Tag Archive for: low back pain

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.

Hamstrings Always Tight? This Could be Why

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If you’ve ever felt tightness in your hamstrings, the typical advice you get from friends, family, and even well-meaning healthcare professionals is to stretch them.

But if even your stretches just aren’t working – what then?

You hear me say this a lot… but if you’re constantly stretching… or even foam rolling a tight or tense muscle… and nothing seems to change… then it’s time to start considering that it might be something else.

I see this scenario ALL the time in our office…

Just recently, a gentleman (we’ll call him “Steve”) came to us with what he thought was a “chronic hamstring strain…”

He had been stretching his hamstrings consistently – but they just weren’t loosening up.

He wanted to know if there were better stretches he could be doing to loosen up the tight, uncomfortable feeling he was experiencing in the back of his thigh every day.

First – it was critical to make certain that Steve’s problem was… in fact… a tight hamstring.

If the chronic tightness in the back of Steve’s thigh was due to a hamstring problem, his stretches really should’ve been having some sort of impact.

Instead, the stretches either did nothing… or made his thigh ache.

Sometimes after stretching a lot – he would “feel” his hamstring for the rest of the day – even when he was just sitting. We checked that he was using proper stretching technique – and he was – so something wasn’t right.

When you’re having a problem with your muscle – and only your muscle – you’ll experience discomfort, tightness, or pain when you’re either using that muscle or stretching that muscle.

Otherwise – you should generally feel perfectly fine.

Muscles are made up of what we call contractile tissue. When you truly strain a muscle, this contractile tissue gets disrupted. You heal it by moving and stretching it – and eventually it goes back to normal. On occasion, people don’t move enough after a muscle strain and the tissue can become chronically tight. But still, you would only experience that tightness when trying to use or stretch the muscle.

This wasn’t the case for Steve.

His pain would, on occasion, linger throughout the day when he was resting or sitting. Sometimes he’d notice hamstring discomfort at night when he was trying to sleep.

Steve was feeling symptoms in his hamstring whether he was using that muscle or not – and his stretches weren’t helping.

This immediately tells me that there was another problem causing his symptoms and it was more than just a tight hamstring. – and when hamstring or thigh tightness doesn’t respond to stretching or exercise – we must always consider the lower back.

Since Steve wasn’t feeling any pain in his lower back – he never considered this himself.

But the key was in how Steve’s pain was behaving…

Your pain behaves in different ways depending on where it’s coming from..

As I mentioned previously, when your muscle is the source, your pain behaves in a very specific and repeatable manner.

But if pain is coming from your spine, it can quite literally be all over the place.

You can feel symptoms in your back, your butt, and your limbs. You’ll have good days and bad days. You’ll feel symptoms at rest, and you can certainly feel tightness in your hamstring – just like Steve.

The other interesting thing about problems that originate from the spine is that you’ll often be able to trigger your symptoms by moving your spine.

When we investigated Steve’s spine… we found that when he moved a certain way over and over… it would produce his hamstring tightness.

Bingo!

This explains why Steve’s hamstring stretches were doing absolutely nothing… He was stretching his thigh when he really needed to stretch his back.

Does Steve’s story resonate with you?

If you’re feeling chronic tightness or pain in your hamstring that just isn’t going away – chances are good that you’re missing something.

Do yourself a favor… DON’T check YouTube or “Dr. Google” for advice…

Talk to one of our experts instead.

Best way to do that is request a FREE Discovery Session.

We’ll talk to you about the symptoms in your hamstring and let you know if stretching is enough… or if you need something more!

CLICK HERE to request a Free Discovery Session with one of our specialists.

 

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.

Should you Rest when your Back Hurts?

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Back pain is the most common type of problem we see here in our office. And the number one question I get from people who’ve hurt their back is, “should I rest until it feels better?” 

The short answer is “no.” 

But I understand why this is confusing. It’s scary to move, or know which exercise is best when something hurts, especially if it’s your back. We also get conflicting advice from the medical community. Many people suffering with back pain have been told they should rest, ice, lie down, and use their back muscles as little as possible until they recover. They’ve been told they should limit their movement and activity until their pain goes away.

Well what if I told you that for 80% of all back problems – movement is actually the BEST medicine.

Research even supports this. Most back pain falls into the category of what we call “mechanical low back pain” – and this type of back pain responds best to movement over anything else. It’s important to note that although movement is good when your back hurts, you want to pick the right type of movement. Generally speaking, early movement like walking is considered one of the best things you can do for your back, along with very specific mobility exercises in a direction designed to relieve your pain quickly. But you’ll want to avoid things like lifting heavy weights at first, or bending/stretching over excessively. If your back pain involves an irritated nerve, stretching forward, even though it might feel good, can often worsen your problem.

So what’s the big deal? Why is it so bad to rest until your back pain goes away?

