Tag Archive for: knee pain

Avoiding Movement

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

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Fear is a natural, protective response to injury.

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

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

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

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

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

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

Let me explain…

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

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

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

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

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

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

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

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

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

Back Pain

Could Back Trouble Be the Root of Your Knee Pain?

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

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

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

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

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

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

So how does a misdiagnosis like this even happen?

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

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

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

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

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



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.

Knee Pain Causes

Six Tips to Improve Knee Pain Naturally and on Your Own

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When you’ve got persistent, nagging knee pain – it can have quite the impact on your quality of life. But the good news is there is plenty you can do naturally and on your own to help relieve knee pain, even if you’ve been suffering for years.

Here are 6 of my top tips for how you can improve knee pain naturally and on you own:

  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 this important muscle group is a key component for not only relieving knee pain, but preventing it as well. When you’ve got weakness or imbalance in your hips and core, it leads to poor alignment and compensatory stress on your knees during movements like walking, running, or squatting. Strengthening your hips and core will improve overall biomechanics, reducing the load placed on the knees and preventing excessive wear and tear.

  1. Get (and stay) Flexible:

One saying you’ll hear me repeat over and over is: “mobility before stability”. That’s because when you’ve got stiffness in your joints, the surrounding muscles will try to compensate. And muscles don’t work as well when the joint they are in charge of moving doesn’t have full and free mobility. Good and optimized joint mobility will enhance the body’s ability to move efficiently and with proper body mechanics, 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 – thus – reducing the risk of overload on your knees.

  1. Interrupt Your Sitting:

Knee pain can come directly from your knee, but also from your spine (even when you don’t have any back pain). When you interrupt your sitting often throughout the day, this 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. Sitting for extended periods can also lead to tightness in the hip flexors and hamstrings, which can negatively impact knee alignment and function. By taking regular breaks to stand up, stretch, or move around, you can relieve pressure on your knees, maintain good joint mobility, and prevent muscle imbalances that will only lead to more knee pain over time.

  1. Get (and keep) Moving:

Regular movement and exercise helps to stimulate blood flow. And if you’ve got inflammation in your knees causing pain, good blood flow helps to 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 the joints. Regular movement also helps lubricate your knee joints, which can reduce friction and discomfort during daily activities. And 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.

  1. Choose Sensible Footwear:

The right (or wrong) footwear can make a huge difference in how your knees feel with walking, running, or standing. When you’ve got proper footwear, it provides the support and cushioning you need to reduce impact on your knees. Depending on the mechanics of your feet and ankles, footwear can also help to enhance or improve your alignment and stability. By choosing footwear that prioritizes comfort, support, and proper alignment, you can effectively reduce knee pain and improve your overall joint health.

  1. Improve Your Balance:

Good balance is important for a lot of reasons, namely, it allows you to have good stability and control during movement, and it reduces your fall risk. But having good balance can also reduce the strain in your knees. That’s because having good balance requires the coordination and strength of your postural muscles, feet, and ankles to all work together and distribute forces evenly. When that doesn’t happen, your knees tend to overcompensate and suffer. So working to improve and maintain balance can 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 awhile and not yet incorporating any of these 6 tips into your daily or weekly routine, get started now and see if it helps.

If knee pain is getting in the way of you even being able to incorporate some of these tips, then it’s time to speak with a physical therapy specialist. They will help you identify the root cause of your knee pain and come up with a treatment plan that is designed to get rid of your pain – and teach you how to keep it gone – naturally and on your own.

Are you local to Portsmouth, NH? Consider speaking with one of my specialists to see if we would be a good fit to help! CLICK HERE to request a free discovery visit.

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 Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected]

Holding Knee with Arthritis

Torn Meniscus? Is Surgery Worth it?

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It’s estimated that approximately 750,000 arthroscopic knee surgeries are performed every year – the majority of them being due to a torn meniscus.

But at a cost of about $4 billion per year – is this surgery even worth it?

Let’s investigate…

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee. The biggest set of pro’s for this procedure is that it’s quick, recovery is fairly minimal, and you will typically experience an immediate relief of pain.

Sounds worth it – right?

Not so fast. There are many cons to this procedure as well, many of which are not realized until it’s too late. So it’s worth a second opinion and considering all of your options before you jump in.

First, as with any surgical procedure, even if it’s minimally invasive, there are risks. Complications include nerve damage, excessive bleeding, infection, reactions to anesthesia, persistent stiffness and swelling, or blood clots. While these risks tend to be rare, they don’t outweigh the other long-term considerations you should be aware of.

