Tag Archive for: core strength

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.

The Right and Wrong Way to Strengthen Your Core

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Good core strength is an important and vital component to life long health. Everyone knows that it’s an important factor in preventing low back pain, but having good core strength also helps you with your balance, overall stability, posture, and it can be crucial in helping you prevent injuries. Not only that, but when you have good core strength, you simply feel better, and have more confidence to do all the activities you love.

But when it comes to core strength, there’s a right and a wrong way about it.

And when you get it wrong, you’re looking at more back problems, pelvic health issues, and even neck and shoulder pain.

Here are some of the most common ways I see people getting core strength wrong – and what you can do to make it right:

 

1. All you do is crunches

Crunches are often considered to be a staple exercise when it comes to core strengthening. But growing evidence tells us that too many crunches may actually be detrimental to the health of your spine. When you perform an abdominal crunch – it typically involves lying on your back, bending your knees, and lifting your shoulders off the ground towards your knees.

This movement puts a lot of stress on your spine – especially when done incorrectly. If your core strengthening routine consists entirely of crunching – the repeated flexion of your spine will eventually lead to wear and tear on the discs in both your back and your neck.

What to do instead…

First – crunches aren’t “bad” for you. The problem is that people inherently do them wrong. I’ve been a back pain expert for over 10 years and I constantly see people doing this exercise incorrectly. If you’re going to incorporate crunches into your core strengthening routine – make sure you are doing them with proper form, proper technique, and with proper breathing. But even if you are doing crunches perfectly, you still need to include other exercises into your core strengthening routine. You have to balance out the forces on your spine and target other muscle groups that are equally important to a good, strong core.

Exercises such as planks, bird dogs, and bridges are some of my favorites. These exercises target your glutes and back muscles, and will reverse some of the stress caused by over-flexing of your spine.

2. You’re not breathing

You can’t activate your deep core if you don’t breathe properly. Your deep core consists of four parts: your deepest abdominal muscles; pelvic floor muscles, deepest back muscles, and your diaphragm. These four muscle groups work together to control intra-abdominal pressure – which is essential to facilitating a strong deep core connection. If something is off in this system, your intra-abdominal pressure will be distorted, which can create more pressure on structures such as your lumbar discs and pelvic floor region. Also, your bigger core muscles (like your outer abdominals, psoas, larger back muscles, and hips) will overwork or not work correctly.

What to do instead…

While there are good, better, and best ways to breathe when performing core exercises – I always say that when in doubt – just breathe. If you’re breathing, you give your deep core a fighting chance at activating properly. The reason being is because your diaphragm is your main breathing muscle. It relaxes and contracts with normal breath. When you hold your breath, your diaphragm stays contracted. That’s part of what disrupts the intra-abdominal pressure in your deep core. It’s also a good idea to incorporate Yoga or Pilates into your core routine. Both of these exercise practices emphasize breath as a central component and it can teach you how to breathe properly when exercising.

3. You aren’t incorporating rotational movements

Our bodies don’t interact with the world via straight-planed motions. We are constantly twisting, turning, and reacting to our environment in a variety of different ways. One of the biggest mistakes I see when it comes to core training is that people keep it very straight forward (no pun intended) and too simple. You can have a perfectly planned core strengthening routine that hits every muscle group but if you don’t challenge those muscle groups with different angles and combined multi-plane movements, your body gets lazy.

What to do instead…

Well, the obvious answer is to add rotational movements into your core routine.

But what does that look like?

You can add rotation as a challenge to almost anything. If you’re in a plank – rotate to your side and twist your arm up to the ceiling in between each rep. When you’re doing crunches – add cross body reaches each time you lift your head and chest. Rotational movements can also be incorporated into balance work – which inherently works your core.

Once you’ve mastered single leg activities – whether it be standing, stepping up, or lunging – you can add a twist or a reach to the end posture as you hold the movement. The possibilities are quite endless and you can get really creative. The point here is to not be “square”, and add variety to your core strengthening routine so that you mimic real life.

