Tag Archive for: mechanical pain

When Your Stretches Don’t Work – This Could Be Why

/in /by

If you’ve ever told someone you’re dealing with tight hips, tight hamstrings, tight calves, or a tight neck, chances are the next thought was: “I just need to stretch more.”

As a physical therapist, this is one of the most common assumptions I hear — and one of the biggest misconceptions when it comes to muscle tightness.

Stretching is not always the solution.
And in many cases, it’s not the problem either.

Tight does not automatically mean short, restricted, or in need of aggressive stretching. Understanding why a muscle feels tight is the key to creating real, lasting change.

Tightness Is Often a Sign of Compensation

Muscles don’t work in isolation. They rely on surrounding muscles, joints, and efficient movement patterns to share load and maintain stability.

When something in that system isn’t working well — such as weak stabilizers, limited joint motion, or poor movement mechanics — other muscles step in to compensate. Over time, those muscles become overworked, fatigued, and stressed, which often shows up as a persistent feeling of tightness.

Stretching a muscle that’s already overworking can:

  • Provide only temporary relief
  • Increase irritation
  • Remove tension the body is using for stability

This is why many people feel worse after stretching or massage — or why the tightness returns no matter how consistent they are.

The real solution begins by identifying what the muscle is compensating for and correcting the imbalance at its source through proper strength, movement, and load management.

Why Traditional Stretching Doesn’t Always Help

Static stretching — holding a stretch for 30–60 seconds — has long been considered the gold standard for flexibility. For many people, it works well.

But for others, it does the opposite.

When the nervous system is sensitive, sustained stretching can cause the muscle to guard instead of relax, making you feel tighter afterward. This is especially common in people with chronic pain, recurring injuries, or long-standing muscle tension.

A Better Option: Movement-Based Stretching

If static stretching hasn’t helped, a movement-based approach may be more effective.

Instead of holding a stretch at end range, you gently move into the stretch, ease off slightly, and repeat the motion. This tells the nervous system that the range is safe, allowing muscles to relax naturally instead of bracing.

For many patients, this approach:

  • Reduces guarding
  • Feels less aggressive
  • Leads to more lasting improvements

When Tightness Is Actually Dysfunction

If stretching and strengthening haven’t helped — and the tightness feels deep, stubborn, or unchanged — the issue may be tissue dysfunction, not flexibility.

Dysfunctional tissue occurs when the elastic components of muscle or tendon become disorganized and lose their ability to contract and release properly. This commonly happens after:

  • Surgery (especially with scar tissue)
  • Chronic tendon injuries
  • Old injuries that never fully rehabilitated
  • Trauma or repetitive overuse

In these cases, the tissue itself must be remodeled, not stretched.

This requires progressive, guided loading to restore collagen alignment, elasticity, and tolerance to stress — a process that takes time, consistency, and expert oversight.

Supporting Healing With Natural, Non-Invasive Therapies

At CJ Physical Therapy & Pilates in Portsmouth, NH, we often combine targeted rehabilitation with non-invasive therapies to help stubborn tissue respond better to treatment.

These may include:

  • Shockwave Therapy and EMTT, which stimulate blood flow, cellular activity, and healing in chronically tight or irritated tissue
  • Dry Needling, which helps reset excessive muscle tone, improve circulation, and reduce protective guarding

These tools don’t replace exercise — they help prepare the nervous system and tissue so movement and strengthening are more effective.

What to Do Next

If you feel tight all the time, the answer isn’t always more stretching.

Sometimes muscles are:

  • Overworked
  • Protecting another problem
  • Or dealing with tissue dysfunction that requires a different strategy

If your tightness keeps coming back, feels resistant to stretching, or worsens with aggressive release techniques, it may be time to stop guessing and get expert guidance.

When you treat the source instead of chasing the symptom, tightness becomes something you resolve — not something you constantly fight.

About the Author
Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Pain Expert and the owner of CJ Physical Therapy & Pilates in downtown Portsmouth, NH. She also writes for Seacoast Media Group.

