Tag Archive for: back pain

Back Pain

5 Simple Tips for Keeping Back Pain Gone

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5 Simple Tips for Keeping Back Pain Gone

Almost half of U.S. adults (39% according to the CDC) suffer from back pain. With the prevalence increasing as we age – folks over age 65 are more likely to experience back pain than any other age group. Economically speaking – back pain accounts for roughly $50B annually – and is the number one cause of missed work days – 83 million each year according to the National Council on Aging (NCOA).  

Given these staggering figures, you might think the title of this article is nuts. If it were that easy to get rid of back pain on your own – why do so many suffer? Well – that is the million dollar question (or rather $50B question). The problem is that the traditional medical approach focuses on symptom management rather than addressing the underlying causes of back pain. This oversight leads to persistent discomfort and recurring issues for many – because the underlying, root cause is never properly addressed.

So what is the root cause of most back pain? 

Eighty percent of back pain is what we call “mechanical” in nature. That means it comes from poor or imbalanced movement habits and postures that are years in the making. This also explains why back pain shows up a lot more in older populations. The root cause of back pain is rarely structural (aka: bulging discs, stenosis, arthritis, etc). Those structures, and structures around the stenotic or arthritic joints, become irritated because of the poor movement habits that slowly wreak havoc on your body. They don’t typically cause problems all on their own. How do I know? Because more than 60% of older adults with zero back pain will have one or more of these findings on their MRI.

The good news is that since most back pain is due to poor movement and postural habits – you can alleviate it with some good movement and postural habits. Here are 5 simple tips for keeping back pain gone on your own:

1. Stop Sitting So Much

Sitting puts a surprising amount of pressure on your spine – even if it feels good in the moment. Compressive forces on your spine increase by 40% when you sit – and even more if you’re slouching. Over time, this pressure can unknowingly aggravate your spinal ligaments and discs without you even realizing it.

One of the simplest ways to counteract this is by breaking up your sitting time. Set a timer to stand up and move every 30 minutes. Even a quick stretch or walk around your office can make a big difference. By interrupting prolonged sitting, you’ll reduce the cumulative stress on your spine and keep your back healthier.

2. Walk More

Walking is one of the best activities for your spine. It promotes mobility, improves blood flow, and acts as a natural lubricant for your spinal structures. Regular walking also helps prevent tightness in your hips, which can aggravate your back due to abnormal forces on your pelvis and spine.

Aim for at least 10-15 minutes of walking each day. If you’re dealing with back pain, start with short, gentle walks and gradually increase your duration and pace. And focus on maintaining good posture while walking. If walking even short bursts continues to aggravate your back – then it’s time to talk to a mechanical back pain specialist who can help you sort out why.

3. Vary Your Posture

Did you notice that I didn’t say: “maintain good posture”?. That’s because maintaining perfect posture all the time is quite impractical and not very realistic. The truth is – no posture is perfect if you stay in it too long. Even the best looking postures can lead to stiffness and discomfort over time. 

Instead of obsessing over perfect posture, aim to vary your positions throughout the day. Your spine is made to be quite resilient – and a healthy spine can tolerate any posture (even bad posture) for a short amount of time. So if you’re sitting or slouching – be sure to move around and change your position. If you’re standing for a while – try shifting your weight side to side. Your spine wants to keep moving – so finding opportunities in any position is going to be beneficial.

4. Strengthen Your Core

Your core muscles include your abdominals, obliques, and glutes – and they provide support and stability for your spine – and go a long way in preventing back pain. But when these muscles are weak, your spine takes on more stress, thus increasing your risk for pain and injury.

Pilates is one of the best overall ways to strengthen your core while also promoting good spinal movement and mobility. But exercises like bridges, planks, and full body functional exercises are also effective for targeting your core. Incorporating core strength into your routine a few times per week will not only help your back feel better – but it goes a long way in preventing future back pain episodes. If exercising or strengthening your core hurts your back pain – then you should seek the help of a mechanical back pain specialist who can help you get back to moving and exercising naturally, and without procedures or cortisone shots.

