Tag Archive for: goals

6 Tips for Healthy and Mobile Knees this Summer

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When you’ve got persistent, nagging knee pain, it can significantly impact your quality of life, and put a real damper on your summer. The good news is there are many things you can do naturally and on your own to help keep your knees healthy, especially with the increased activity that often comes with summer. 

Here are six of my top tips to ensure your knees stay strong and pain-free during your summer adventures:

1. Strengthen Your Hips and Core

Your hips and core provide essential support and stability to your entire body, but especially your lower limbs and knees. Strengthening these important muscle groups is key for not only relieving knee pain – but preventing it as well. Weakness or imbalance in your hips and core can lead to poor alignment and compensatory stress on your knees during movements like walking, running, or squatting. So when you focus on strengthening your hips and core – you’ll improve your overall biomechanics – and reduce the wear and tear by minimizing the load placed through your knees during summer activities.

2. Get (and Stay) Mobile

One saying you’ll hear me repeat over and over is: “mobility before stability.” When you’ve got stiffness in your joints, the surrounding muscles will try to compensate. Muscles don’t work as well when the joint they are in charge of moving doesn’t have full and free mobility. I see this a lot in people suffering from knee pain.

Good and optimized joint mobility will enhance your body’s ability to move efficiently and with proper body mechanics, thus, reducing the strain on your knees. By increasing (and maintaining) your flexibility and range of motion, your body will move more freely and distribute forces more evenly throughout your joints and muscles (including your knees).

3. Don’t Sit so Much

Knee pain can come directly from your knee, but also from your spine (even when you don’t have any back pain). Interrupting your sitting throughout the day (I recommend once every 30 min) addresses both potential causes. For knees in particular, prolonged periods of sitting can cause stiffness and lead to poor blood circulation in and around your knee joint. That’s why sometimes after sitting for a while, you can experience sharp stabbing pain in your knee when you go to move.

Sitting for extended periods can also lead to tightness in the hip flexors and hamstrings, which can negatively impact knee alignment and function. When you take regular breaks to stand, stretch, and move around – you relieve knee pressure, maintain good joint mobility, and prevent muscle imbalances that (when left unaddressed) can gradually creep up and ruin your summer.  

4. Keep Moving

Regular movement and exercise helps to stimulate blood flow. If you’ve got inflammation in your knees causing pain, good blood flow helps to actually reduce inflammation by delivering essential nutrients and oxygen while also removing waste products. If your knees are on the arthritic side, engaging in low-impact exercises like walking, swimming, cycling, or Pilates can help build strength and endurance around your knees without putting excessive stress on your joints.

Regular movement also helps lubricate your knee joints, which can reduce friction and discomfort during summer activities. Perhaps the biggest benefit of regular exercise and movement is the release of endorphins, which are your body’s natural painkillers that can help alleviate discomfort in any joint, not just your knees.

5. Wear Sensible Footwear

The right (or wrong) footwear can greatly impact how your knees feel when walking, running, or standing. Proper footwear provides the necessary support and cushioning to reduce knee strain. And depending on the mechanics of your feet and ankles, the right footwear can help improve overall alignment and stability. 

In the summer, people love wearing sandals and flip flops. However, if you’re prone to knee problems, you may want to reconsider this choice or only wear them for short periods when you won’t be standing or walking for long. Flip flops, in particular, offer little support and can exacerbate knee pain. By choosing shoes that prioritize comfort, support, and proper alignment, you can effectively reduce knee pain and enhance overall joint health for a happy and active summer.

6. Work on Your Balance

Good balance is crucial for stability, control during movement, and reducing fall risk, especially in summer activities like paddleboarding, pickleball, and walking on the beach. When you work on your balance, it helps reduce knee strain by ensuring your postural muscles, feet, and ankles work together to distribute forces evenly. Without this coordination, your knees overcompensate and suffer. When you make a conscious effort to improve and maintain balance – it will help to decrease the stress on your knees by getting other joints and muscle groups to “join the party.”