To get in touch or request one of her free guides to back, knee, neck, or shoulder pain, visit cjphysicaltherapy.com or call 603-380-7902.

A Physical Therapy Expert’s Guide to Enjoying Fall Activities Pain-Free

/in , , , /by

A Physical Therapy Expert’s Guide to Enjoying Fall Activities Pain-Free

Fall is my favorite season-and I know it is for many of you too. Crisp air, colorful leaves, pumpkin patches, and cozy outdoor gatherings are some things that come to mind. But there’s also raking leaves, picking apples, chopping wood, and moving heavy things like hay bales or pumpkins. Any of these activities can produce unwelcome strain on your body if you’re not careful. 

Here’s a guide to enjoying all that fall has to offer-from a back pain and mechanical pain expert-so you can do as much as you want this fall season while keeping your back and joints pain-free.

  1. Rake Leaves with Care

Raking is a quintessential fall activity, but it’s also repetitive and strenuous, which can lead to back pain if done improperly. To protect yourself, begin by warming up. Just as athletes warm up before a game, you should warm up before raking. Try a brisk 5-10 minute walk around your yard or neighborhood to get your blood flowing, followed by gentle stretches for your back, shoulders, and legs. A few torso twists and arm circles will help loosen up your muscles and prepare them for the repetitive motions of raking. Next, choose a lightweight rake with a long handle that allows you to stand upright. Avoid bending forward too much, and alternate sides regularly to avoid overusing one side of your body. When bending to gather or bag leaves, squat using your legs and keep your core engaged. Avoid twisting from your waist, as this puts your spine in a vulnerable position. Instead, pivot your entire body to avoid strain. Raking for extended periods can tire out your muscles, making you more susceptible to injury, so set a timer for every 20-30 minutes and take a short break to stretch your back and shoulders.

  1. Safely Pick Up and Carry Pumpkins

Pumpkin picking is a fall favorite, but carrying heavy or awkwardly shaped pumpkins can strain your back and shoulders if you’re not careful. Here’s how to keep things safe and pain-free. First, when lifting a pumpkin, bend at your knees and use your leg muscles to power the lift. Keep the pumpkin close to your body and avoid twisting as you lift. If possible, use a cart or wagon to transport heavier pumpkins and prevent carrying strain. Many farms and pumpkin patches provide carts-take advantage of them! If you’re decorating with multiple pumpkins or other fall items, consider limiting the number of trips you make to and from your car or home to avoid repetitive strain. This advice applies to picking up and carrying anything-whether it’s hay bales, fall decorations, or putting away summer furniture.

  1. Use Good Posture When Apple and Pumpkin Picking

Apple orchards and pumpkin patches can be so much fun, but both activities involve a lot of bending, reaching, and lifting. Use these tips to protect your body. Instead of overstretching to reach that perfect apple, use a ladder or stool. Overreaching can lead to shoulder and back strains, so play it safe and keep a good base of support as you reach up. When standing or walking for extended periods in the orchard or patch, practice standing tall, with your weight evenly distributed between both feet. This not only helps reduce fatigue but also protects your lower back. Additionally, if you know you’ll be walking and standing for prolonged periods, wear good, supportive shoes. This will go a long way in helping your spine and the rest of your joints absorb the load of your body as well as those pumpkins and apples.

  1. Move Often and Stay Hydrated

All-day outdoor fall activities can wear you out, especially if you’re standing, bending, or lifting frequently. Staying mindful of your body can make a big difference. Make a point to take a stretch break every hour or so. Focus on simple movements that lengthen your spine and open up your chest and shoulders, such as reaching your arms overhead and gently twisting your torso side-to-side. Cooler weather can make you feel less thirsty, but it’s still essential to stay hydrated. Dehydration can lead to muscle stiffness, fatigue, and even unwanted spasms and cramps, increasing the risk of strains.

  1. Cool Down After Activities

Once you’ve wrapped up your fall fun, give your body a few minutes to cool down and recover properly. A little bit of post-activity care can go a long way in keeping pain at bay. After raking, decorating, or any heavy lifting, spend five minutes stretching your back, legs, and shoulders. Simple stretches like extending your spine backward or pulling your knees to your chest can help relieve tension. After a full day of physical activity, it’s tempting to sink into a couch or recliner, but try to avoid slumping immediately afterward. Instead, sit with a straight back, or go for a light walk. This can help prevent stiffness and reduce the likelihood of soreness.

