Tag Archive for: knee problems

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.

knees

Spooky creaks and cracks coming from your knees?

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Does the cracking in your knees “spook” you out?

Yes – it’s Halloween – and we’re having some fun over here… But in all seriousness – when it comes to cracking in your knees (or any joint for that matter) – people get nervous.

First of all, cracking in your knees (as well as your other joints) is quite common – and most of the time there’s a reasonable explanation for it.

Crepitus is the term used to describe any grinding, creaking, cracking, grating, crunching , or popping that occurs when you move a joint like your knee. You can experience this at any age – but it’s certainly more common as you get older.

So what causes crepitus – and should it be a concern…

The most common causes of crepitus include air bubbles popping inside your joint, tendons or ligaments snapping over your joint’s bony structures, or the degeneration of your joint’s cartilage that generally occurs with arthritis. You may experience uncomfortable sensations, or even a tiny bit of pain when this happens, but in most cases, none of this should scare or concern you.

It’s all a normal part of aging and wear and tear.

But if the cracking in your joints starts to become more regular – is accompanied by joint swelling and more constant pain – or if the cracking turns to “clunking” and your knee starts to feel unstable… then you’re smart to be concerned and it’s possible something more serious could be going on.

If you suspect something like this could be happening – get your knees checked out by an expert.

But assuming you haven’t let your knees get to the “concerned stage” yet… and the most annoying thing to you right now is the cracking, grinding, or crunching…

There are things you can do to prevent it from getting worse.

The first thing I always recommend is to keep moving.

Motion is lotion.

And regular movement throughout the day helps keep your joints lubricated. It’s like applying WD-40 to a creaky door hinge – when your joints creak – move them to lubricate them.

The second important thing to consider if you want to reduce crepitus and prevent it from becoming something more serious is your biomechanics.

Biomechanics refers to how well your muscles and joints function together.

If you’ve got imbalances – it will impact the way your joints move and function – causing more creaking and cracking.

For example, let’s say your hips are on the weak side. How your knees tolerate various activities depends a lot on how strong your hips are. I’ve experienced this first hand… I love to hike. And if my hips aren’t doing their part, I feel the entire hike in my knees, especially on the way down.

And you know what else happens?

My knees crack a lot more on the days after I hike.

The imbalances in my body cause more stress on my knees and the result is they crack a lot more. Now, as I mentioned previously, this isn’t a big concern for me… yet. My knees don’t hurt – they are just very noisy. But in the interest in prevention – I make a conscious effort to regularly stretch my quads, and strengthen my hips and core – so that I can keep this problem at bay and not let it get worse.

My FAVORITE way to do this is with Pilates.

Specifically… on the Pilates Reformer!

When you use the Pilates Reformer – it allows you to both strengthen and lengthen at the same time – as well as focus on your coordination. These three things – when combined together – help to significantly optimize your biomechanics.

If you’ve never used the Pilates Reformer and want to give it a try – check out our Pilates program HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth. To get a FREE copy of her guide to knee pain – CLICK HERE

Failed Knee Surgery

Knee Surgery Gone Wrong? It’s More Common Than You Think.

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Arthroscopic knee surgery is one of the most common surgeries performed. Despite research telling us that it’s not nearly as effective as most people are led to believe.

Science tells us that people who do undergo arthroscopic knee surgery are likely to have knee arthritis that advances rapidly. This results in a total knee replacement that you could avoid.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint. It’s done if  you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

Well… it is until it isn’t.

The big problem is that arthroscopic knee surgery is not necessary for most cases of knee pain.

If there is a complication – which there are many even with “minimally invasive” procedures – you could end up being worse off than when you went in.

Plus – if you never even needed the surgery to begin with – you just put your knee through unnecessary trauma that you’ve got to now heal from. This further delays you from addressing the root cause of your knee pain.

The truth is that most people can get full relief of their knee pain as well as full restoration of knee function without any type of surgery or procedure. This is true for 70% of all knee pain cases.

An early research study from 2002 by JB Moseley 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 more than ever?

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 believe that the physical therapy “didn’t work”.

But more often than not, you just haven’t found the right physical therapist yet – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery.

