Tag Archive for: exercise

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].

Traveling

4 Tips to Avoid Neck and Back Pain When Traveling

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4 Tips to Avoid Neck and Back Pain When Traveling

Memorial Day weekend is the “unofficial” start of summer – and AAA estimates that 39.2 million people will travel this weekend. That’s 8.3% more than last year, and it’s going to mean the exacerbation of neck and back pain for a lot of folks out there – especially the over 40 crowd.

So why does traveling wreak such havoc on our spines? 

Road trips, planes and trains typically involve lots of sitting and driving, which necks and backs just don’t like when done frequently and for prolonged periods. You’re typically off your routine when you travel, and sleep on surfaces you’re not accustomed to.  Any one of these things – but especially when combined together – can flare up old patterns of neck and back pain.

The good news is there are lots of things you can do when traveling to ease neck and back pain. Here are 4 of my top tips:

 

1. Use the 30 Min. Rule

The biggest strain on your body while traveling is undoubtedly the prolonged periods of sitting – often in cramped spaces. Our bodies are made to move continuously throughout the day. Whenever possible, getting out of your seat often is critical for keeping your neck and back healthy and mobile. Motion is lotion. And one of the best things you can do for your neck and back is to interrupt any prolonged posture – especially sitting – once every 30 min. If you’re unable to actually stand for a few seconds, then try arching your back or stretching your arms up over your head while sitting. Do a few neck rolls and chin tucks to stretch your spine. The more you move, the better your spine is going to feel.

2. Use a Lumbar Roll

Our spine is made up of distinct curves for a very good reason. They are designed to balance forces and sustain shock – and it’s best if you can maintain them. When you sit, the curve in your lower back (lumbar spine) decreases, or sometimes disappears all together, when not supported. While it’s perfectly acceptable to sit like this for small increments of time, it will start to cause problems after several hours. Prolonged curvature of your low back puts unwanted stress on the discs, ligaments, and muscles in your spine.

Your neck also responds to this posture by assuming a position we call “forward head”. This can give you headaches, neck pain, and cause extra tension to occur in your mid back and upper shoulders. One of the best things you can do is use a cylindrical lumbar roll to help maintain the natural curve in your low back. If you’re driving, the lumbar support in your seat usually isn’t enough. Take a small towel roll, sweatshirt, or pillow and place it at the small of your back any time you’re sitting. You’ll find it’s easier to maintain the natural curves in your spine – and you’ll have a lot less strain on your neck and back.

3. Bring your own pillow

Sleeping on surfaces we’re not accustomed to can not only ruin a vacation but set us up for unwanted neck and back pain. If possible – bring your favorite pillow from home – or ask for extra pillows wherever you’re staying. If a mattress is too firm for you – you can use pillows to cushion areas of your body like hips and shoulders so that you don’t wake up sore. Conversely, if a mattress is too soft, you can use extra pillows to build up the surface under your waist if you’re a side sleeper, under the small of your back if you’re a back sleeper, and under your belly if you’re a stomach sleeper.

Lastly, if a pillow is too fluffy or too flat – your neck will end up paying for it. When you’re sleeping – the goal is to position yourself in a way that allows your spine to stay in neutral alignment. You don’t want your head tilted down or up – it’s the fastest way to stir up an old neck injury or wake up with a tension headache.

4. Extend instead of bend

Did you know that the average person bends or flexes forward between three and five thousand times per day? When you’re traveling – you’re going to be on the upper end of that metric. Our spines crave balance. And because of the disproportionate amount of time we spend bent over – we need to make a concerted effort to move our spines in the opposite direction. When you’re traveling – look for opportunities to be upright and mobile.

Walking is an excellent, therapeutic activity for your spine – plus – it’s a great way to see the sights wherever you’re going. When you’re practicing the 30 min rule, give your back and neck a nice stretch backwards each time you stand to interrupt your sitting. But probably more important than what you do during travel is what you do when you’re back home. Be cautious when jumping back into your typical gym or exercise routine. All the sitting and bending that comes with travel makes your spine vulnerable for injury. It’s very common to get injured a week or two after you’re home – seemingly “out of nowhere”.

 

Looking for more help with your neck and back pain?

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you get rid of your neck and back pain for good.

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

5 Summer Activities on the Seacoast to Keep You Active, Healthy, and Mobile!

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With the weather getting warmer, it’s time to start appreciating all the amazing assets that the Portsmouth area has to offer for summer fun! The best way to prevent back pain and all-around stiffness or soreness is to stay moving as much as possible, and what better way to do so than out in nature?