If you’ve been suffering from knee pain for a while and you’re worried about it ruining your summer – get started on any of these six tips and see if they help. Now, if knee pain is getting in the way of you being able to incorporate any of these tips, then it’s time to consider expert help and speak with a physical therapy specialist.

The right therapist will help you identify the root cause of your knee pain and come up with a treatment plan that not only gets rid of your knee pain, but teaches you how to keep it gone – naturally and on your own. 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or to download her Free Report on Knee Pain – CLICK HERE.

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].

Why Proper Breathing is Essential for Good Core Strength

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When I’m working with clients, one of the most common things I see when someone is having trouble engaging their core is that they tend to hold their breath.

Why is this important?

Because breathing properly allows you to activate your deep core – and good activation of your deep core is essential if you want the rest of your core muscles to work properly and help you prevent things like back pain.

Let me explain…

Your “deep core” is made up of your diaphragm, pelvic floor, transversus abdominus (deepest layer of abdominals) and your multifidi (deepest layer of back muscles). These four muscle groups work together to make up your deep, inner core. If your deep core doesn’t function properly – your outer core muscles (abdominals, glutes, hip and back muscles) won’t have the support they need to work well. This can all lead to inefficient and compensatory movement patterns over time, and contribute to something like back or neck pain.

Your diaphragm controls how well and how deeply you breathe. When working properly, your deep core acts like a piston system, driven by your diaphragm. Upon inhalation, your diaphragm expands, causing your pelvic floor to lengthen and drop. When you exhale, your diaphragm contracts and your pelvic floor lifts like an elevator – all acting like a piston system moving down and up.

Additionally, the pressure created by this system also acts a bit like a balloon. Breathing in expands your pelvic floor and abdominal muscles out, stretching like a balloon would. Exhaling releases the air and allows your abdominals and pelvic floor muscles to contract, like the natural recoil that would occur if you let the air out of a balloon.

So, if this is a natural process, why do so many of us have problems activating our core properly?

It’s because as we age, and allow poor movement and posture habits to form, we “forget” how to breathe normally and most of the time aren’t even aware this is happening.

Here are some of the most common things I see with clients suffering from neck and back pain, and who aren’t activating their deep core properly:

1. Chest breathing

I see a lot of people breathing deeply but the only thing moving is their chest. Instead of their ribs expanding out and back, all you see is their upper chest moving out and up. This is very common, and it happens because your diaphragm isn’t expanding fully and thus, not pushing air down into your belly. Chest breathing often contributes to tight and elevated shoulders, back pain, and even tight hip flexors – because the deep abdominals can’t kick in properly, causing the rest of your body to compensate. Next time you want to take a deep breath, place one hand on your belly and make sure that it’s moving out and in along with your chest. That’s a first step to learning how to breathe properly so that your deep core can activate!

2. Your neck feels tight

Although back pain is often what’s associated with a “weak core”, people can also suffer from neck pain when they lack proper core activation. When people first start working with us for Pilates, a big complaint is they feel tightness in their necks when they are first learning how to activate their core and do a proper chest lift. The fascia (web like substance that holds and surrounds your muscles) of your deep core is connected to the deep fascia of your neck. If you’re not breathing properly and your deep core can’t activate, your neck may try and help out because it’s partly “connected”. We even see neck tightness like this in our experienced Pilates goers – and it’s a clear sign they’ve lost connection to their deep core or perhaps simply lost connection to their breath. Next time you’re doing abdominal work, check in with your neck and see if it feels tense. If so, it could be a sign you’re not fully activating your deep core. Improving how you breathe during abdominal work could help.