5. Education is Power

There’s a lot of misinformation out there when it comes to both diagnosing and treating back pain. So one of the most important steps you can take is to educate yourself on this. You’re already off to a good start because you’re reading this article. But the second most important thing to keep in mind is to never let your MRI or X-ray alone make a diagnosis and dictate your treatment plan. I’ve already alluded to this concept previously – but structures in your spine rarely cause problems spontaneously. They get irritated over several years – but it’s not the structure itself that’s the problem. When you are educated on this nuanced concept – you’ll realize it’s possible to treat back pain on your own – and are less likely to become a victim of unnecessary procedures, cortisone shots, and back surgery.

Just remember – 80% of all back pain is mechanical – and comes from poor movement patterns, habits, and postures over several years. The solution lies in correcting these movement patterns and habits – and for the most part – they are very “correct-able” and reversible. A mechanical back pain specialist is the best person to help you with. They are experts in back pain and won’t rely on MRIs or X-rays to dictate your treatment plan.

Local to Portsmouth, NH?

Consider speaking to one of my back pain specialists by clicking here.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Active senior man in sportswear suffiering from pain in his back after cycling, in park in summer.

Exercise-induced Leg Soreness or Sciatica? How to Tell the Difference.

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It’s that time of year – when people set goals and take action to improve their health, get back in shape, and ramp up exercise routines.

But what happens when your body isn’t ready for what your mind has planned? How can you tell if the soreness you feel is “good pain” – or a problem brewing?

This concept is particularly confusing when it comes to leg pain. Whether it’s ramping up your strength training, more frequent Peloton rides, or getting back to running/jogging… These activities will make your legs sore. The problem, however, is that leg soreness can mimic a common (and sneaky) condition called “sciatica” – that if missed or ignored – could completely derail you from your health and fitness goals. So it’s important you know the difference and what to watch out for – especially if you have a history of sciatica or back pain. 

Here are some key things you to look out for – that will help you tell the difference between normal leg soreness from exercise – versus sciatic pain that’s caused from your back:

Exercise-induced leg soreness…

With exercise-induced leg soreness – you’ll typically feel pain deep in your muscles (especially those you specifically worked on) – and your legs may feel tender to touch or even “swollen”. This type of soreness comes from challenging your muscles beyond their usual capacity – something you want to do during exercise. The soreness is caused by microscopic damage to your muscle fibers – triggering an inflammatory response. This inflammatory response then triggers a repair phase in the area of the “damaged tissue” (aka your muscles). It’s in this repair phase that your body builds back stronger muscles – so that they’re more resilient the next time you exercise. 

Another key characteristic of exercise-induced leg soreness is that it will typically occur anywhere from 24-72 hours after the activity. This phenomenon is known as “DOMS” (delayed onset muscle soreness) and it will usually dissipate in a similar amount of time. The soreness you feel from DOMS is often felt symmetrically (in both legs) – because most exercises are done using both sides of your body. But even if you’ve done an activity that favors one leg over another – the pain you experience during the DOMS period will occur when you’re moving or stretching the affected muscles – and not so much during periods of rest.

Now let’s look at sciatica…

Sciatica is a problem that comes from your spine and that causes pain in your buttock and/or leg. In between each vertebrae (the bones that make up your spine) are small spaces that allow the nerves originating from your spinal cord to exit. These nerves control everything from sensation, to pain, to muscle strength. If the nerves in your lower back get irritated – or structures around those nerves get irritated (for example, bulging discs) – anything in your leg (or butt) that those irritated nerves “touch” can also be affected. This is the phenomenon known as sciatica.

The tricky part about sciatica is that the timeline of your pain – and the feeling you experience – can be very similar to the leg soreness you get from exercise. Just like exercise-induced leg soreness – sciatic pain can include a deep ache in your muscles, tenderness to touch, and a feeling of swelling. People often describe to me a feeling of “heaviness” in their leg when they are experiencing a sciatic episode. Sciatic pain can also come on 24-72 hours after exercising or activity.

But with sciatica – one of the most important factors you need to pay attention to is how your pain behaves. Leg soreness from exercise arrives in a fairly predictable manner – and leaves in a fairly predictable manner. And you generally won’t have much pain at rest.

Sciatica, on the other hand, is more unpredictable.