Enjoy Fall the Pain-Free Way

Fall activities are a great way to enjoy the season and embrace the outdoors, but they don’t have to come with pain and strain. Taking a few preventive measures, such as warming up, being aware of your body, and using proper lifting techniques, can make a significant difference in how you feel afterward. With these tips, you’ll be ready to fully enjoy apple-picking, pumpkin patches, and all the beauty that fall has to offer-with a lot less ache. That being said, if you try every tip I’ve mentioned and don’t notice any difference in how you feel or tolerate these activities, your problem might need expert help. Reach out so we can help you find a mechanical pain expert in your area who can work with you.

Are you local to Portsmouth, NH? If so, consider speaking to one of my specialists in a Free Discovery Session. This 30-min session is a designed to: 1. Make sure we can help you 2. Make sure you’re a good fit for what we do 3. Make sure we’re a good fit for you. Click here to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, call 603-380-7902, or CLICK HERE to get a free guide for preventing back pain.

Back MRI

Are your Back MRI results reliable? Research says otherwise.

/in , /by

Whenever pain flares up – one of the most popular questions and concerns I get from clients is whether or not they need an MRI. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI, right?

Not necessarily.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. But what we now know from research is that all those findings on an MRI don’t always correlate with what’s actually causing your pain.

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.”

Let me explain.

When it comes to back problems – or joint problems in general – what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature. That means your pain has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration and other age-related changes show up on an MRI.

What it’s important to understand is that disc degeneration, arthritis, and bulging discs are ALL a normal part of aging, but they often get blamed for problems they don’t actually cause. In other words, the source of your pain is often a movement dysfunction learned and repeated over time that is irritating you – not the age-related changes themselves. The best way to figure out if your problem is movement-related vs structure-related is… well… with a movement assessment… NOT an MRI.

So how does movement testing work and why is it more reliable than an MRI? 

This is a great question and not one that is easily explained… but I’m going to try!

When your back, neck or joint pain is mechanical in nature – one of the most important things to look at and pay attention to is how your pain behaves. Not necessarily where it’s located. With pain – the most important thing to determine is how it reacts against certain triggers and with different activities.

Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain?

When your pain is variable, it’s the most reliable sign that your pain is “mechanical” in nature. It also means you don’t need surgery or any kind of procedure to fix it. In fact, a procedure or surgery could leave you feeling worse off than before. Let’s say you “cut out” the structure – or inject it to make it numb – your movement problem hasn’t gone away and it’s only a matter of time before it starts aggravating something else.

Take home point…

MRI’s are a super powerful and amazing diagnostic tool – but their results when it comes to diagnosing neck, back, or joint pain MUST be taken with a grain of salt – and should absolutely be coupled with an expert mechanical joint evaluation before you decide on a treatment plan.

Because if you are dealing with chronic, long-standing aches and pains that have come and gone over the years – or have recently gotten worse – there is a 70-80% chance that it is a mechanical problem finally catching up to you and not a structural problem.

Figure out the root source of your neck, back, or joint pain by seeing a movement expert who specializes in mechanical pain FIRST. Because when you automatically assume that you need an MRI first, and you base your whole treatment plan off of those results – you can end up down a rabbit hole of unnecessary medical procedures or surgery that ultimately won’t give you the long-term relief you’re looking for.

Are you local to Portsmouth, NH?

Consider speaking to one of our specialists by clicking here.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

tight hips

Why Stretching Isn’t Solving Your Tight Hips

/in , /by

If your hips always feel tight – whether during workouts, long walks, or just sitting at your desk – it can be incredibly frustrating. Not only is it uncomfortable, but tight hips often contribute to nagging lower back pain. And what’s even more confusing? No matter how much stretching you do, the tightness keeps coming back.

For me – that’s typically a clue that the problem isn’t what you think it is.