Although most back pain will go away on its own with time, the problem with resting instead of moving is that it can prolong the time it takes to truly heal. And in some cases, rest can make your back problem worse. Too much rest leads to deconditioning of your muscles, and can even lead to biomechanical changes to the curves in your spine. Resting may take your back pain away, but it’s going to leave you feeling much stiffer and weaker, putting you at risk to just hurt your back all over again. One of the biggest problems I see with back injuries is a lack of mobility, sometimes due to weakness and sometimes due to not moving around enough. A flexible spine is a healthy spine. That’s why choosing activities like walking and corrective stretching exercises over rest will not only relieve your back pain, but will give you a better chance at keeping the pain gone over time.

Another issue with too much resting, especially lying down, is the impact on your discs.

Back problems frequently involve some variation of a bulging disc, and when you lie down, your disc changes in size. Lying down does relieve pressure from your disc, but also causes it to absorb more fluid, making it bigger. You won’t know this is happening until you go to get up. That enlarged disc will not feel good when it gets pinched. It’s why most people who are dealing with back pain feel worse first thing in the morning, just after getting out of bed. Their pain eases once they stand and start moving around a bit. When you walk around and move, you get natural compression of your disc, keeping the disc bulge smaller and thus, less of an irritant. A bulging disc in your spine is a pretty classic form of mechanical low back pain, and we already know that mechanical back pain responds best to movement.

Remember that the absence of back pain does not mean the absence of a back problem.

Back problems can be complicated and they love to linger under the surface until one day, a certain movement just tweaks you. The best way to figure out a back problem – and heal a back problem quickly – is with movement. As tempting as it is, don’t just rest to get rid of your back pain. Try walking, and even some easy stretching, and take note of what happens. You’ll either start to feel better the more you move or worse. If your pain is easing up with the movement you’ve chosen – you’re on the right track! If your pain is not responding or getting worse, then it’s a clue you need to see a professional. Either way, movement is your friend, because it’s going to tell you something. Rest won’t do that for you and if anything, potentially prolong the issue when you could have been doing something about it.

Why Proper Breathing is Essential for Good Core Strength

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

Why is this important?

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

Let me explain…

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

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

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

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

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

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

1. Chest breathing

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

2. Your neck feels tight

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

3. You hold your breath when you exercise

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

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

Remember that good core strength starts with your breath!

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

Man getting knee pain treatment

Could your Knee Pain be Caused by your Lower Back?

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Is your knee pain actually due to a problem in your knee – or could it be caused by your lower back?

One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the source. And often times that source can be your lower back.

One of the biggest clues that you’ve missed 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, and stretching… but no matter what, your knee pain just won’t seem to go away.  This is often when knee doctors start to get involved, which is great if you actually have a knee problem. Knee pain that doesn’t respond to conservative treatment should be looked at further. It’s possible that you might need some kind of procedure or surgical intervention.

But what if your knee pain is a symptom of something else?

 

If so, and you don’t get it properly checked, then you risk having unnecessary knee surgery. 

I just spoke to someone who this happened to. She had knee surgery to “clean out” some wear and tear from arthritis after trying several months of physical therapy. She was told it would be a “quick recovery” and that her pain would be significantly reduced. 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 surgery! She came to us for a second opinion, and the very first thing we did was screen her lower back to see if it might be the cause of her knee pain. Turns out it was! This woman’s knee pain was never actually coming from her knee, and she ended up having unnecessary surgery because the root cause – her lower back – was missed. 

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 even if you don’t have any knee pain. This is why you should never dictate your treatment plan, and certainly not surgery, based on an MRI or X-ray alone.

Here are a few clues to help you figure out if your knee pain could be coming from your back.

 

First, pay attention to how and when your knee pain started. If you’ve had a fall or some kind of trauma to your knee, and you experience knee pain or swelling shortly after, then odds are very good you have an isolated knee problem. With isolated knee injuries, you often know exactly when and how you hurt your knee. It may have been associated with a pop or specific strain of some kind. But if your knee pain comes on slowly or out of nowhere, then you must consider that the source of the problem could be elsewhere. 

Another clue is how your pain behaves. When your lower back is the source, often you’ll have difficulty pinpointing exactly where your knee pain is. It may feel dull or even numb. It might move around, or perhaps travel up or down your leg. One day your knee will feel great, and other days it could feel excruciating. When someone comes into our office with pain like this, we ALWAYS check their lower back first. Knee pain that moves around a lot, or that comes and goes frequently, can quite often be due to a back problem.

If you’ve been suffering from knee pain for awhile, it’s worth considering that the root source of your problem could be your lower back.

Before you think about getting images of your knee, or undergoing some kind of surgery or procedure, you’ll want to make certain that your knee problem is indeed a knee problem.

 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. To get a free copy of her free guide: 7 Ways to Stop Knee Pain – click here.

Could your Hamstring Strain Actually be a Back Problem?

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

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

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

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

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

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

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

And her instincts were right! Let me explain.

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

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

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

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

Has anything like this ever happened to you?

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

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

MRI

How MRI’s Lead Back Pain Sufferers Toward Unnecessary Procedures

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

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

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

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

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

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

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

Here’s the problem.

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

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

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

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

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

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

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

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