3. You hold your breath when you exercise

Did you know your diaphragm is a muscle? When you hold your breath, you’re contracting that muscle. For a muscle to work properly it needs to contract AND relax. If you hold your breath during exercise, it’s impossible for your diaphragm to expand (relax) and push air into your abdominals and activate that piston system we talked about earlier. In other words, your pelvic floor and deep abdominal stabilizers don’t have an opportunity to activate properly when you hold your breath. Without activation of your deep core, the rest of your body is going to have to compensate somehow. And this can set you up for unnecessary aches and pains, or worse, injury. I always say to my clients, “when in doubt, just keep breathing”. Because if you’re actively breathing, you at least have a shot at activating your deep core properly, even if you’re not 100% sure how to do it.

If you have trouble “feeling your abs” when you exercise, your neck and shoulders tense up when you work out, or your back and neck always hurt every time you work your core – it’s a sign you might not be activating your deep core very well.

Remember that good core strength starts with your breath!

Next time you work out, especially core-focused work, pay attention to the way you’re breathing. If you still have trouble, or you’re noticing back or neck pain, then reach out for a FREE Discovery Session or check out our Pilates offerings.

Could your Hamstring Strain Actually be a Back Problem?

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Have you ever strained your hamstring but the pain just doesn’t go away?

It’s been months since you first started hurting, you can’t actually remember how you injured it (it just started aching one day), you’ve been stretching and massaging it diligently, yet your hamstring still hurts.

This happened to a recent client of ours (“Sandy”).

Sandy was a runner and regular gym goer, who one day noticed an ache in her hamstring. She assumed she had just overdone it working out. She rested it a few days and the pain went away, but when she tried to get back to running she couldn’t. Her hamstring pain came right back. Thinking she hadn’t let it heal enough, she went back to resting it, but this time, decided to add some massage and stretching to her routine. 

A few weeks later… you guessed it… Sandy still couldn’t run.

She also noticed the pain in her hamstring started to feel “different.” It was becoming more deep and achy and started to hurt all the time instead of only when she tried to exert it. It even hurt when she sat for too long. She still couldn’t run and was starting to get worried. Her doctor told her it was just a “strain” and that she had to let it heal. The problem was that it wasn’t healing. Several months had now gone by and she was running out of exercises and stretches to try that would “let it heal.”

Luckily, Sandy attended our recent back pain and sciatica class and realized that the pain in her hamstring might not be a strain at all. 

And her instincts were right! Let me explain.

When you truly strain a muscle, it means you have done damage to your muscle tissue. Although it’s possible to have chronic problems from a strain that isn’t rehabilitated properly, strains typically do in fact heal. Once the inflammation from the tissue damage goes away, and you start doing the proper stretching and strengthening, your muscle eventually gets back to normal. Until a muscle strain is fully healed, it will typically be aggravated if you accidentally over-stretch it or exert it. But you usually don’t feel anything when you’re resting the muscle. In Sandy’s case, her hamstring was starting to feel worse when she was resting — the longer she sat, the worse she felt. Your hamstring is completely relaxed when you are sitting, so something wasn’t adding up.

This was the first sign we were likely dealing with something other than a “hamstring strain.” The second sign was that we could take her pain away by moving her back! Yes, you heard that right.

By moving and stretching her back in a specific way, we were able to significantly relieve the pain in her hamstring.

The reason her hamstring was actually hurting was because a nerve had been aggravated in her back. The nerve was causing pain to radiate into her thigh. That’s why it hurt when she sat for too long and it’s why she couldn’t tolerate any running. Sitting puts more stretch and pressure on the nerves in your back, and running puts a lot of compression through your back. Generally speaking, nerves don’t like to be stretched, especially aggravated nerves, and they don’t like to be compressed if they are aggravated either. By stretching her back in a very specific way, we were able to relieve the pressure from the nerve that was giving Sandy her “hamstring strain.” This confirmed that she was indeed having a back problem.

Has anything like this ever happened to you?