Looking to avoid a knee replacement in your future?

Then you’ll definitely want to think twice about getting arthroscopic meniscus surgery. Research tells us that people who undergo arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that quite possibly could have been avoided. This is because you’re removing vital cushioning and shock absorbing mechanisms (the meniscus) from your knee joint. Plus, a meta-analysis published in Oct 2020 in the Knee Surgery, Sports, Traumatology, Arthroscopy journal revealed a 36% failure rate by year two – and a 13% failure rate by year five for meniscus repairs – resulting in more surgery and eventual knee replacement.

And then there’s the elephant in the room…

It’s more common than you think for knee pain to be coming from somewhere other than your knee, even when your MRI shows a meniscus tear. Knee pain can be caused by problems in your ankle, hip, or back. One study showed that 40% of the time – knee pain comes from a source in your spine – even when you don’t have any back pain. MRI’s add even more confusion to this because degenerative changes, which are normal as we age and very commonly lead to a torn meniscus, make surgeons think your meniscus is the cause of your knee pain when it might not be. The only way to truly determine the cause of your knee pain (in the absence of trauma) is through a proper mechanical exam that involves repeated movement testing to reveal the actual pain generator. 

The truth is – 70-80% of all knee problems can be resolved naturally and without surgery.

An early research study from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery to repair a torn meniscus?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain. If you’ve gotten physical therapy and it wasn’t effective, people are led to believe that the physical therapy “didn’t work”. But more often than not, you didn’t get physical therapy from a specialist – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery. 

If you’re young and involved in high-level sports, meniscus surgery is likely worth it for you.

But for most people, especially those over the age of 40, there’s a 70-80% chance you can get full relief of your knee pain, and full restoration of knee function without any type of surgery or procedure. This is not a popular opinion by the way, so be careful who you speak to for a second opinion. But for me, both the research as well as my 22 years of clinical experience tell me that most people (especially those over age 40) can resolve their knee pain naturally and with better long-term results if they avoid arthroscopic knee surgery – even when there’s a meniscus tear.

Is running bad for your knees?

Turns out – Running isn’t Bad for your Knees

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Is Running Bad For Your Knees?

I love to play family-feud style trivia. And if there was ever a question – “Name an activity that is bad for your knees” – I know that running would be the number one answer. 

But this is simply not true – and there is research to prove it.

There is a common myth that continued running will eventually cause, or accelerate arthritis in your joints. But in a 2013 study published in Medicine & Science in Sports & Exercise (the American College of Sports Medicine’s flagship journal) this theory was debunked. The results of the study concluded that runners were statistically less likely to develop knee and hip arthritis compared to other types of exercise. In a more recent study from 2020, published in PeerJ, it was found that although running does indeed create a lot more “pounding” in your knees compared to something like walking – this process actually helps to “build-up” your cartilage and make it stronger – which is a huge factor in helping to slow down arthritis.

But what about those that do get knee pain when they run? What’s the explanation?

Healthy running comes down to having optimized running form and body mechanics – otherwise it could become problematic for your knees.

So if you’re having knee pain when you run – instead of blaming the sport – consider one or more of the following:

Check your ankle mobility

Ankle mobility is going to influence the way force from the ground hits your foot, which can in turn impact how force (load) impacts 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.” Everything from the types of shoes you were to old ankle sprains can all have an impact on how well your ankle moves. A specialist in movement and joint mechanics can help you test and improve your ankle mobility – and let you know if it’s impacting your knees when running.

Don’t just run – strength train too.

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 hamstrings and quadriceps 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.

How’s your core?

It may seem like running is all in the legs, but in reality, so many of our physical actions stem from the core. You derive all your power, speed, and stamina from your core muscles, and if they are weak, all your joints suffer — including your knees. A stable core is key for maintaining balance and rhythm while running. It also keeps your weight distributed between your legs and prevents undue stress from resting on your knees. My favorite way to improve core strength is Pilates, especially for runners, because this exercise system gives your joints a nice break. But any core strengthening routine that focuses on using your body weight and minimizing stress on your joints is going to be beneficial for you if you’re a runner.

Practice good running form

It doesn’t matter if you’re a marathon runner or an occasional jogger — good running form is essential. It determines where and how the impact of every step is distributed throughout your body. But here’s the thing… Good running form is dependent on optimized joint mobility and strength – so simply changing your form might not be enough – and could even cause you more problems. You want to figure out why you’re running with a “bad” or inefficient form – correct what’s causing it – and then work to train your body to run in a more efficient way. This will not only help your knees – but all your other joints as well.