So how does your core strength training routine measure up? Have you been doing it right or wrong?

Here at CJPT & Pilates our favorite way to strengthen the core and whole body is through Pilates. If you’re struggling with pain or just getting started, I recommend consulting with an expert. They’ll be able to guide you in the right direction and set you up for success.

Are you local to Portsmouth, NH and interested in trying Pilates? CLICK HERE to schedule a call with one of my specialists. Learn more about Pilates and see if you would be a good fit!

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, email her at [email protected].

When You Can’t Feel Your Abs

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I’ve been a physical therapist for 20 years, a Pilates instructor for 11, and have been specializing in back pain for the past 10 years of my career. When it comes to core strength and preventing back pain, I am an expert in my field. Yet for some reason this morning, during my Pilates workout, I just couldn’t feel my abs. I teach people how to do this every single day yet this morning, I couldn’t seem to access my own.

What was happening?

And more importantly – if it can happen to someone like me – it can certainly happen to someone with less training than I have. I started to think about all the reasons this could be happening to me. Had I gotten enough sleep? What had I eaten the day before? Could it be stress?

And then it hit me.

I had just come back from a 2-day course where I’d been sitting far more than usual. I sat for 8 hours straight. Two days in a row. Not to mention all the very cramped sitting I did on the plane to and from this course. When one of my clients is about to have a few days like this, this is what I recommend. Get up from your chair and stretch backwards as frequently as possible every few hours.

But guess what – I didn’t follow any of my own advice. The result? A stiff back and sleepy abs upon my return.

Our bodies are highly intelligent and have every capacity to heal themselves when given the right environment. Conversely, when in the wrong environment, our bodies will also do what it takes to naturally protect from harm and injury. In my case, I came home from this course with a stiff lower back.

Back stiffness is the first sign that your back is not happy. This means your chances of tweaking it or exacerbating an old back injury are higher. When any joint is stiff and not moving well the muscles surrounding that joint will become naturally inhibited or weakened. This occurs on purpose as a protection mechanism. Your body doesn’t want a fully contracted muscle compressing an unhappy joint. In the case of your lower back, the muscles that can get inhibited when your back is not happy include your abdominals as well as back muscles.

So what can you do when you feel less core strength?

The good news is I’ve already helped you with step one: awareness. Inhibited muscles are not the same as weak muscles. In my case, I do have strong abdominals. My weekly routine consists of a regular Pilates practice, lifting weights, and I perform activities like hiking and running that engage my core. Yet despite all this, my abs were simply not having it this particular morning. They were not set up for a successful workout.

The combination of my stiff back and having sat for several days just meant that I needed to do something different to prepare my lower back and abdominals for this workout – so that I wouldn’t injure myself. My sleepy abs and stiff back were, in effect, trying to tell me just that.

All I needed to do was have the awareness this was happening so I could take appropriate action.

It’s no different than when you go on vacation and you get off your routine by eating more than usual. You might return a bit bloated and not feeling your best self. This kind of feeling we are accustomed to. And might respond by getting a bit strict with our diets until feeling back on track. Our joints can react similarly to a change in routine – we’re just not as accustomed to the signs and symptoms that let us know. But once you are – you can easily manage this and avoid injury. Had I pushed through my Pilates routine as normal this morning despite sensing that my back and abdominal function was off – there’s a good chance I’d be sitting here writing to you with full on back pain instead of just some lingering stiffness.

If you’re reading this, and you’re over the age of 40, odds are pretty good that you’ve experienced back pain at some point in your life. The odds are also pretty good that you’ve experienced back pain more than once.

If this is a recurring pattern for you, your abdominals and deep core may not be functioning at their best.

You could be caught in a vicious cycle of trying to improve your core strength only to keep hurting your back.