If you’ve got pain anywhere in your buttocks, hip, thigh, or leg that isn’t going away — especially if you’ve done your due diligence and tried all the “right things” — it’s possible you could have a back problem causing this pain instead. These types of back problems are easily missed if you don’t know how to accurately assess them and it won’t be picked up by an MRI or X-ray. The best way to figure this out is through specialized movement testing, like we did with Sandy. 

We talked all about this in our recent back pain and sciatica class. If you want access to the recording, just call our office: 603-380-7902. If you want to take the next step and meet us in person — you can schedule a FREE Discovery Session with one of our specialists right here! 

MRI

How MRI’s Lead Back Pain Sufferers Toward Unnecessary Procedures

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One of the most popular questions and concerns I hear from clients at our specialized physical therapy practice in Portsmouth, NH is whether or not they need an MRI when they are experiencing back pain or sciatica. It’s pretty standard protocol, but is it necessary? In most cases, no.

About 70 to 80% of back problems, even sciatica, are considered mechanical in nature and quite normal.

That means there isn’t anything “serious” causing your pain. Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist and will typically require advanced medical intervention.

An MRI can be useful in these cases to get more clarity before medical intervention begins.

But when your back pain is mechanical in nature, an MRI is more often than not misleading and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment, you most likely have mechanical back pain. The root cause of mechanical back pain cannot be diagnosed by an MRI.

And if your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen so many Portsmouth physical therapy patients with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually not the root cause of your back pain. What typically happens is the MRI finds them, and your back pain gets blamed on them. But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain.

Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain. That’s how we know the root cause of your back pain is coming from something else.

One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain.

Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

If you notice that certain positions or movements relieve your back pain, or you feel better after walking and exercise, your back pain is likely mechanical in nature, and you don’t need an MRI to diagnose you. Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does not respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc only to find that it didn’t help their problem, or it came back again with a vengeance.

And once you have surgery, mechanical back pain can actually become more difficult to fix because your tissues and ligaments are now compromised from surgical scarring, no matter how minimally invasive they say your surgery will be.

You can sign up for a FREE 30 minute Discovery Session with one of our specialist physical therapists in Portsmouth, NH right here.

How to NOT let Aches and Pains Ruin your New Year’s Goals

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It’s that time of year, when we start looking ahead and setting goals for ourselves. It’s especially exciting now because we aren’t only entering a new year – but a new DECADE!

Exercising more and losing weight are the top New Year’s resolutions on everyone’s lists year after year. But what if you’re suffering from back or knee pain?  One of the worst things you can do is ignore pain and assume that by simply exercising more or losing weight, your ailments will just go away. It’s certainly a reasonable expectation, however, I typically see an influx of people calling my office right around March because these aches and pains have not only worsened — but derailed their New Year’s goals completely.

I don’t want to see that happen for you. So here are my top tips to NOT let aches and pains ruin your New Year’s goals:

1. Get assessed by an expert:

 

Your first thought might be to go see your doctor if you’re suffering from something like back or knee pain. But most medical doctors are trained to screen you for problems like broken bones or serious pathologies – not to actually assess your movement. You need to know how your pain behaves during everyday functional movements to truly fix it – and to avoid unnecessary procedures and surgery.  X-rays, MRI’s, or simply moving your limbs around on a treatment table won’t do that… but that is what a medical doctor is trained to do. A specialty physical therapy practice will be able to assess your movement in detail, through various movement tests, which will tell a much better story about how your pain may or may not impact the new exercise or weight loss program you’re about to start. Plus, we’ll be able to give you customized modifications so that you can embark on your new goal while decreasing your risk of injury.

2. Mobility before Stability:

This is a saying you hear me say all the time in my office. Your muscles won’t function at their best if you don’t have optimal joint mobility. In other words, you don’t want to strengthen around a stiff joint, or you’ll encourage compensation. Full and free mobility requires adequate flexibility in your joints as well as your muscles. Most people don’t think – or even know – how to assess their joint mobility. If you’re suffering from chronically stiff joints, you’ll want to get them checked before you start a new exercise program. I recommend seeing a movement expert, like those employed in our office, to make sure you’re ready and able to start on that new exercise program you’re so excited about!