If you’re someone who loves to run and wants to keep running – I have good news for you – it’s not bad for your knees. But if you’re currently having knee pain while running – you’ll want to look at and consider one more of these strategies to figure out why. The best thing to do is enlist the help of an expert – such as a specialist physical therapist or movement expert – who can help you diagnose where your knee pain is coming from and get you on a path to fix it.

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 Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

pain

Your Pains Location May Not be it’s Source

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Pain is both a confusing and scary topic.

There’s lots of advice out there on what to do when you experience pain and it’s hard to know who to listen to. Should you rest – exercise – apply heat – apply ice – see a doctor – get an MRI – or just wait it out to see if it goes away on its own? Any or all of this advice could be right – but it’s irrelevant until you accurately determine where your pain is coming from.

For example, if you have pain in your knee, and it’s coming from your back, the best knee treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the most common reasons why so many people suffer longer than they need to, and it’s one of the biggest contributors to unnecessary procedures and surgery. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain, alone, is not a reliable way to figure that out.

Let me explain.

I’ve met people who’ve suffered from unrelenting tennis elbow for years – despite treatment protocol after treatment protocol – only to find out it was coming from their neck. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, they found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms, even when there wasn’t any spine pain. In other words, the pain they were feeling in their knee, elbow, or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you.

But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 40% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear. But what most people don’t realize is that these findings are quite normal and happen naturally as you age.

Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite the science proving this over and over – doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery – they let images and an inaccurate diagnosis lead the way.

Whenever I meet someone with isolated extremity pain, especially if it came on suddenly and out of nowhere, I always consider that it could be coming from their spine.

How can you figure this out?

Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time if it’s not addressed.

Moral of this story… If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source, and that where your pain is may not be where your problem is. And if you’re considering some kind of surgery or procedure, you definitely want to rule out that the problem could be elsewhere.

Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your elbow, knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

Looking for help and local to Portsmouth, NH? Click here to speak with a specialist.

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 get one of her free guides to knee and back pain, visit www.cjphysicaltherapy.com or email [email protected].

Pain when gardening

Six Ways to Protect your Knees and Back when Gardening

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Gardening is a favorite activity for a lot of folks – and lately I have been hearing many people having knee and back pain when gardening. To add more frustration to this topic, you might not even notice the pain until hours or days afterwards, which can make it challenging to address.

The good news is that there are several things you can do to protect your knees and back while gardening.

Here are 6 of my favorite tips to manage pain when gardening:

1. Warm up first

Before diving into any activity that you know you’ll be doing repetitively and for more than a few hours, it’s a good idea to warm-up. It doesn’t have to be anything crazy or excessive and 10 min is plenty.

Typically, you’ll only be gardening during nice weather. So enjoy it by taking a walk around your neighborhood first. Then do some easy light stretching to lubricate your joints before you begin. It won’t take long but your knees and back will thank you.

2. Avoid bending from the waist

Lifting and carrying heavy bags of soil or plants can put a lot of strain on your back and knees. You really want to make sure you’re using proper posture and body mechanics to avoid problems.

When lifting, be sure to use your legs instead of your back and hold objects close to your body. If you hinge only from your hips, for example, which a lot of people like to do, you will put extra strain on the back of your knees and lower back. Get in the habit of bending your ankles, knees, and hips in unison – kind of like an accordion – so that you build good muscle and body memory and don’t even have to think about it next time you’re gardening or lifting.

3. Take frequent breaks

It’s easy to get lost in the activity of planting and weeding. But even if you’re choosing good postures like I mentioned above – your back and knees still need a break. Our joints don’t enjoy anything when done repetitively or for prolonged periods, but especially too much bending or sitting on your knees. When you bend too much and too often, the discs in your lower back can get aggravated, and when you’re sitting on your knees, it’s a lot of pressure and can annoy your arthritis.

I recommend setting a timer and giving yourself a break every 30 min to change positions. Simply stand up and get out of the bent or sitting posture. Your back and knees will thank you and you’ll be able to garden for much longer and without risk of injury.

4. Pivot instead of twist

Your lower back and knees aren’t really designed to rotate, they are designed for bending and extending. So if you’re not careful – you can strain these areas with poor twisting and turning mechanics. When you have to rotate, you’ll want to pivot from your pelvis.

What does this look like?

Make sure your hips are always in line with the object you are moving and maneuvering. Keep your ribs in line with your pelvis and your pelvis in line with your knees and feet – and always move them as a unit. While it’s ok to bend and twist from your waist or legs on occasion – you’ll find yourself in some trouble when you do this over and over again – especially if you’re already prone to back or knee pain.