The missing solution for you might be that nobody has fully examined your back in a way to ensure that it’s moving fully and freely like it should. Once your back moves well, you can usually start to strengthen your abdominals without a problem.

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

The take home point here is that if you keep experiencing weakness in a particular area despite trying to strengthen it consistently, it’s possible you could have a problem in your joints that is keeping your muscles from fully activating like they should.

Talk to one of my specialists about it.

Someone from my client success team will call you right away and see if you are a good fit for what we do. At the end of the day – we’re here to help.

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

Physical Therapist

Piriformis syndrome and Sciatica – PT not working?

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

Here is a great question I received from John:

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

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

1) where your pain is coming from and

2) what movement patterns trigger and relieve your symptoms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shoulder Pain

Neck Pain Not Going Away? 3 Reasons Why

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Over 30% of people report they have neck pain, and of those, 50% will continue to have problems without any real answers or solutions. And during the pandemic, we saw more people becoming generally less active, falling off their routines, and working from home in less than optimal “work stations”. It’s no surprise that people are suffering from more neck pain than usual.

Having been a mechanical spine pain specialist for the last 10 years – and a physical therapist for just over 20 – I can tell you that resolving neck pain is trickier than resolving back pain.

And there are some good reasons for that. Your neck is the most mobile area of your spine – which makes it more complicated to manage – and the muscles in your neck are a bit more fragile than some of the bigger muscles in your lower back. The way you strengthen muscles in your neck can’t be approached in the same manner you might tackle your lower back – for example.

If you suffer from persistent neck pain – there could be several explanations as to why it’s not going away. But the biggest culprit I have found is an inaccurate diagnosis. Without the correct diagnosis – your neck pain treatment fails – and it’s more likely you’ll be prescribed injections or pills to relieve your neck pain and get stuck with this treatment regimen for the long-term.

Here are three reasons why the root cause of your neck pain might be getting missed – and why your neck pain just isn’t going away:

 

1. Your neck problem is disguised as shoulder pain:

Shoulder problems are confused with neck problems more often than you would think. If this happens – you risk spending weeks (or months) trying to resolve shoulder pain that is actually a neck problem. Not only will your shoulder pain not fully resolve – your neck pain won’t either – and could actually become worse. Because your neck is so mobile, it’s easy for nerves in your neck to get irritated and refer pain into the middle of your shoulder blade, top of your shoulder, or down the side of your arm. When you consider this, it makes sense why neck problems are so easily mis-diagnosed as shoulder problems. It’s a very common scenario that not only results in neck pain not going away – but persistent shoulder problems too. My general rule of thumb – if you’ve been working on a particular problem persistently and consistently for 2-3 weeks or more without significant improvement – something is missing. You’re either treating the wrong thing or have the wrong treatment approach. It happens a lot with neck pain so be sure to pay attention to this common error – especially if you’ve got coinciding shoulder pain.

2. Your core is weak:

Lack of core strength is commonly associated with back problems – but believe it or not – it can have a lot to do with neck pain too. Most people are familiar with how muscles and joints are connected – but did you know your muscles and organs are connected as well? They’re connected by a web of tissue called fascia – and this connection is often referred to as myofascial. “Myofascially speaking” – your deep neck muscles are connected to your core. If your core isn’t functioning properly – your neck will try to compensate and it will result in neck pain. Do you consistently feel neck pain or tightness every time you do a core workout? This could be a sign that your neck is compensating for your core – and there’s a good chance proper core strengthening is what’s missing. It could explain why your neck pain isn’t going away no matter how aggressively you treat it.