3. Stay Hydrated:

Drinking lots of water has two great benefits. It will give you the extra hydration you need if you’re planning to be more active. And it will help you lose weight by curbing your appetite. Some additional benefits of staying hydrated include increased muscle strength and stamina, more lubrication in your joints, more supple skin, better cardiovascular function, and improved energy and mental alertness. One really easy tip to jumpstart your day and improve your daily hydration intake is to begin with 10 oz of water first thing upon waking. Add a squeeze of lemon for extra vitamin C and supported weight loss.

4. Pace yourself:

It’s very appealing and motivating to go “all in” on your new exercise or weight loss goal and 10x it… and I applaud you for it. But remember, you have 12 months, and really, the rest of your life to accomplish your goal in any way that you see fit. In other words, take pleasure and pat yourself on the back for simply setting a goal. That’s a first step that many don’t even get to. Be proud of yourself for setting an intention and envisioning a better quality of life. To give yourself the best odds of staying on that path, I encourage you to listen to your body and take your time in acclimating to a new exercise program. Don’t fight your body if it’s talking to you.  Our bodies talk to us for a reason. If you need help figuring out what your body is trying to say to you – click here to schedule a FREE Discovery Session with us in Portsmouth. We’re happy to translate for you!

Happy New Year – and Happy New Decade! 

5 benefits of adding pilates to your fitness routine

Setting Goals for the New Year? We can help!

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A new decade is on the horizon, and so are new health and wellness goals for many of us!

Are you already discussing resolutions or considering ways to make 2020 your best yet? The new year is a great opportunity to form new habits that will help us become our healthiest, happiest selves. Setting detailed goals is a constructive way to approach the 2020’s that can help you feel more motivated and hopeful about the future.

The idea of New Year’s resolutions is great, but most people only stick to them for a couple weeks.

Resolutions are so often left unfulfilled in part because they’re usually pretty general statements that are made without much forethought, intention, or planning. At some point we’ve probably all resolved to “get healthy” or “eat more vegetables” or “spend less money.” All worthy ideas, but can you see why people don’t follow through?! There’s WAY too much wiggle room, and nowhere near enough specificity. That’s why oftentimes, setting goals with distinct processes will help you accomplish much more than a run-of-the-mill resolution.

There are two essential factors in goal setting. First, the goal must be attainable. Secondly, you must define concrete steps that you intend to take towards reaching that goal.

Most of us want to be healthier, but what does that actually look like? One person’s journey to becoming healthy could be totally different from another’s. These goals can be made in conjunction with a health professional such as a physical therapist, especially if they relate to mobility, strength, and physical activity. Many of us have intended to “exercise more,” but those two words rarely yield results. A more effective goal might be to enroll in a Pilates class, take a half hour walk outside five days a week, drink the recommended 64 ounces of water each day, or to do ten minutes of stretching every morning after getting out of bed.

A group program such as Pilates can be especially helpful because it gives you a sense of accountability and camaraderie. In fact, our signature Pilates 101 program is relaunching in January, and we are so excited about it! Pilates 101: Get [Your] Back to Health is a one-of-a-kind 8-week program that delivers safe, yet highly effective Pilates-based core strengthening exercises that are easy on the joints, designed to lessen back pain, and help improve your flexibility and posture.

If you can track, schedule, or measure the steps of your goal, you’ll know when you’re making progress. If those steps happen alongside people who share similar goals and under the direction of a movement expert who can support you for two whole months — even better!

So, let’s finish off this decade strong — and don’t miss out on Pilates 101! These spots go fast, so apply now to make sure you don’t miss your chance.

Knee pain? Top three causes and what to do about it.

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Knee pain is one of the most common complaints that brings people into our office.