5. Use ergonomic gardening tools

The right gardening tools can be of significant help when it comes to maintaining good posture and avoiding overuse of your muscles and joints. Long-handled tools can help reduce the need for bending and stooping, which as already discussed, puts strain on your knees and back when overdone. Another consideration is the weight of your tools. It might be worth the investment to swap out your older, heavier tools for more modern, lightweight alternatives.

When you have to lift something heavy – especially repeatedly – use a wheelbarrow. This valuable gardening tool will allow you to lift and move heavy things with significantly less strain on your back. If you’ve got to be on your knees or squatting a lot – consider using a gardening bench and/or knee pads. These tools will make it easier to sustain activities that require prolonged bending or kneeling.

6. Use beds to raise your gardens

Raised garden beds not only look pretty but they are extremely ergonomic. Especially if you suffer from more chronic back and knee problems. Raised garden beds are elevated off the ground. They are easier to maintain and limit the amount of bending you have to do.

Raised garden beds are relatively simple to build and create. Even if you’re not having problems now with gardening, if it’s an activity you love to do, you might want to consider it. Making the investment in raised gardening beds now could go a long way in preventing knee and back problems in your future.

Gardening has so many positive benefits for both your mental and physical health – and the last thing I want is for back or knee pain to get in your way.

If you are experiencing pain when gardening – Give these tips a try.

But if it’s not enough, don’t give up.

Enlist the help of a musculoskeletal pain and movement expert who can help you figure out the source of your problem and provide you with practical solutions so that you can get back to gardening as quickly as possible.

If you are local to Portsmouth, NH – consider speaking to one of my specialists.

It’s a free, no-obligation call where you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you.

Click here to speak with a specialist.

golf injuries

Five Common Golf Injuries and How to Avoid Them

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Golf is a beloved passion enjoyed by millions around the world, and the season has officially begun here in New England. Let’s talk about golf injuries. Most golfers won’t let anything get in the way of tee time – but when you’re dealing with back, knee, elbow, or shoulder pain – playing 18-holes is just not as fun.

An injury of any kind during golf season not only impacts your performance – but it keeps you from enjoying the game to the fullest.

Your buddies are walking the course while you have to drive the cart… Instead of focusing on your swing, you’re thinking about your pain and whether or not you should push through it…

The good news is that with the right knowledge and preparation, you can avoid some of the most common injuries impacting golfers.

Here are five of the most common golf injuries and what you can do to avoid them:

1. Back Pain

Back pain is the most common injury to plague golfers. Repetitive bending and twisting is a well-known source of back problems – and that’s literally all you’re doing when you play golf. While practicing proper swing mechanics can help, it might not be enough.

If you lack adequate mobility in your spine, for example, the best swing in the world won’t compete. It’s important that you take time to optimize and maintain good spinal mobility during golf season.

Stretching backwards regularly, and avoiding excessive sitting during the day, are two things alone that could make a huge difference in your back mobility – and pain – and help you to get through golf season injury-free.

2. Elbow Tendonitis (Golfer’s Elbow)

Golfer’s elbow occurs when the tendons on the inside of your elbow become inflamed from the repetitive swinging motion of the golf club. Once again, good swing mechanics can go a long way in preventing this from happening. But it’s also important to consider what’s happening above and below your elbow joint.

If you’ve got a weak rotator cuff, or weak and stiff wrists for example, your elbows will experience added and unwanted strain when trying to do something like swing a golf club. It’s important that you perform regular conditioning of these areas (both mobility and strength) during golf season to keep your elbows from suffering the consequences.

3. 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 could develop pain as the season goes on. 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 could take the brunt and eventually suffer.

Much like the elbow, the most common source of knee pain comes from the joints above and below, and not necessarily 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 the stability in your feet and ankles.

4. Rotator cuff (shoulder) Injuries

Another common injury for golfers is strain, tendinitis, or impingement of the rotator cuff. Your shoulder is the most mobile joint in your body, and the rotator cuff’s job is to provide strength and stability to your shoulder joint. If it’s weak, or compromised in any way, you could eventually see problems during golf season.

There’s quite a bit of stability required from your shoulder joint to withstand the acceleration and deceleration forces that come with a golf swing. The repetitive swinging of a golf club could take a rotator cuff on its last leg and push it over the edge.

As mentioned several times already, work on your golf swing. But given you don’t want your shoulder girdle or rotator cuff bearing all the strain, you have to make sure your core is strong, as well as your mid back muscles and upper thighs and hips.