3. The Wrong Neck Exercises:

The anatomy of your neck, more so than the rest of your spine, is fairly intricate and quite mobile. Not only does this require special care and accuracy when it comes to examining your neck, it makes it easy for someone who is not expertly trained to miss things. For example, one of the most common things I see is someone thinking that full range of motion has been restored in your neck when it hasn’t. If you start strengthening your neck when it doesn’t have full mobility, you can run into problems later on that result in persistent pain. Additionally, strengthening the muscles in your neck, especially in a neck that hurts, needs to be done carefully. The muscles in your neck were designed for stability – which is very different from say – the muscles in your legs – which are designed for power. You can’t approach strengthening them in the same way. All too often I see neck strengthening exercises that are too aggressive for the small muscles in your neck. This results in unnecessary neck tension – and delayed resolution of neck pain.

Generally speaking – if you’ve been suffering from neck pain for a while now – and you’ve tried lots of different treatments without any success – there’s a really good chance you’ve been misdiagnosed and have the wrong treatment plan. Don’t settle for relying on pills or injections for the rest of your life. And don’t undergo any kind of surgery or procedure until you’ve truly exhausted all possible causes of your neck pain. Ideally, find a mechanical pain expert who understands the intricacies of neck problems and work with them. If diagnosed properly, it’s not only possible to get rid of your neck pain naturally, but you can learn to keep it gone all on your own.

 

Ready to get rid of your neck pain?

Download 7 Easy Ways to Get rid of Neck & Shoulder Pain written by Dr. Carrie Jose – leading physical therapy specialist and mechanical pain expert in Portsmouth, NH

morning neck pain

Neck Pain During Crunches? 3 Reasons why and what you can do.

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Abdominal crunches are one of the most popular “ab exercises” around. It’s a move that emphasizes your upper abdominal strength more so than your lower. You start by lying on your back – typically hands behind your head and knees bent – then lift your head and chest off the floor – “crunching” your upper body into a C-shaped curve. 

Over the years, many healthcare and fitness professionals have dismissed this exercise entirely claiming its ineffectiveness for working the core. While I agree that it shouldn’t be the only core exercise you do – the abdominal crunch does have its place. When done correctly, mastering this move can help you get up from the floor, and sit up out of bed with more ease and less risk of injury. And of course, you see this move a lot in exercise classes, so it’s important to know how to do this move correctly without hurting your neck. 

If you’re feeling crunches in your neck instead of your abs – here are the biggest problems I see and why they might be hurting you.

     1. You’re not using your abs. 

This sounds pretty obvious, right? Of course you use your abs when you crunch. Anatomically-speaking – it would be impossible for you to perform this move without some form of engagement with your abs. But many people don’t engage their abs enough or in the right way. And this can result in neck pain.

Here’s what happens. 

If you don’t engage your abs enough or in the right way during a crunch – your neck will often kick in to try and help. Eventually your neck gets sore from this because your neck muscles aren’t designed to be the primary mover during a crunch. One easy tip to try next time you do a crunch is to make sure you inhale deeply – and then exhale as you begin to crunch. At the same time, check in with your neck. Make sure you can easily turn and wiggle it side to side. If that is challenging – then you are likely using your neck to help you crunch and your abdominal engagement could use some work.

    2. Your neck is in the wrong position. 

When you’re doing an abdominal crunch your neck position is critical. There is an illusion that your neck moves during the crunch but it should actually stay pretty stationary. The ideal position for your neck is to begin with a slight nod of the chin (like you’re nodding “yes”) and then keep it there. The rest of the curling motion will come from contracting your abdominals to move your trunk. As you curl up, you want to keep a nice C-shaped curve of your upper body – and keep a tennis ball’s distance between your chin and chest. 

Most people either curl their neck too much, or not enough. If your chin is touching your chest you’re curled too much – and you’ll experience strain behind your neck. And if you keep your neck too straight you’ll experience strain in the front of your neck. Another common mistake with neck positioning during a crunch is jutting your head forward. This will put strain in your upper neck right behind your head. While any of these positions will cause temporary discomfort in your neck – they could lead to more long-standing problems down the line if not corrected. 