Since most of our clients are in their 40’s, 50’s and 60’s, they start to really worry that knee pain could bring an end to their active lifestyle. But that doesn’t have to be the case! The good news is that unless you’ve had some serious trauma (like a major accident or fall), 80% of all knee problems can be resolved without any kind of procedure or surgery – and most importantly – you can learn how to continue managing them on your own so that they never get in the way of your favorite activities again.

Sound too good to be true?

It’s not – I promise – but the first step is figuring out where your knee pain is coming from. Once you know that, you can get on the right path to resolve it.

Here are three of the most common causes I see that make people suffer from knee pain and what you can do about them:

1. Iliotibial band syndrome

This is a very common problem that typically affects runners, avid walkers, and hikers. It is often misdiagnosed and confused with patellofemoral syndrome (see below). Your iliotibial band (IT band) is a very large thick band on the side of your knee that will often get overworked due to a muscular imbalance elsewhere in your body (usually your hips and core). When this happens, you’ll feel pain that is on the side of your knee that is usually very sore and tender to touch, and typically sharp and stabbing versus achy. It will impact you most when you’re going downhill or down the stairs.

It’s important to note that even though a tight, and painful IT band is the structure causing you to have pain – it is typically a symptom of an underlying problem. Like I said before, IT band problems are usually the result of your core and hips not stabilizing your pelvis properly – which ultimately results in your knee not receiving the support it needs when you’re running, walking, or hiking.

Getting rid of the actual pain is the easy part… in our office we use things like dry needling, soft tissue work, and sometimes even some taping. But if you want to keep the pain gone – you MUST address the underlying causes as well. This is what a lot of people miss. We love using Pilates-based exercises in our office because they not only target your core, but also get your muscles working in a coordinated, symmetrical fashion, helping to keep things balanced as you get back to your favorite activities.

2. Patellofemoral Knee syndrome

This problem is very similar to IT band syndrome, with just a few key differences. This first is that it can impact almost anyone – not just runners, hikers, and walkers. You’ll also experience the pain in the front of your knee – typically under your kneecap – and it will tend to be more achy than sharp. This problem will often come on very slowly and can be more chronic than its IT band cousin. You’ll feel this more when you’re going up stairs, up hills, and with squatting. You’ll also notice stiffness and pain in the front of your knee after sitting awhile – that usually will go away once you start moving.

Much like IT band syndrome – these are all symptoms of an underlying cause. A weak core and hips can cause this problem too, but I usually see more weaknesses in glutes and hamstrings with this one. When the backs of your hips and legs aren’t kicking in like they should, it can result in tight hip flexors or quads. This is a super common culprit for patellofemoral syndrome. So once again, you can get rid of the pain quite easily in most cases, but you must make sure to determine – and address – the root cause so that you can keep this pain gone for good.

3. Osteoarthritis

Many people hear that they have osteoarthritis in their knee and think there isn’t anything they can do about it. Not true!! Arthritis is often blamed for knee problems but it isn’t always the cause of what you’re feeling… Let me explain….

When arthritis is the true cause and culprit for your knee problem, it will be painful and stiff all the time. You’ll lack significant mobility and it will be almost impossible to walk and bear weight without support or a cane. When this is truly your problem – you are a great candidate for total knee replacement surgery. Now here’s the catch… sometimes your X-ray or MRI will show that you have terrible arthritis or that you have “bone-on-bone”… but that doesn’t mean you need to rush to surgery! Your symptoms should really decide that.

If your pain comes and goes (meaning you have good days and bad days), if you can walk around most days and go up and down the stairs and your knee just “catches”, or maybe you feel stiff a lot but this eases up with movement – you might have arthritis in your knee but it is not the root cause of your knee problem. Because here’s a hint – arthritis does NOT come and go – but other common musculoskeletal problems can. When your pain comes and goes, you know it can’t be entirely from arthritis.

So what should you do?

With arthritis, whether it’s partially to blame, or whether it’s just something that shows up on the X-ray and gets blamed… we still need to look at the surrounding structures and root cause of the problem.