Although it can come on in the same time frame as exercise-induced leg soreness – it won’t just “go away” in the same, predictable amount of time. Pain from sciatica can linger – particularly at rest – and with activities such as sitting, driving, standing too long, or walking. It can end up in just one leg even though it started in both – and it tends to come and go. For example – you’ll think it’s better – only to suddenly wake up with a sore leg again – or bend the wrong way and have the pain annoyingly return. And finally – sciatic pain won’t go away completely with stretching or massage (although it’s tempting to think it did). 

But one of the most important things to notice about the behavior of sciatic pain versus exercise-induced leg pain is whether or not numbness or tingling is present. It’s possible to have sciatic pain without numbness and tingling – but it’s not possible to have it with healthy, exercise-induced leg soreness. That’s because only nerve irritation can cause the sensation of numbness and tingling in your leg. And speaking of nerve irritation… If your leg soreness “goes away” – but you’re left with a lingering back ache – your leg pain was almost certainly a sciatic episode that has temporarily resolved – and it’s only a matter of time before it returns with a vengeance.

So there you have it – next time you notice leg pain after exercising – pay attention to how your pain behaves.

How long does it last? Does it come and go? Is it only in one leg vs both? Do you have any numbness? Does it linger or return with mundane activities such as sitting or standing?  If the answer to any of these questions is “yes” – and especially if you’ve got a history of back pain – you must consider that it could be sciatica. To make sure – seek out the help of a mechanical back pain specialist who can tell you for certain.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

sciatica

How Ignoring Back pain could ruin your New Year’s Goals

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Now is the time when people shift their focus to the New Year and start thinking about new and exciting goals for themselves.

According to statista.com – the three most popular New Year’s goals are 1) doing more exercise and improving their fitness, 2) losing weight, and 3) saving money.

Would you be surprised to know that if you are currently suffering from back pain – and you continue to ignore it – it could significantly impact your chances of success at achieving any of these goals?

Let me explain.

Let’s start with doing more exercise and improving fitness. Most people think that if they start exercising more – especially their core – it will solve their back problem. Not necessarily. While the research studies show (overwhelmingly) that exercise is one of the best treatments for back pain – what they don’t reveal is that there are typically some key things that must be in place in order for exercise to be effective. For example, you must have good mobility before you start focusing on stability (or strengthening). If you’ve got a stiff back, general exercise could be all you need, and you’ll notice improvement. But you won’t know until you get going and by then it could be too late.

What if your back is stiff because it’s compensating for something – say a bulging disc or muscle weakness?

If that’s the case, and you go all in with an exercise program in January, it’s only a matter of time (usually about 3 months in) before your back becomes worse, forcing you to abort your grand plan for the new year. When stability is there for a compensatory reason, it’s important to figure that out before adding more exercise or strengthening to the mix. This is one way back pain could derail your New Year’s resolution of doing more exercise and improving your fitness.

Say you want to lose weight. This is a fabulous goal. And if you’ve got back pain, losing weight will surely help. But once again, it’s critical to understand why you’ve got back pain in the first place. For example, being overweight is rarely the cause of back pain. A few extra pounds can certainly exacerbate your back problem, but it doesn’t usually cause back pain all on its own. The most common causes of back pain are mechanical (movement) problems.

In other words – bad movement habits such as sitting all the time, bending and rotating too much, or having terrible posture can all lead to back pain slowly over time.

If you lose weight, but never correct these mechanical/movement problems, your back pain isn’t going to improve. When it comes to the process of losing weight, in addition to watching your diet, more exercise is often incorporated into a weight loss plan. If you’ve got back pain, it’s more than likely due to poor movement habits. More exercise will not address these, and worse, could exacerbate the problem. If your back pain increases, not only will you not want to exercise, but you could be more inclined to sit at home and eat more – completely derailing your New Year’s resolution of losing weight.

Finally – we come to saving money. What on earth could back pain have to do with this? Well, you’ve probably heard the saying: “If you think wellness is expensive, try illness”. And this couldn’t be truer. When you ignore back pain, it’s only going to get more expensive to address later. As back pain worsens, you’ll have less willpower to bear it, and you’ll be more likely to opt for expensive fixes such as outpatient procedures and surgery. Not to mention the rehab that needs to take place afterwards for an optimal recovery and the expensive tests that need to take place before-hand to ensure you’re ready for surgery.