     3. You have an underlying neck problem. 

Sometimes you will get all of the above right – and still have neck pain when you perform an abdominal crunch. This could be a sign that you have an underlying neck problem – and doing a lot of crunches has just exposed it.

Let me explain.

Let’s say you have a small bulging disc in your neck that you weren’t aware of, or you thought was “fixed”. The curled position of your neck during a crunch can exacerbate this problem, even if you are using your abs correctly and following every tip I just mentioned above. 

Pay attention to what you feel during and after performing an abdominal crunch. If you notice pain that shoots into your shoulder blade, or any numbness or tingling down your arm (especially if past your elbow) – these are clues you could have an underlying neck problem that is being aggravated by crunching. You might experience these symptoms during your crunches, or even up to several hours after. Either way, symptoms like this could be a sign there is more to your neck pain than simply incorrect crunch-technique or weakness in your abs. And it would be important to talk to an expert about this.

If you’re experiencing neck pain during abdominal crunches – hopefully these tips give you a better understanding why – but most importantly – please know this is a very common issue and you’re not alone.

It’s partly why I created Pilates 101: Get [Your] Back to Health™

Although this program is primarily geared toward helping folks who’s back pain is keeping them from strengthening their core and exercising the way they want to…

We actually talk quite about about the relationship between your abdominals and your neck – and teach you how to “crunch” safely and correctly.

I’ve been personally teaching this program for the past 4 years – and previously – you could only do it live with me 1-2x per year…

But NOW – I’m excited to tell you that we’ve opened it up to the entire world!

We’ve had people signing up from all across the country right now – people who’ve been wanting to get help from me but couldn’t because of where they were located.

This program is not for everyone – but if you want to learn more and see if it might be for you – CLICK HERE.

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

5 Signs Your Core is Weak – And What You Should Do About It!

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A strong, healthy core is important for our health and posture. When your core is strong and working properly, you will have less back pain, better posture, and will move with more ease and endurance.  But how do you know if your core strength is where it needs to be? 

Here are five signs that might indicate your core is weak and what you can do about it:

1. Your Back Hurts

The most common side effect of a weak core is back pain. Your core’s job is to support your spine and act as the center from which all movement stems. If those muscles are not properly conditioned – meaning, if they aren’t conditioned to engage when they are supposed to – your spine is at risk for being overworked and muscular strain and tension is inevitable. 

What can you do? When it comes to back pain, it’s really important that you talk to an expert about how to properly strengthen your core. Don’t go at it haphazardly. A lot of people jump to core strengthening to fix their back pain when there are other things that need to be addressed first. Without proper guidance, you could make your back worse doing the very thing that is meant to help you.

2. You Have Poor Balance

Believe it or not, it’s not just your feet and ankles that help you balance. Your core strength plays a huge role in this as well. Your core muscles surround your pelvis and help to stabilize it – if those muscles are weak – particularly your hips and glutes – your balance will undoubtedly be affected. 

What can you do? Work your core in a functional manner. If you’re already practicing balance exercises, don’t just hope for sheer luck. Actively focus on the connection between your foot and your deep core. You’ll be surprised at what this visualization will do for both your balance and core activation. If you struggle with this – then it’s a good idea to work with an expert who can help you.

3. You slouch all the time

If you’re struggling to maintain good posture – you might have a weak core. Observe your posture right now. Are your shoulders rolled forward? Is your low back missing its natural curve? Is your head poked forward? When you go to correct your posture – does it feel difficult or tiresome to maintain? If so, your core might need some endurance-training.  

What can you do? This is a situation where consistent core training will carry over into your sitting posture. Your postural stabilizers are what allow you to sustain prolonged sitting and standing postures. The more accustomed they are to being activated and working – the more likely they will naturally kick in when you’re standing and sitting. Over time, it will become easier to maintain good posture and with a lot less effort.