If your quads are really tight, and the muscles around your knee are imbalanced, this can create compressive forces in your knee joint which will exacerbate what might normally just be “mild” arthritis (compression will aggravate arthritis). You could also have weakness or problems in your ankles, feet, or core that are causing your knee to work harder than it needs to. This can cause pain all on its own, OR aggravate your arthritis. The point is, get checked by a musculoskeletal expert – people trained like us – so that instead of just fishing for the problem or only treating symptoms, you are getting to the root cause of your problem and setting yourself up for success!

If any of this sounds familiar to you, you may benefit from working with a specialist physical therapist who can help you get back to the activities you love – without pain pills or unnecessary procedures. You can click right here to request a FREE Discovery session with one of our specialists. We’d love to help you figure out the root cause of your knee problem so that you can get back to doing everything you love – instead of spending time in the doctor’s office 🙂

Is Running Bad for Your Knees when you’re Over 50?

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Is Running Bad for Your Knees when you’re Over 50?

This is a question we get asked a lot — especially by patients at our specialized physical therapy practice in Portsmouth, New Hampshire — who are getting older and worried that they won’t be able to keep running into their 50s and 60’s.

The short answer? No!

If you experience knee pain when you run, it’s not that you’ve “aged out” of the sport! It’s probably just a biomechanical issue that can be fixed with proper education and strengthening (best offered by a specialist physical therapist).

In fact, research supports that running may actually be GOOD for your knees!

Here are some factors that could be responsible for knee pain when you run:

1) Poor ankle mobility

Ankle mobility affects the way force hits your foot, which can in turn impact your knee. According to Trail Runner Magazine, “if your ankle can’t move adequately, then excess forces are shifted up to the knee. The knee may be forced to flex, and/or rotate, and/or tilt more than it should. This may result in loads that the tissues of the knee can’t handle.”
A physical therapist can help you improve ankle mobility in order to prevent long term damage to the joints, tendons, and ligaments of your knees. This might be especially important for you if you’ve ever sprained or twisted an ankle in the past!

2) Weakness

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing strong lower limb muscles is critical. The hamstring and quadriceps groups play a crucial role in stabilizing the patella, otherwise known as the kneecap. Running is an extremely repetitive action and consequently requires durability and endurance from your joints — something that is lost quickly when you neglect strength training.

3) Unstable core

It may seem like running is all in the legs, but in reality, every physical action begins at the core. You derive all your power, speed, and stamina from your core muscles, and if they are weak, all your joints suffer — especially your knees. A stable core is key for maintaining balance and rhythm. It also keeps your weight distributed between your legs and prevents undue stress from resting on your knees.
Our favorite way to improve core strength is Pilates! If you are a runner but think you could benefit from a stronger core (let’s be honest, we all could), consider giving it a try — for FREE.

4) Running form

It doesn’t matter if you’re a marathon runner or an occasional jogger — running form is important. It determines where and how the impact of every step is distributed throughout your body. If your body mechanics are compromised — for instance, you’re dragging your feet or running with your shoulders tense and shrugged — you’re more likely to suffer from chronic knee pain, or even experience a serious injury. Work with a movement specialist – like the PT’s in our office – to analyze your form and help you be more efficient when you run.

Running is good for you at any age, if you do it right!

Research shows running can actually slow knee arthritis. According to an article published by Outside Online, “animal models show that exercise promotes cartilage thickening and protects its stretchy properties… instead of wearing down your bearings, running may grease them. That’s key, because cartilage thinning and the loss of elasticity are both prominent causes of osteoarthritis.”

Want to make sure you’re running right? Get in touch!

If you are local to the Seacoast region and considering physical therapy in Portsmouth, NH – you can schedule a FREE Discovery Session if you have chronic knee pain (or any type of pain) to talk about what you’re dealing with and figure out the course of action that works best for you.