And then there’s the elephant in the room…

It’s very common for knee pain to be coming from somewhere other than your knee. Knee pain can come from your ankle, hip, or back. One study showed that 40% of the time – knee pain is caused by your back – even when you don’t have any back pain.

MRI’s add even more confusion to this. It’s entirely possible to have degenerative changes, a torn meniscus, or advanced arthritis in your knee – and still have your knee pain stemming from a source other than your knee.

Over the course of my 20 year career, I’ve seen many knee surgeries go wrong.

Most of the time, it has nothing to do with the procedure itself. It has everything to do with an incorrect diagnosis going in. Say your knee pain can be resolved conservatively. Then you put it through unnecessary trauma (surgery). There’s a good chance you’re going to have more problems afterwards. You get knee surgery when your knee problem isn’t even coming from your knee. Then you’re definitely going to have problems afterwards.

The moral of this story is to make absolutely certain that:

1) Your knee problem is really a knee problem and

2) You’ve fully exhausted all (quality) conservative therapy options before going under the knife.

Remember that 70% of all knee pain cases do not need surgery.

Science has proven this. Don’t resort to knee surgery unless you’re 100% sure you really need it. Because it can go wrong and when it does – it’s much harder to come back from then if you had avoided it to begin with.

Want help with your pain now? CLICK HERE to talk to one of my specialists for free – you can tell them all about your knee pain and we’ll let you know if we can 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 Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

golf injuries

Common Golf Injuries and How to Avoid Them

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

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

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

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

Elbow Tendonitis

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

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

Back Pain

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

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

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

Knee pain

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

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

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

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

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

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

Common Pickleball Injuries and what to do

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If you haven’t heard of pickleball yet, odds are good you will very soon. Pickleball is quickly becoming one of the most popular recreational sports in the US, especially in the over 50 crowd, and especially in Portsmouth and all around the Seacoast of New Hampshire. It’s essentially a cross between tennis, racket ball, and ping pong. The court is smaller than in tennis and the net is set lower. People love pickleball because it’s a great way to not only get exercise – but to socialize and meet new friends.

But like any other sport, injuries happen. And because injuries become more significant and harder to rehabilitate as you get older – it’s important to have an awareness about the common injuries that tend to occur in pickleball players and what you can do to prevent them.

Here are four of the most common injuries I see in Pickleball and what you can do:

 

1. Rotator cuff strains

Your rotator cuff is a group of muscles in your shoulder that play a critical role in both stability and mobility of your shoulder joint. Because pickleball involves repetitive swinging – your shoulder is at risk for overuse injuries and strains. To help minimize the risk of rotator cuff injury, it’s important to ensure that you have good mobility in your shoulder joint, and good mid-back or scapular strength. Your scapula is also called your shoulder blade – if your scapular muscles are weak – then your rotator cuff might be tasked with extra work or strain. The more mobile your shoulder is, and the more balanced the strength around your shoulder joint is, the more effective your rotator cuff will be when playing a repetitive sport like pickleball.

2. “Pickleball” elbow

This is pretty much identical to tennis elbow – known medically as lateral epicondylitis. It causes pain and tenderness on the side of your elbow or forearm – and happens due to overuse of your forearm muscles – typically due to poor mechanics above, below, or in the elbow itself. To prevent this, you want to make sure the areas above and below your elbow joint are strong and stable. Your shoulder needs to be both strong and mobile for when you swing – otherwise your elbow will compensate and try to help out. Your wrist needs to be stable when holding the racket – or your elbow will need to kick in and try to help. The ligaments and muscles around your elbow aren’t designed to do the job of both your shoulder and your wrist – so if you don’t give these areas some love – you could end up with pickleball elbow.

3. Ankle sprains

Because there is a lot of pivoting and starting/stopping directions during pickleball – it’s easy to sprain your ankle if you’re not careful. Most ankle sprains occur from rolling on the outside of your ankle. This results in bruising, pain and swelling of the ligaments along the side of your ankle. While this injury does heal over time, it can often result in chronic weakening or scarring of those ligaments as well as tightness in your ankle joint – which only makes you susceptible to future ankle sprains. It’s best to make sure you have a good warm-up before you play. One that conditions your ankle and feet for quick stepping and flexibility. You also want to make sure you have strong hip muscles. If your side hip muscles aren’t strong and helping you stay stable in your pelvis – your ankle will take the brunt – and you’ll be more likely to sprain it.