4. Your feet and wrists hurt

When you have a weak core – and lack the proper central support and stability you need – your outer muscles and joints will eventually suffer. We already talked about balance. If your core isn’t working to help you stay more stable, your feet will have to work harder, resulting in overtaxing of the tissue on the bottom of your foot. If your middle back can’t support you when you’re pushing or pulling, your wrists will take the brunt and this can result in stiffness or pain over time. If you’ve got any chronic problem that isn’t getting resolved over time, something is missing. In the case of your wrists and feet – it could be a weak or underfunctioning core.

What can you do? If you’ve been trying to resolve your foot or wrist pain for a while and aren’t getting the results you hoped for – consider shifting your focus to deep core training. I’m not talking sit-ups and crunches, I’m talking about deep stability training that is going to result in a better balanced body – where your wrists, core, and feet are all connected and working together. Something like Pilates can help you achieve this – provided you’re working with a highly skilled instructor. Pilates is specifically designed to strengthen your core in a way that emphasizes full body strength.

5. You’re always holding your breath 

If you’re always being reminded to breathe when you move or exercise, it’s a sign your core might not be working properly. Your deep core is made up in part by your diaphragm, which is your main breathing muscle.  When your core lacks stability, or in most cases, doesn’t know how to engage in the right way, your diaphragm will contract to compensate.  One of the most tell-tale signs that this is happening is that you always hold your breath during exercise. 

What can you do? I always say – when in doubt – just breathe. If you’re breathing through every movement then your diaphragm can’t stay contracted. Start here. If you notice that other things start to get tight and uncomfortable as a result – namely your hips and your neck – then it means you’re now using those muscles instead of your diaphragm to compensate for your weak core. In that case – consider getting expert help because these movement patterns are hard to break on your own. 

If any of these signs sound familiar to you, then you might want to start paying more attention to your core strength!

There’s so much more to a strong core than 6-pack abs and the ability to hold a plank for days. Pay attention to the more subtle signs I’ve just outlined for you. If you’re noticing one or more – it could be a sign that your core needs some extra love and attention – and the you need to learn how to strengthen it properly. 

Are you local to Portsmouth, NH? 

Check out our Pilates offerings and other services here. We have specialists who may be able to help you strengthen your core properly – from the inside out.

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, email her at [email protected].

Why Pilates?

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Why Pilates?

If you’ve ever experienced muscle and/or skeletal pain, it was probably the result of one or more mechanical stressors occurring in joints or muscles. When I treat a patient, I am often working to help them change the mechanics of their movement and therefore decrease or eliminate those stressors. It’s one of the main reasons why I incorporate Pilates into my treatments. It’s also why most of my patients will tell you that it is often difficult to tell where physical therapy leaves off and fitness exercises begin — which is precisely the way it should be.

Pilates isn’t just about strength and balance, it’s about body mechanics.

Each exercise is carefully designed to direct and reinforce the way in which a healthy musculoskeletal system should function. By practicing Pilates, you are strengthening your muscles correctly in a way that is conducive to all forms of exercise, as well as improving posture and balance. It’s a really great supplement to physical therapy because as you’re retraining or rehabilitating a specific part of your body, you have the opportunity to match that progress holistically.

Many people who come to us with back pain think that their pain would prevent them from participating in an exercise program like Pilates – but the truth is, it’s the opposite! Guided, individualized Pilates combined with a physical therapy regimen is actually one of the best things you could do for your back. We even offer a specific at home program  designed for people with back pain! It’s incredibly beneficial for clients dealing with pain or injury to have the support system of a physical therapist and a Pilates instructor working in tandem to find the right movements to rehabilitate each particular individual.

Our goal is always to get our clients back to their full range of movement and activities.

We NEVER want to avoid any movement permanently in order to avoid pain. But on the road to that full recovery, the structure of Pilates and the opportunity for physical assistance can be an extremely powerful counterpart to physical therapy. Pilates strengthens your entire body, starting from your core, which naturally prevents future back issues stemming from muscular weakness or imbalance. Furthermore, Pilates (combined with PT) teaches correct movement – which is the number one way to relieve any current pain!