When you ignore a back problem it’s only a matter of time before it becomes unbearable.

And when we’re desperate, we make poor decisions, which often leads to more money spent than necessary. All that money (and more) that you set out to save as part of your New Year’s goals eventually goes to waste. Instead, get in front of your back pain. For 80% of back pain cases, there is a natural, movement-based solution. Natural solutions are far less expensive – and much safer long term compared to something like surgery. While the impact of ignoring back pain may seem indirect when it comes to a New Year’s resolution of saving money – it will impact you in some way – at some point – in a monetary way if you don’t address it now.

When you’ve got back pain (or any pain for that matter) that isn’t going away, it’s your body trying to tell you something. Don’t ignore it. It’s only a matter of time before it gets worse and starts to derail more than just your New Year’s goals.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. If local to Portsmouth, NH and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

5 Tips for Wrapping Gifts Without Aggravating Neck or Back Pain

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If you’re anything like me – you’ve left your Holiday wrapping to the absolute last minute. And if that’s the case – there’s a very good chance you’re going to overdo it – and aggravate any existing neck or back pain you might have.

The good news?

There are things you can do to significantly mitigate the chances of your neck and back pain flaring up – and perhaps avoid it altogether.

Here are five great tips – and even a bonus recovery tip – to help you get through your last minute gift wrapping without aggravating your neck or back:

1. Create an Ergonomic Wrapping Station

The way you set up your wrapping station matters. Sitting on the floor or crouching over a low coffee table forces your spine into unnatural positions, creating stress on both your neck and back. Instead, wrap your gifts on a surface that allows you to sit or stand comfortably at waist height.

If you’re sitting, use a supportive chair along with a lumbar roll to keep your back and neck in their most natural position. For those who prefer standing, consider using an anti-fatigue mat to reduce strain on your back. Elevating your workspace ensures you’re not constantly hunching over, which is a common culprit for neck and back pain.

2. Don’t Sit or Stand Too Long – Move!

Sitting or standing in one position for extended periods can lead to stiffness and pain in your neck, shoulders, and back. Set a timer to remind yourself to take movement breaks every 20-30 minutes.

During these breaks, perform a few gentle stretches for your neck and back. Try rolling your shoulders backward, gently tilting your head side to side, or doing a seated spinal twist. Movement encourages blood flow, which helps reduce stiffness and tension. Plus, breaking up the task gives you a mental refresh so you can focus on getting your wrapping done instead of neck or back pain.

3. Use the Right Tools

The tools you use can make a big difference in minimizing strain. Opt for ergonomic scissors with padded handles to reduce stress on your hands and wrists. Tape dispensers are also a must-have to prevent repetitive wrist motions that can lead to discomfort.

If you’re wrapping on the floor, use a cushion to support your hips and lower back. For added neck relief, consider placing a rolled-up towel under your neck during floor session breaks to give it some relief and maintain its natural curve. These simple adjustments can help you avoid unnecessary strain while you focus on creating perfectly wrapped packages.

4. Check Your Posture

Poor posture is one of the biggest contributors to both neck and back pain. While wrapping, make a conscious effort to:

  • Relax Your Shoulders: Keep them down and away from your ears to avoid tension in your neck and upper back.
  • Maintain a Neutral Spine: Whether sitting or standing, ensure your lower back keeps its natural curve.
  • Align Your Head: Avoid craning your neck forward. Bring the gift closer to you instead of leaning toward it.

These small posture corrections can go a long way in keeping discomfort at bay and ensuring your body feels great long after the wrapping is done.

5. Spread Out Your Wrapping Tasks

Rather than saving all your wrapping for Christmas Eve, try wrapping a few gifts at a time over several days. This approach prevents prolonged periods of repetitive motion and reduces the overall strain on your neck and back.