Here are some of our favorite places to walk, bike, and otherwise enjoy the outdoors!

 

1. Great Bay National Wildlife Refuge

The Great Bay National Wildlife Refuge includes more than 1,000 acres of protected land in Newington, NH. Its two main trails are open to both hiking and biking and offer a close look at the flora and fauna of the Great Bay area. While visiting the reserve, you might see bald eagles, foxes, otters, turtles, deer, and a huge variety of songbirds. There are two main trails for the public to explore this unique and largely untouched area. The half mile Upper Peverly Pond path is a boardwalk trail, meaning it is fully wheelchair accessible and inviting for both young children and seniors! The William Furber Ferry Way trail is a more ambitious, yet not intimidating, two miles that delves deeper into the forest and features a beaver pond and old orchard.

NH Wetlands

2. Picnic by the Sea at New Castle

New Castle’s Great Island Common is a perfect destination for a relaxed, yet active day spent outdoors. You can spend the morning kayaking, an excellent core and upper body workout, and then kick back with a picnic on the beach or lawn. The park area also offers a large playground if you’re accompanied by young children. No matter where you stand, you’ll have a breathtaking view of the ocean, multiple lighthouses, and boats entering and leaving the harbor.

3.  Take a bike ride around Portsmouth

Get some exercise in while riding along all of the scenic views that the Seacoast area has to offer! Port City Bike Tours brings groups on historic and coastal bike tours with 5 different routes to chose from for a private or public tour. All of the tour guides are local to the area and have a love for New Hampshire history and historic preservation!

4. Odiorne State Park

Odiorne is the ocean lover’s ideal hike- gorgeous views of the rocky coastline, twisting trails through the woods that open up onto a salt marsh, and a paved bike path all in one place. Odiorne is comprised of about 330 acres of protected land, and is open year round to walkers and explorers! In the summer, you can even go tidepooling while you walk along the shore. You might find sea stars, snails, minnows, crabs, and more! And you will undoubtedly see seagulls throughout the entire coastline walk. On the wooded trails, you could come across deer, songbirds, chipmunks, and squirrels. Odiorne is a great place to stretch your legs and get some fresh air while enjoying the seacoast at its best!

5. Try Stand-Up Paddleboarding

Stand-Up Paddleboarding is a perfect way to get a core workout in while enjoying the ocean! This low-impact outdoor activity has gained popularity over recent years not only for being great exercise, but also because standing at your full height above the water gives you a unique view of your surroundings – which are beautiful at any location along the Seacoast! The balance and core stability that goes into paddleboarding is something we focus on with our Pilates program as well. In fact, Pilates and paddleboarding would be great activities to pair this summer!

Is pain getting in the way of you doing your favorite summer activities?  CLICK HERE for a free discovery visit with one of our specialists to see how we can help!

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

golf injuries

Common Golf Injuries and How to Avoid Them

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Most golfers I know won’t let anything stop them from being out on the course – especially here in New England where the golf season is not very long.

But let’s face it, when something hurts, playing 9-holes is just not as fun.

Jack Nicklaus had it right when he said, “Professional golfers condition to play golf; amateur golfers play golf to condition.” That explains why 62 percent of amateurs will sustain a significant golf injury, typically because they’re out of shape, have poor swing mechanics, or don’t adequately warm up.

Here are three common golf injuries and things you can do to avoid them.

Elbow Tendonitis

Tendonitis is characterized as the painful inflammation of a tendon. It’s caused by repetitive movements that overload the tendon, eventually causing it to feel strained and overworked. When it occurs on the inside of your elbow, which is something that happens a lot with golfers, it’s called “golfer’s elbow.” The treatment is ice and rest initially (which means you don’t get to play golf for a while) followed by progressive and proper loading of the tendon to get it back to a healthy state. This whole process, if done properly, takes time… and it can certainly ruin your golf season if it’s not caught early.

What causes elbow tendonitis? We know that technically, it’s inflammation of tendons in your elbow. But what leads to that in the first place? Often weakness in your mid-back and shoulders along with mobility restrictions in your wrists. Your elbow is significantly influenced by what happens above and below it. If your mid-back and shoulder area are weak, the rest of your arm won’t feel supported and your elbow can get overworked. If your wrist is tight and immobile, your elbow will be forced to move more than it should, especially through a golf swing. This will cause extra stress on your tendons and eventually result in tendonitis. The best way to prevent this from happening is to make sure you’ve got adequate mobility in your wrists, and good strength in your mid back and shoulders.