This group of “powerhouse” muscles will give you a stable foundation so the more distal areas of your body (knees, elbows, and even shoulders) don’t get injured from having to work so hard.

5. Wrist and Hand injuries

Wrist and hand injuries – such as sprains, strains, and even fractures – are also quite common in golf due to the gripping and twisting of the club.

Using proper grip technique when holding your club is paramount, but you’ll also want to make sure the club you’re using isn’t too heavy or long. And as mentioned previously, make certain you’ve got a strong and stable shoulder girdle, because much like the elbow, your wrists can compensate for weakness above the chain.

But one overlooked area when it comes to wrist and hand problems is your neck.

Did you know that 47% of upper extremity pain (including wrists and hands) can come from a source in your neck?

An underlying neck problem could be the cause of your weak hands and wrists, if this is the case, working on grip strength will not make a difference. You must first resolve what’s going on in your neck.

Hopefully these tips help you to understand why golf injuries happen and most importantly, how to prevent them.

If you try these tips and are unsuccessful, then it might be time to talk to an expert who can help you work through these aches and pains so you can be back on the course in no time.

Are you dealing with pain now and local to Portsmouth, NH?

Consider talking to one of my specialists for free. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. CLICK HERE to speak with a specialist.

tendinosis

Why the Difference between Tendinitis and Tendinosis Matters

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Tendinitis and Tendinosis: Why the Difference between them Matters.

Many patients at our specialized physical therapy practice in Portsmouth, NH, suffer from either Tendinitis or Tendinosis. Tendinitis and Tendinosis sound very similar, and are often used interchangeably but they couldn’t be more different. And neither should their treatment regimen.

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon.

Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

Tendons are tight, yet flexible bands of fibrous tissue that connect your muscle to bone. Without tendons, your muscles would be useless. Tendons are extremely organized, and the fibers are designed in a way to withstand and transmit high forces of tension so your muscle can function properly.

With tendinitis, your tendon becomes inflamed and irritated, typically due to repetitive overuse, and it will hurt when you try to move. The most common areas for tendinitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

Tendonitis is an acute condition, and the best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. But this should only be for a short period of time. From there, you want to figure out what caused the tendinitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendinitis.

When you don’t manage tendinitis properly, and it goes on longer than a few months, it can result in tendinosis.

Tendinosis is a very different condition where the fibers in your tendon actually start to break down. An important thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you, and could even worsen the condition.

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers and get blood flowing to the tissue (actually create some inflammation). Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to get blood flow to the area and re-organize those fibers so your tendon can work properly again. Passive treatments like ice, rest, and medicine will not help tendinosis.

The only exception is shockwave therapy (also known as Extracorporeal Pulse Activation Technology).

With shockwave therapy, high-energy sound waves stimulate the body’s natural healing mechanisms by increasing blood flow to the injured, affected area. The increased blood flow delivers oxygen and nutrients to the damaged tissue to help accelerate healing and reduce inflammation.

With pain reduced and the healing process promoted, your tendon is now primed for physical rehabilitation and re-organization of the tendons, the next most essential part of getting rid of your tendinosis.

The only way to truly re-organize tendons is to put stress on them so they can “remodel”. To do this, you have to put just the right amount of stress to cause a little bit of pain (inflammation) – but not so much that your tendon gets inflamed again.

This is literally one of the few times where “no pain no gain” actually holds true. A properly trained physical therapist who is well-versed in tendinosis rehabilitation will know how to do this and can guide you through it.

You have to retrain the fibers in your tendon to withstand normal forces again – and this process takes both time and careful loading strategies.

The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love again as if nothing ever happened. You don’t have to accept this as a chronic condition.

If you’re confused on tendinosis and tendinitis after reading this don’t worry – so is half the medical community.

The take home points to remember are that tendinitis involves pain and inflammation. There is no damage to your tendon, and it only lasts about 4-6 weeks.

Treatment for tendinits should involve passive modalities like ice and rest. The focus should be on what caused your tendon to get irritated in the first place. Then, you can get rid of it before it turns into tendinosis.

If the problem in your tendon has gone on longer than 3 months, you must suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon. Passive treatments (with the exception of shockwave therapy) will not work. They could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies, aka strengthening. That will properly re-organize your tendon so that it can be strong and functional again. This is extremely challenging to do on your own.

So it’s a good idea to talk to an expert about this. If you are local to and looking for physical therapy in Portsmouth, NH, reach out to schedule a FREE 30 minute discovery session.