4. Achilles tendonitis

Your Achilles tendon is a very strong, thick tendon that connects your calf muscle to your heel. It’s responsible for generating a lot of power to help you spring off your foot and jump. Its power is generated from its ability to stretch and then contract. Therefore, your ankle needs to have good mobility in order for your Achilles tendon to do its job. If your ankle is stiff and tight, you could be at risk for developing Achilles tendonitis. One other consideration is the strength of your glutes (or butt). Calf muscles love to compensate for weak gluteal muscles. If that happens over and over, they become tight and can put extra strain on your Achilles tendon – since they are connected. So make sure your butt is strong and your ankle is mobile in order to help prevent this common pickleball injury.

If you’re a pickleball lover – or perhaps wanting to get into this popular sport for the first time – I hope these tips help you to become more aware of what you can do to protect yourself from injury.

Ready to get help with your pain or injury?

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

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. 

 

Man getting knee pain treatment

Is Your Knee Problem Really a Problem? How to tell.

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Is Your Knee Problem Really a Problem? How to tell.

Knee pain is the second most common musculoskeletal complaint after back pain. Studies say that 1 in 4 adults now suffer from chronic knee pain, and the number of swollen and stiff knees has risen 65 percent in the past four decades. But just because you have knee pain – doesn’t mean you have a knee “problem”. Knee pain can be tricky to figure out – especially if it’s chronic. Over the course of my career, I’ve seen so many cases of chronic knee pain that weren’t getting resolved because the real problem was coming from someone’s back or ankle. One of the most important factors in successfully resolving knee pain for good is correctly identifying its source.

So how do you know if your knee problem is really a knee problem?

First – pay attention to how and when your knee pain started. If you’ve had a fall or some kind of trauma directly to your knee, and you experience knee pain or swelling shortly after, odds are pretty good you have an isolated knee problem. People who perform regular, intense activities like soccer, hiking, skiing, football, and basketball are much more at risk for an isolated knee injury. Typically, you’ll know exactly when and how you hurt your knee. You may even recall a specific pop or strain of some kind.

Osteoarthritis (OA) of the knee is another example of a knee problem that could really be a knee problem. However, this one is tricky because if you’re over the age of 50, you most likely have OA in your knee, and it will show up on your X-ray whether you have knee pain or not. So what commonly happens is that if you’ve had knee pain for a while, and you get an X-ray that shows you have OA, the OA will get blamed for your knee pain. So yes – knee OA can be an isolated knee problem – but knee OA tends to be an over-diagnosed source of knee problems.

So what are the clues that tell you your knee problem might not be a knee problem?

One of the biggest clues that you’ve missed the correct source of your knee pain is that it doesn’t go away no matter what you’ve tried, or it keeps coming back.

This is the biggest complication I see with folks suffering from long-lasting knee pain.  They’ve iced it, taken pain medication, foam rolled, stretched, and strengthened – but their knee pain doesn’t get resolved.  And once your problem becomes chronic, knee doctors start to get involved.  This is great if you’ve actually got a knee problem. But if your knee pain is a symptom of something else, then you risk getting recommended unnecessary knee surgeries or procedures.

I spoke to a woman the other day who had surgery on her knee to clean out some cartilage and wear and tear from arthritis. It was supposed to be a “quick recovery” and take her pain away. Well, three months later, her knee is feeling worse than pre-surgery. And to fix the new pain she has, they tell her she will need even more procedures. Her initial problem wasn’t coming from knee OA – it was coming from something else. And now she’s going to have even more problems because she had surgery she never needed.

How does something like this happen?

The biggest reason is because of the over-reliance on imaging to form a diagnosis and treatment plan. If you’re over 50, 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, whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee – and then blame your knee pain on it. But here’s the thing – and research backs this up – there is no way to tell for certain from a picture of your knee where the true cause of your pain is coming from. The only way to tell if what you see in the imaging is actually the cause of your pain is with proper movement testing. If you don’t do that, you risk getting an unnecessary procedure when the real problem might be coming from somewhere else.

In conclusion…

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 leg – there is a good chance your knee pain is a symptom of a mechanical problem elsewhere – typically your back or your ankle.