Now – if you HAVE waited till Christmas Eve to wrap your gifts – then ignore this tip and move on to your bonus recovery tip 🙂 

Bonus Recovery Tip: Treat Yourself to a Little TLC

Even with the best precautions, some muscle soreness and tension might still sneak in. Combat this by treating yourself to recovery techniques like foam rolling, deep breathing, a good stretching session, or one of our Regenerative Therapy Sessions! 

And if your pain persists or worsens – don’t ignore it. Seeking advice from one of our mechanical pain specialists can help you address the root cause or your neck and back pain and prevent it from becoming a much bigger issue that impacts more than just wrapping gifts.

Live near Portsmouth, NH? Connect with one of our mechanical pain specialists by clicking HERE!

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. If local to Portsmouth, NH and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

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 Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Portsmouth NH physical therapist demonstrates proper raking posture to prevent back pain.

6 Tips to Protect your Back when Raking Leaves

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6 Expert Tips to Protect Your Back When Raking Leaves in New England

Here in Portsmouth, NH, and across New England, fall foliage is beautiful — until all those leaves end up in your yard. As a local physical therapist, I often see an increase in back pain and strain injuries this time of year from people raking leaves without realizing how much stress it puts on their spine.

The good news? There are many simple things you can do to protect your back when raking leaves and prevent unwanted pain this fall season.

Below are six expert tips I share with my clients at CJ Physical Therapy & Pilates in Portsmouth to help you stay active, healthy, and pain-free while raking leaves.

1. Warm Up Before You Start

Just as athletes warm up before a game, you should too before tackling your yard. Starting any physical activity cold can lead to unnecessary strains and injuries.

Take a quick walk around the block to get your blood flowing — the gentle rotation in your torso is great for your spine. You can also include torso twists, shoulder shrugs, and arm circles to loosen up your joints and lubricate your spine before raking. A 5-10 minute warmup goes a long way in preventing back pain.

2. Choose the Right Rake

When it comes to raking ergonomics, the right equipment matters. Choose a rake that’s lightweight, durable, and long enough so you can maintain an upright posture while using it.

Poor ergonomics waste energy and increase your risk of injury. A well-designed, ergonomic rake might cost a little more, but it’s a worthwhile investment in your long-term spinal health — because back injuries are far more costly.

3. Bend with Your Legs and Hips

When raking or lifting, one of the worst postures for your back is being bent forward and twisted. To protect your spine, bend and lift using your legs and hips, not your back.

Maintain an upright posture while raking, and when scooping up leaves, squat and pivot with your hips and knees instead of twisting at your waist. Making this a habit — not just during yardwork — will keep your back strong and injury-free.

4. Take Regular Breaks

Raking is repetitive and can tire your muscles quickly. When your muscles fatigue, your form suffers — and that’s when injuries happen.

Take a short break every 30 minutes. Set a reminder on your phone, put the rake down, and give yourself a gentle back stretch or stand tall and reach overhead. These quick resets help maintain good posture and protect your back during longer yardwork sessions.

5. Engage Your Core

You don’t need six-pack abs to protect your back, but simply engaging your core muscles can provide essential support.

While raking, gently draw in your lower abdominals — you should still be able to breathe and talk easily. This subtle engagement keeps your spine stable and supported, reducing strain and helping prevent injury.

6. Keep Moving Afterwards

What you do after raking is just as important as what you do during. The biggest mistake people make is collapsing onto the couch afterward.

Right after strenuous activity, your spine is more pliable and vulnerable — so avoid slumping. Instead, take a short walk, do gentle stretches, or stay upright for a while before resting. Being mindful of your posture post-raking can save you from feeling that familiar “tweak” hours later.

Protect Your Back This Fall

Hopefully these tips give you a few things to think about before tackling all those leaves — and most importantly, help you protect your back and avoid unwanted pain this fall season.

If you’re in Portsmouth, NH or the Seacoast New Hampshire area and find yourself struggling with back pain after raking or other fall activities, we can help.

At CJ Physical Therapy & Pilates, we specialize in helping active adults in the Seacoast stay strong, mobile, and pain-free — naturally.

Call us today at 603-380-7902 or visit www.cjphysicaltherapy.com to learn more and download your free guide to preventing back pain.

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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.