You’ll get the opportunity to tell one of my specialists everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

Looking for more information on Knee Pain? – Download our free guide “7 Ways to Stop Knee Pain” HERE.

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].

New Year — New You — New Pain?

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New year, new you, right?

We’re officially in 2019 and it’s a brand new start… You’re excited, you’re motivated, and you’re on your way to achieving your goals for the year. But what happens when back pain hits you? Or your knee starts to hurt? Or your hip starts bothering you? The last thing you want is for your new routine to be disrupted and your progress halted…

So how do you know if the pain you’re experiencing is something to really worry about, or if it’s just a result of your body adjusting to a more active routine? (related: Where is your pain really coming from?)

These FOUR questions will help you clarify the type of pain you’re dealing with, help you figure out what to do about it, and most importantly – prevent “new pains” from getting in the way of your goals in the new year!

1. Does your pain come and go?

If the pain comes and goes, and starts to decrease the more you improve your fitness level, it’s probably just a sign that your body is getting used to your new activities. For example, if you’ve started doing squats for the first time and notice some knee pain when you first begin, you shouldn’t worry unless the pain gets progressively worse as you exercise.

Best practice: Keep an eye on this kind of pain – or download one of our FREE GUIDES – but there’s no urgent need to run to the doctor.

2. Does the pain last after the activity but go away the next day?

If your pain follows a pattern — e.g., your knee pain stays with you for the rest of the day after doing your squat sets but is gone when you wake up the next morning — means your body is trying to tell you something. This type of recurrent pattern is a warning sign that your body isn’t responding correctly to the exercise and could start to incur damage. If you’re experiencing a similar phenomenon, now is the time to make an appointment with a specialist physical therapist. Going to the doctor or orthopedic surgeon would be a less productive path to take, as they will likely send you down a rabbit hole of unnecessary tests and procedures (Do you really need an MRI?). But meeting with a physical therapist before the problem becomes too serious can help you adjust your movement and strengthen the right muscles so that you’re able to continue exercising as planned.

Best practice: Talk to a physical therapy specialist who can analyze your movement and the source of your pain.

3. Is the pain causing you to move differently?

People who ignore pain without seeing a physical therapist often end up here, which leads to a more difficult recovery. They often end up limping, walking “crooked,” modifying movements such as bending over, and moving stiffly. This is a result of your body compensating for the pain initially triggered by the exercise. Such compensations start to cause wear and tear on other areas, which only create more problems down the road.  If you’ve hit this phase – it’s still not too late to get some help.  Working directly with a physical therapy specialist will help you to quickly get rid of your pain and correct the compensations you’ve started to develop – so they don’t get worse.

Best practice: Make an appointment with a physical therapy specialist (at our office your first one is FREE)

4. Is your pain causing you to avoid or stop doing something?

When your pain is stopping you from doing something — whether that be doing squats, running, or picking things up off the floor— it’s a sign that your body is in distress and needs help from a physical therapy specialist, orthopedic specialist, or your doctor. However, I encourage people to seek out a physical therapist first. Traditional doctors typically don’t perform movement tests, relying solely on imaging and procedures to make diagnoses. They’re also more likely to prescribe rest, surgery, or painkillers  — despite the fact that 80-90% of ALL aches and pains can be resolved through corrective exercise and movement strategies administered by a movement expert (such as a specialist physical therapist). If the problem does require further intervention, then a physical therapist can refer you to the appropriate medical specialist.  Most states (including NH) don’t require a prescription to see a physical therapist. You can give us a call and come straight in!

Best practice: See if physical therapy can help FIRST by talking to a specialist and getting an evaluation

The moral of the story is, don’t wait to ask for help! You’re better off being extra-careful and addressing your pain early than waiting for it to become a full blown injury. If you are experiencing pain and/or need any help staying on track with your new movement program, don’t hesitate to reach out! You can also find us on Facebook and Instagram and learn more about our services here.

Happy New Year!