Before you think about getting images of your knee, or undergoing some kind of surgery or procedure, you’ll want to make sure you get a thorough screen by a mechanical pain expert. Never rely on imaging to tell you the full story.

Remember that knee problems can be resolved 80% of the time without procedures or surgery. You just have to have some patience and make sure you’re working with someone who understands mechanical pain and the importance of looking at the whole body – beyond just where the pain is.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

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

Why Strengthening Your Core Could Be Hurting Your Back

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

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

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

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

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

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

NOT TRUE!

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

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

 

1. You feel stiffer after workouts.

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

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

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

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

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

2. Your neck hurts

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

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

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

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

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

3. Your hamstrings are sore and achy

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

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

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

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

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

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

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

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

Looking for ways to safely strengthen your core?

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

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

Travel Plans? Avoid Neck and Back Pain on the go

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We typically see an uptick in travel plans every August. But this year we’re seeing more than ever given that travel was basically non-existent for the entirety of last year.

Traveling is so good for the mind and soul – but it’s not always fun for your neck and back.

When our clients get back from a long trip, we hear common complaints of stiff necks and backs, aggravated sciatica, and just overall achiness.

The good news is you can prevent or significantly minimize most of these symptoms with just a few easy tips. Whether you’re traveling by train, plane, or automobile – here are some of my top tips for easing neck and back pain when you travel.

1. Remember the 30 min rule

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

2. Use a lumbar roll

Our spine is made up of distinct curves for a very good reason. They are designed to balance forces and sustain shock – and it’s best if you can maintain them. When you sit, the curve in your lower back (lumbar spine) decreases, or sometimes disappears all together. While it’s perfectly acceptable to sit like this for small increments of time (remember the 30 min rule), your spine will not like this after several hours. Plus, your neck responds by changing it’s curve as well. Typically, you’ll find your neck in what we call a “forward head” posture if your lower and mid back or curved over.

One of the best things you can do is use a cylindrical lumbar roll to help maintain the natural curve in your lumbar spine. Place it right at your lower back any time you’re sitting and you’ll find that your spine has a lot less strain.

Want to purchase a lumbar roll for yourself? We have them right here in our office. Reply back to this email if you want us to put one aside for you 🙂

3. Stay hydrated

We all know that it’s important to stay hydrated, but why is it especially critical for avoiding back and neck pain during travel? Well, water is the vehicle responsible for transporting nutrients to your cells, including the nutrients your muscle cells need to do their job. Dehydration causes muscle cramps because it deprives your body of electrolytes. Proper hydration increases strength, balance, and flexibility. Water also helps to lubricate your joints, which is a bonus for keeping your spine working smoothly and allowing it to support the movements of your entire body. So, if you’re planning to hit the road soon, make sure you bring a reusable water bottle and fill it up regularly. And the extra bathroom breaks will give you an excuse to stay moving!

4. Pack light

No matter where you’re going or how you’re getting there, traveling involves packing, and packing too much stuff can be a quick recipe for back pain. Anyone who has flown knows that lugging multiple bags and/or suitcases around an airport is not only exhausting and stressful but can leave you sore and unbalanced for days. Even if you’re traveling by car, you still have to load and unload your bags, and carry them to wherever you’re staying. Your best bet is to pack light. If you’re bringing a suitcase with wheels, pack heavier items in there so that you don’t put unnecessary strain on your neck and shoulders. Opt for a backpack instead of an over-the-shoulder bag to avoid uneven distribution of pressure, and stock it with your water bottle, small travel essentials, and healthy snacks.

5. Prepare your body

The best way to prevent injury or pain (in general) is to stay as mobile as you can and maintain an active lifestyle. Oftentimes when you travel, you are walking more than usual and doing more activities than you are accustomed to when you’re home. If you’ve got an active trip planned, it’s best to prepare your body beforehand. Something else to consider is your sleeping surface. Different mattresses and sleeping surfaces can really wreak havoc on your neck and back. It’s a good idea to bring your favorite pillow with you, and plan to use extra blankets or clothing items to provide extra cushioning or support where you need it. Whatever you can do to simulate what it’s like to sleep at home is going to help minimize neck and back stiffness.

I hope at least one of these tips helps you to have less back and neck pain on your next travel excursion.