Are you experiences nagging back pain and want to incorporate pilates to help? We offer a program just for you! Our At Home Pilates 101 Get [Your] Back to Health program might be perfect for you, to apply and learn more CLICK HERE! We’d love to have you start your Pilates journey with us.

man getting back pain treatment

5 Reasons Exercise is Hurting your Back

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5 Reasons Exercise is Hurting Your Back

The research continues to show that the best “treatment” for back pain is exercise. But what do you do when exercising hurts your back instead of helps? 

This is one of the most common frustrations I hear from my clients. The doctor looks at their back and takes an X-ray. He or she only sees something like arthritis or degenerative disc disease. Surgery doesn’t make sense – so the advice is to go exercise – and specifically to strengthen their core. But when it doesn’t work they are at a loss.

Why would exercise hurt your back when the research overwhelmingly shows that it’s supposed to help? 

Here are 5 reasons why…

1. It’s the wrong type of exercise

While the research isn’t wrong about exercising and back pain – it doesn’t always reveal the specifics on the type of exercise that’s being done. For example, walking is considered one of the best activities for back pain sufferers, and for the majority it will help significantly. But I also have clients who get worse just walking to their mailbox at the end of the driveway. What the research is really saying is that movement – not necessarily “exercise” – is what’s really good for back pain – even acute back pain. But you need to make sure it’s the right type of movement for YOUR specific type of back pain. If you get the type of exercise or movement wrong you’ll feel worse. This is one reason why exercise will sometimes hurt your back instead of help.

2. Stability training is introduced too soon

 

Stability training is an important part of back pain recovery – but I often see it introduced too soon. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. You want to make sure you explore that fully and get the spine moving the way it should be before you begin stabilizing or strengthening it. Every now and then I stabilize first, but it’s rare. More often than not I see that people with long standing back pain are suffering from a mobility problem that was missed. When your spine doesn’t move well, you risk developing compensatory movement pattern. These can cause structures in and around your spine to get irritated. You want to figure that out first before jumping ahead to stability training of your core and spine.

3. You aren’t activating your core

 

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your 6-pack abs are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or performing complicated movements that require good coordination, you’re setting yourself up for injury.

The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. Pilates (when done properly and with a well-trained instructor) can accomplish this quite well. If you’re constantly having back pain every time you exercise or try to strengthen your core, it could be that you lack the ability to activate it when it counts.

4. You aren’t breathing properly

 

Not breathing properly – or not breathing at all – can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, your deep back muscles, your pelvic floor, and your diaphragm.

Your diaphragm is what controls your breathing. Let’s say you hold your breath when you exercise. When this happens it means your diaphragm isn’t expanding or contracting in the way it needs to for your deep core to be fully functional. Additionally, when your diaphragm doesn’t work like it should, it adds unnecessary strain and work to your back muscles. This is one reason why you might not be able to activate your core properly – and why exercise might be hurting your back.

5. You’re using improper form

 

The last and most common reason why exercising might be hurting your back is because you aren’t doing it right. There’s a lot of people out there who think posture and form don’t really matter. But they do. If you’re lifting weights – especially when frequently and repetitively – you want your spine to be in good alignment. It might not hurt the first time you lift with improper form, but it will hurt when you get to your 100th rep. Same goes for body weight exercises. Just because you aren’t adding load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. That’s really where people get in trouble. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture or it’s going to catch up to you and cause you unnecessary back pain.

If exercising is currently hurting your back – it could be one of these 5 things. Get expert help to figure out which one it might be – because at the end of the day – exercise IS good for your back. You just might need some help to get there first.

 

Want to safely strengthen your back? Check out our Pilates 101 Get [Your] Back to Health Program. This is our one-of-a-kind 8-session program that delivers safe, yet highly effective Pilates-based core strengthening exercises that are easy on the joints, and help improve your flexibility and posture. Apply here!

