or more injury, the more that hurt sensation fades. Your nervous system no longer interprets it as pain. This is a normal and healthy response to pain when dealing with any injury – but especially those that are chronic and didn’t come on so suddenly.

The danger you run into when you never allow hurt to happen and avoid any amount of pain altogether – is that you encourage fear to run the show. Your nervous system never “learns” what good pain is vs bad pain – and it starts to get confused. Before you know it, any kind of sensation is perceived as pain (danger) by your nervous system – which only serves to fuel the fear of movement even more. It becomes a vicious cycle that is hard to break.

If you’re confused right now I don’t blame you.

This can be a nuanced and complicated concept to understand – and it’s why I don’t recommend going at it alone. Working with a movement expert who truly understands the process of healing and how your nervous system plays into all this will help take the guesswork out of all this and build confidence in this process.

Movement really is medicine and it’s a powerful one – when you’ve got the knowledge to use it properly.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To book a free discovery visit with one of our specialists CLICK HERE.

Back Pain

Could Back Trouble Be the Root of Your Knee Pain?

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One of the most important things to get right when it comes to successfully resolving knee pain is to make sure you’ve correctly identified the root cause.

Sometimes, your knee pain is due to a problem within your knee joint – such as with arthritis or torn cartilage. But other times (and more often than you think) – the source of your knee pain can be coming from elsewhere – such as your lower back. 

Did you know that 25% of the time, your knee pain is due to a problem within your back – even when you don’t have any back pain?

One of the tell-tale signs you’ve misidentified the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, stretching – even physical therapy – but no matter what – your knee pain just won’t seem to go away. If the root source of your knee pain is within the knee joint – and you address your joint with any combination of the above mentioned interventions – it will help.  

But how do you figure out if the root cause of your knee pain is in your lower back? 

Pay attention to how your knee pain behaves. When your lower back is the source, you’ll typically have difficulty pinpointing exactly where your knee pain is. It may feel dull, achy, or even numb at times. It might move around, or perhaps travel up or down your thigh. One day your knee might feel great, and you’ll think the problem is finally gone – while other days it could feel excruciating. When your knee pain is more vague and moves around a lot, or it comes and goes throughout the day for no apparent reason, there is a good chance that your back is the root source. With true knee pain, you can usually point to where it hurts and describe pretty well when and where it will bother you.

So how does a misdiagnosis like this even happen?

One of the biggest culprits is imaging. If you’re over age 40, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears. Studies have shown that arthritic changes and meniscus tears are a normal part of aging, so they will show up on your images whether you have any knee pain or not. While I have many stories about people getting the root cause of their knee pain wrong – one in particular stands out in my mind that I want to share with you. 

I remember a 56 year old tennis player who had knee surgery to “clean out” some wear and tear from arthritis and a meniscus tear. This was after trying several months of physical therapy that had “failed”. She was told the procedure was routine and that her recovery would be quick. Sadly, after three months, she was still limping around and her knee was feeling worse than pre-surgery. The pain had moved, it spread more to her thigh now and it ached a lot more at night and when she wasn’t moving around. She could play tennis, but her knee felt more tired now and her leg would just ache. When she came to me for a second opinion, the very first thing I did was screen her lower back for problems. She thought this was weird at first because she had never had any real back pain. But it turns out that when we started moving her back around and testing it – her knee pain reacted to this. The root cause of her knee pain was actually in her spine. So it made sense all the physical therapy she had for her knee, and the knee surgery didn’t work.

If you’ve been suffering from knee pain for a while, and typical treatments don’t seem to be working, it’s worth considering that the root source of your problem could be your lower back. 

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your thigh – it’s worth getting your lower back checked by a mechanical pain specialist before give up all together – and especially before jumping into any surgery or procedure on your knee.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or sign up for her upcoming Masterclass for Knee Pain Sufferers CLICK HERE.



Why Strengthening your Core Won’t Cure your Back Pain

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

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

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

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

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

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

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

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

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

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

So when should you focus on strengthening your core?

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

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

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

Woman sleeping facedown on a bed.

Tips and Solutions for Morning Back Pain

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

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

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

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

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

Poor Sleeping Position

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

Insufficient Exercise

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

Bulging Discs

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

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

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

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get a free copy of her guide to back pain – click here.

Pain when gardening

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

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

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

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

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

1. Avoid bending from the waist

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

2. Take frequent breaks

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

3. Pivot instead of twist

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

4. Use gardening tools wisely

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

5. Raise your gardens

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

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

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Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or get a free copy of her guide to back pain – click here or call 603-380-7902