Back Pain

One of the most common ways to hurt your back is with repetitive flexion (bending) and rotation (twisting). Well, what does a round of golf consist of over and over? Repetitive bending and twisting! Every time you swing that golf club, you’re putting your spine through one of its most stressful positions. And if it’s not prepared — it’s going to get injured.

One of the best ways to prepare your spine for a long and healthy golf season is to avoid a lot of sitting and keep it mobile. Sitting for prolonged periods makes your back more susceptible to injury in general, but especially if you’re going to be doing a lot of bending and twisting. Interrupting your sitting frequently during the day is a very easy way to minimize its harmful effects. 

If you lack adequate mobility in your spine, it will feel strained every time you try and swing your club. When you overstress a joint that is stiff, the muscles around it tend to tighten up and spasm in response. It’s important that you take time to optimize and maintain your best spinal mobility for golf season. This will significantly help to decrease the stress that occurs in your spine when you swing in one direction repetitively, and ultimately help you prevent a back injury.

Knee pain

Between walking 18 holes, and the repetitive twisting that happens at your knee when you swing a golf club, there’s the potential for lots of stress (and injury) through your knee joints. If you lack adequate mobility or stability in and around your knees, you’re going to have problems. Much like the elbow, the most common source of knee pain I see in my golfers comes from the joints above and below, and not from the knee itself. To keep your knees mobile and healthy and prevent them from getting overstressed during golf season, it’s important that you take measures to optimize the strength in your core and hips, as well as stability in your feel and ankles. 

The power in your golf swing should come from your hips and core, not from your knees (or back). If they aren’t very strong, your knees will want to try and help, and they are not designed for this. Your knees need to be loose and free during a golf swing. If not, the muscles and ligaments around your knee joint will take on unwanted stress. 

Another cause of unwanted stress to your knee joint is lack of support from your feet and ankles.

Your knees need a stable foundation if they want to bend and twist without stress. If stability below is lacking, your knees will tighten up in an effort to compensate. Moral of the story: make sure you’ve got mobile knees, a strong core and hips, plus stable feet and ankles, so that knee pain doesn’t derail your golf season.

Hopefully these tips help you understand why golf injuries happen and most importantly, how to prevent them. If you’re feeling stuck and looking for individualized expert help – request a FREE Discovery Session. We look forward to speaking with you!

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 taking care of back pain – click here.

When exercise hurts your back instead of helps

When Exercise Hurts Your Back Instead of Helps

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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? 

What most people do when exercise flares their back up is they just stop. They simply wait for the pain to go away – and begin the cycle all over again. This is not the best strategy. Instead, why not figure out why exercise might be hurting your back and do something about it?

Here are 5 reasons why exercise might be hurting your back instead of helping:

 

1. Its the wrong type of exercise

While the research isn’t wrong about exercising and back pain – the type of exercise you choose is important. For example, walking is generally considered one of the best exercises for back pain sufferers. But there are certain types of back pain where walking flares you up. In these instances, it doesn’t mean that walking is “bad” for you – and it doesn’t mean you have a serious problem. Many times, it simply means you need a different type of exercise first that gets you back to walking normally. Same goes for strength training and core training. Exercise is good for back pain – but if it flares you up – don’t be quick to blame the exercise. You may just be doing things in the wrong order. Working with a back pain expert can help minimize this and make sure you’re doing the right exercises at the right time – and that won’t flare you up.

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 – and typically before good mobility is fully restored. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. And when your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. When it comes to stability training, there is often resistance or load involved. The last thing you want to do is add load to the spine that is already compensating and irritated. This is a sure-fire way to flare up your back and why exercise might be hurting you instead of helping.

3. You aren’t activating your core

Knowing when and how to properly activate your core is different from having a strong core. You can have the strongest abs in the world – but if you can’t use them when they count – it’s 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. 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 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 to both your back muscles and your discs. If you’re not in tune with your breathing, and you aren’t timing it properly, it’s another reason why exercise might be hurting your back instead of helping.

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 after several weeks or months when you get to your 100th rep. Same goes for body weight exercises. Just because you aren’t adding an external load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. This is where I see most 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 keep causing your back to flare up.

 

If exercising is currently hurting your back instead of helping  – it could be due to one of these 5 reasons. Get expert help to figure out which one it might be. Because at the end of the day – exercise really is good for your back. If done correctly, timely, and in the right order – it will help your back instead of hurt it.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to 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.

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

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

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

1. Stand Up & Take a Load Off

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

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

2. Watch for Curves

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

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

3. Extend instead of Bend

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

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

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

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