Need more tips?

CLICK HERE – to talk to one of my specialists for free if you’re currently looking for help with neck and back pain right now.

5 Tips to Treat Back Pain on your Own and Avoid Surgery

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5 Tips to Treat Back Pain on your Own and Avoid Surgery

Back pain impacts approximately 31 Million Americans at any given time, and our health care system spends $50 Billion per year on low back pain treatment. It’s the single leading cause of disability keeping people out of work, and it’s the second most common reason for doctor’s visits. Back pain is a big problem in this country. But the even bigger problem, in my opinion, is how the traditional medical system treats and manages those suffering from back pain.

Despite what you may have been told, getting rid of back pain on your own is entirely possible and preventing it can be even easier.

But it starts with understanding what the true cause of back pain is for most people.

Eighty percent of back pain is “mechanical” in origin, which means it’s not due to any serious pathology like cancer, infection, or fracture. Mechanical back pain is the result of abnormal or unusual forces occurring in the structures of your spine – like your ligaments, muscles, discs, and vertebrae. These abnormal forces can accumulate slowly over your lifetime or happen quickly in a single event – such as picking something up the wrong way.

The good news is that if abnormal forces can cause your back pain, then reversing those forces can get rid of your back pain. Surgery and other medical procedures won’t do that. They only impact the structure or irritant that is aggravated, like when you remove a piece of your bulging disc. The goal for true back pain recovery is to eliminate what is causing those structures to be aggravated in the first place – and the best way to do that is with healthy movement you can do on your own!

Here are 5 tips to help you treat back pain on your own and avoid surgery:

1. Stop sitting so much

Compressive forces on your spine increase by 40% when you sit – and it goes up even more if you’re slouched! Over time, these compressive forces will start to aggravate the ligaments and discs in your spine. Because it happens slowly, you may not notice right away, so one of the best things you can do is interrupt your sitting at least every 30 min. This minimizes the accumulation of abnormal forces on your spine throughout the day.

2. Walk more 


Our spines were designed to be upright and moving. Walking is one of the best and easiest ways to promote this. When you walk regularly, it helps to promote good mobility and blood flow, which can act like lubricant for the structures in your spine. Walking also helps to keep your hips from getting tight. Tight hips can cause abnormal forces to occur at your pelvis, which in turn, will create abnormal forces on your spine.

3. Vary your posture

You might be wondering why I didn’t say “maintain good posture.” To be honest, perfect posture all the time is kind of a myth when it comes to back pain. The truth is your spine is quite resilient and should be able to tolerate lots of different postures – even bad posture for a short period of time – without pain. The problem is when we assume the same posture all the time.

Imagine if you never straightened your knee, eventually it would get stiff and be difficult to move in that direction. The same thing happens in our spines. One of the best things you can do is choose activities (like Yoga or Pilates) that work your spine through lots of different postures and range of motion. This helps keep your spine happy and healthy and it minimizes abnormal forces from the same repeated postures or activities day after day.

4. Strengthen your core

The stronger you are, the more resilient your body is going to be – period. When it comes to back health, having a good strong core is going to minimize stress on ligaments and even discs. When the muscles around your spine are strong, it’s going to be easier for you to lift and carry things, which is one of the most common ways people injure their backs. If your abdominals, glutes, and hips aren’t doing their job, your spine ends up taking more of the stress – and this can lead to both pain and injury. Pilates is my favorite way to strengthen your core because the exercises are designed to target your abdominals.

5. Educate yourself 

There is a lot of misinformation out there when it comes to both diagnosing and treating back pain. You should never let an MRI or X-ray alone dictate what your treatment should be. Remember, the structures in your back don’t get spontaneously irritated. Irritation typically occurs due to abnormal forces on your spine. If you only address the irritated structure – like with an injection, procedure, or surgery – you’re not actually fixing the problem. The best way to address abnormal forces in your spine is with movement – movement that is designed to even out the forces in your spine and relieve pressure from those structures that have become aggravated.

If you don’t currently have back pain – then these tips are going to help you prevent back pain from ever occurring. If you’re currently having some mild back pain or discomfort, then see if any of these tips help you to relieve it on your own! But as always, if you’ve been suffering for a while, then it’s best to seek professional advice from an expert.

tight hips

Should Age be a Reason to Avoid Certain Activities?