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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Tips and Solutions for Morning Back Pain: Causes and How to Fix it

One of the most common complaints from people suffering from chronic back pain is how stiff and sore their back feels first thing in the morning. For some, it seems random – almost like they’ve “thrown their back out” overnight. For others, it’s a daily struggle, waking up achy no matter how good they felt before bed.

But why does morning back pain happen? Isn’t sleep supposed to be restorative to help your body heal?

The truth is, back pain shows up differently for everyone. And while it’s easy to blame your mattress, the real causes of morning back pain could be due to other factors – like your sleeping position, lack of regular exercise, and bulging dics. 

Let’s dive into each of these potential triggers and look at ways you can address them naturally:

 

Poor Sleeping Position

Your sleep posture can make or break how your back feels when you wake up. But what’s interesting is that the “wrong” sleeping position really depends on the root cause of your back pain. There is no one-size-fits-all. For example, some people find that lying on their back with legs elevated feels wonderful, yet for others, this position leaves them feeling stiff and sore come morning. Others experience tremendous relief sleeping on their stomach, while for some this position places a lot of strain on their spine and they wake up very stiff and achy.

Generally, the most back-friendly sleeping position is on your side. Side-sleeping makes it easier to keep your spine in a neutral, supported position, which reduces stress and tension while you sleep. It’s more challenging to find a neutral spine position when on your back or stomach. If lying on your side bothers your hips or shoulders, you can try placing a pillow under your waist and head, along with one between your thighs, to provide extra support and maintain better alignment. A pillow topper over a firm mattress makes side-sleeping a lot more comfortable as well. Small adjustments like these can significantly improve how your back feels in the morning and allow you to wake up feeling more refreshed.

Lack of Regular Exercise

A lack of regular exercise is one of the most overlooked reasons for waking up with a stiff, sore back. When you’re not moving enough during the day, your muscles (especially those supporting your spine) become weak and tight. Inactivity also reduces circulation, which means less blood flow delivering oxygen and nutrients to your muscles, joints, and discs. Without this nourishment, your tissues stiffen, and when you’re sleeping overnight, that stiffness builds. But regular movement doesn’t just strengthen muscles and nourish tissues – it keeps essential body systems like circulation, digestion, and even your nervous system running smoothly – setting the stage for more restful, regenerative sleep.

Incorporating consistent activity into your daily routine helps break this cycle. Simple exercises like walking, yoga, strength-training, and stretching encourage better blood flow throughout your body. The result? You’re less likely to experience that locked-up, achy feeling when you wake up – and you’ll likely notice deeper, better quality of sleep, too. Movement during the day primes your body to recover more efficiently overnight, reducing the likelihood of morning back pain.

Bulging Discs

This is one of the most common causes of morning back pain that I see. Your vertebral discs play a crucial role in your spine’s health by absorbing shock, holding your vertebrae together, and allowing for movement. What many people don’t realize is that your discs are made up mostly of water. Over the course of a typical day, your discs compress and lose some of that water content. But at night, while you’re lying down, they re-hydrate and can regain up to 17-25 millimeters in height.

While that might sound beneficial, it can actually be problematic if you’re dealing with an irritating, bulging disc. A bulging disc already has the potential to limit movement in your spine. But when it fills up with fluid overnight, it becomes even stiffer, leading to increased restriction and pain when you wake up.

If you’re consistently waking up feeling locked up, in significant pain, or hesitant to move – there’s a strong chance a bulging disc is contributing to your discomfort. Seeking guidance from a mechanical back pain specialist can help you get a proper diagnosis and develop a plan to manage and treat your bulging discs effectively and naturally – so you can avoid resorting to injections or procedures right away.

Don’t Always Blame your Mattress

If you’re dealing with morning back pain, hopefully this article has helped shed some light on why it’s happening. Before you go out and spend a fortune on a new mattress – consider addressing these common causes first. Take a look at your sleeping posture, evaluate whether you’re moving enough throughout the day, and rule out whether bulging discs might be part of the problem.

The good news is that 80 percent of all back pain cases can be treated naturally – and without the need for injections, procedures, or surgery. More often than not, the solution to a pain free back lies in simple, movement-based approaches that strengthen, support, and restore your body’s natural function.

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.