 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. 

Why Strengthening Your Core Could Be Hurting Your Back

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As you probably already know, we specialize in back pain and core strengthening via Pilates…

So why on earth then – would we be writing about how strengthening your core could actually be hurting your back instead of helping?

One of the number one reasons people come to see us is because they want to strengthen their core – in hopes that it will put an end to their back pain.

But here’s the thing about core strengthening and back pain…

In most cases, it will make you feel better and possibly even take away your pain. But there are many times when going to core strengthening first is not right for your back, and can actually make it worse.

The biggest misconception I see when it comes to getting rid of back pain is that if the pain is gone – the problem is gone.

NOT TRUE!

And this is where people can get in trouble. If they try to strengthen their core too soon, back pain will come back with a vengeance.

Here are a few ways to tell if strengthening your core could be hurting your back instead of helping…

 

1. You feel stiffer after workouts.

As I mentioned previously, the absence of back pain does not mean you have addressed the root cause of your back problem. This is especially true if you’re prone to “throwing your back out” year after year.

One of the precursors to a full-blown back pain episode is stiffness.

If you find that your spine feels more stiff after your core strengthening routine, it could be a sign that you are aggravating your back instead of helping it. It’s only a matter of time before you wake up one morning stuck in pain and unable to move.

In our office, whenever we transition our clients from back pain treatment to our Pilates program, we teach them how to self-assess and check their spines.

This allows them to know if the core strengthening being done in Pilates is starting to aggravate them for some reason. If their self-assessment reveals a stiffening back, they know how to correct this before it turns into pain, allowing them to quickly get back to strengthening without skipping a beat.

2. Your neck hurts

I’ve spoken about this before, but increased neck pain or tension during or after core workouts is typically a sign that you’re not activating your core properly.

If you’re trying to work your core to recover from back pain, this could be a big problem for you. It’s only a matter of time before your back pain returns.

When you don’t know how to activate your core properly, you aren’t able to properly control pressure and tension in your abdomen. And you likely have difficulty controlling and coordinating your breath. When this happens, you can end up with unwanted pressure in your lower back every time you work those abdominals. This will eventually result in back pain.

This is one of those cases where core strengthening could be the right thing for your back, but you just aren’t doing it at a level that is appropriate for you.

Learning how to activate and build your core strength the right way is important all of the time – but it’s critical when you’re recovering from back pain.

3. Your hamstrings are sore and achy

A good core strengthening program targets more than just your abs. You should be strengthening your hips, glutes, and hamstrings as well.

While it’s normal to have some soreness after a good workout, when it comes to back pain, it’s important that you know the difference between muscle soreness and pain caused by nerve irritation.

Where you feel your pain and how it behaves is one of your best clues.

Let’s say that after a good Pilates session you notice soreness in both of your thighs and hamstrings the next day. This is typically considered “good” soreness. It’s symmetrical, feels better when you stretch, and likely subsides in 2-3 days. The more you work out, the less this soreness seems to occur.

But let’s say you feel an ache or a pull-down only one of your hamstrings after a Pilates class. You stretch and it doesn’t help. It possibly even aggravates your leg. You rest, the pain goes away, but then comes right back after your next workout.

This could be a sign that your core strengthening routine is causing irritation to a nerve in your spine.

If you don’t address the irritation, your leg won’t feel any better and your back will start to hurt as well.

Plus, if you feel pain or soreness anywhere in your body after a workout, it’s important that you learn to recognize the difference between good and bad pain so that you can correct problems before they happen.

Looking for ways to safely strengthen your core?

Our At Home Pilates 101 Get [Your] Back to Health program might be perfect for you, to apply and learn more CLICK HERE! We’d love to have you start your Pilates journey with us.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. To get a free copy of her Guide to Easing Back Pain and Stiffness – click here.