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We’re continuing with our topic of the month – Getting Fit After 50 – and people have been asking me…

Are there certain types of exercise I should avoid once I hit a certain age?

The short answer is no.

Most of our clients are over the age of 50 and they do everything from surfing, to playing tennis, hockey, running, and even tap dancing!

None of these activities are considered “easy on the joints,” but they do them anyway.

So why is it that some folks see age as just a number – where others use it as a reason to stop doing certain things?

After age 50, the number one reason I see people avoid activities they want to do is because of pain. The second most common reason is because they were told to.

Let’s start with pain.

Having been a physical therapist for twenty years, I know a thing or two about what goes through people’s minds when they are dealing with back or joint pain. In most cases, the pain itself is not the biggest concern. People are willing and able to tolerate a certain amount of pain at the expense of doing what they truly love. We do it all the time in our 20’s or 30’s… and don’t think twice about it.

But as we age – a little bit of fear starts to set in when we’re in pain.

We’ve typically seen or heard horror stories from friends or family who have paid the price for either pushing through – or ignoring pain all together. When we’re younger, we’re more likely to approach pain with a “wait and see” approach. But as we age – pain becomes a bigger concern and we’re more likely to seek professional medical help sooner.

This leads me to the second reason people over 50 will just stop doing certain exercises…

Because they were told to. And often by a well-meaning health care professional.

Let me explain that.

Our medical system is overloaded, and everyone does the best they can to keep up. But if you’re a musculoskeletal health professional who’s NOT up with current medical research – you’re likely to give advice based on “old-school” ways of thinking.

For example, diagnosing all musculoskeletal pain based on X-rays and MRI’s… If your X-ray shows “bone on bone” arthritis – then a joint replacement is assumed to be your only option. If your MRI shows a meniscus tear or bulging disc – then you automatically need arthroscopic surgery.

But the current research disputes this line of thinking…

And says 80% of ALL musculoskeletal problems – even when you’re over 50 – can be solved without surgeries or other procedures.

How your pain behaves is what matters most. Not your age or arthritis. The best way to explain this concept is with a case study!

This client (we’ll call him “Jim”) is 57 years old and was told knee replacement surgery was his only option to resolve the knee pain he was suddenly experiencing.

When he questioned the knee replacement and asked if he could wait, his doctor’s response was that because of his age – and because of the “bone on bone” arthritis that was showing on his X-ray – surgery was his best option. Otherwise, if he wanted to wait, he would need to stop the running and hiking he had been enjoying so much until very recently.

Research studies show that the indication of osteoarthritis on X-ray alone does not mean it’s the cause of your pain.

In other words, it’s entirely possible Jim’s knee pain could be due to something other than his “bone on bone” arthritis.

Did he really need surgery? And did he really need to stop some of his exercises because of arthritis or his age?

Ceasing his activities would have certainly made Jim’s arthritis worse. And if he went through with the knee replacement without being completely sure if arthritis was the main cause of his knee pain – he not only risks unnecessary surgery – but also risks getting set back several months for recovery.

This would delay his ability to get back to running and hiking even further.

Although age is most of the time NOT a factor in your choice of exercise… it is a factor when it comes to how quickly you’re able to recover from surgery.

So here’s what happened.

We prescribed him a corrective movement strategy to see if arthritis was the main factor causing his knee pain. And just like we see over and over again – his knee pain significantly improved after just a few visits!

Research says that if pain responds quickly to a corrective movement done repeatedly – your pain is primarily due to a mechanical origin – and not arthritis. Arthritis doesn’t change that quickly – in fact it doesn’t change at all (unless you get surgery). But mechanical pain does.

Turns out that Jim’s knee pain was due to some mechanical imbalances in his knee joint, and NOT the arthritis. Arthritis was a factor for sure – it made his knee stiff – but it was not the main cause of his knee pain.

If you’re getting older… know that age related changes like arthritis are quite normal and nothing to be afraid of.

And arthritis, along with your age, are certainly not reasons to avoid exercise.

Jim was given medical advice to have a surgery he does NOT need yet based solely on his X-ray and his age. But there are SO many other factors worth considering as well.