Muscles can feel tight for many different reasons – and not all of them have to do with flexibility. While some muscles truly are short and need to be lengthened – others feel tight because they’re overworked, weak, or compensating for something else. In those cases – stretching alone won’t solve the issue – and might even make things worse.

Let’s break this down…

Take your psoas muscle, for example. It’s one of your deep hip flexors and also plays a key role in spinal and pelvic stability. If your core and glutes (also spinal and pelvic stabilizers) aren’t doing their jobs – your psoas will kick in to help. That overcompensation can lead to it feeling chronically tight – even though it’s not technically “shortened”. So while the inclination will be to stretch your psoas – you’re actually putting an unintended strain on an already tired and stressed muscle. 

While stretching might give you a temporary break in this instance – it won’t address the real problem. You need to strengthen your deep abdominals, your core stability, and your glutes. When all of these systems kick in collectively, your psoas can finally relax – and your chronic tightness will resolve on its own.

But there’s one more thing most people don’t even think of –  and it’s that the tightness in your hip flexors could also be a symptom of a mechanical problem – not a muscular one.

Mechanical pain refers to pain (or tension) that’s caused by poor movement patterns or joint dysfunction, not necessarily tissue damage, compensation, or tightness. If the way your hips, pelvis, or lower back are moving is off – even slightly – your body will compensate. Over time, this leads to overuse of certain muscles – like your psoas, for example – which then feel constantly tight or strained. Unless the underlying movement problem is corrected, you’ll keep chasing symptoms instead of fixing the root cause by constantly stretching.

This concept of tightness due to overworking and compensation can happen to any muscle in your body. With hips in particular, your psoas isn’t the only culprit. Your piriformis and TFL (tensor fascia latae) can become victims of these patterns as well. In addition to your psoas muscle – your piriformis and/or TFL loves to pitch in and compensate for weak gluteal and core muscles as well. An overworked piriformis leads to difficulty sitting cross-legged – and a tight TFL can be painful and lead to IT band problems. You can stretch all you want – but if you don’t address the underlying cause and give these muscles a chance to relax – your hips will constantly feel tight. Plus, stretching in and of itself is a form of load on your muscle. You don’t want to add more load to an already tired and angry muscle.

The moral of the story? 

If your hips feel chronically tight – and stretching all the time isn’t making a lasting difference – it’s time to consider a different approach. Most people don’t think to strengthen a muscle that feels tight – but it might be exactly what your body needs. When it comes to your hips, the areas to assess are your deep abdominals and your glutes. Often, there’s an underlying weakness or movement dysfunction you just can’t see on your own. And if your muscle tightness stems from a mechanical issue – like poor joint alignment or faulty movement patterns – no amount of stretching or strengthening will fully work until that’s addressed.

A trained mechanical pain expert can help you identify whether it’s a strength problem, a movement problem, or a combination of both – so you can finally get lasting relief.

Feel free to reach out to our mechanical pain specialists if you’re local and looking for help by clicking here.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Back MRI

Do You Really Need an MRI for That?

/in /by

Possibly the number one question I get from clients on a daily basis is…

“Should I get an MRI for that?”

Hey… I get it… you’ve got pain that won’t go away and you want to see what’s going on inside… why not?

Not so fast!

What if I told you that getting an MRI too soon (or when you don’t even need one) can actually lead you to getting unnecessary procedures, or even surgery! 

Don’t get me wrong… 

MRI’s are an amazing advancement in medical technology that have saved many lives. And if you’ve had trauma – like a major fall or accident – or you’re exhibiting symptoms that we call “red flags” (progressive/serious neurological deficits, bowel and bladder issues, unrelenting/unexplainable pain) –  then you want to get an MRI. But when it comes to musculoskeletal pain (back, neck, knee, hip, shoulder, etc) – again – unless you’ve had a major fall or trauma – you typically DO NOT need an MRI.

Let me explain…

When it comes to musculoskeletal pain – 80% of the time it’s what we call “mechanical” in nature. That means it’s due to the way you are (or aren’t) moving. For example, let’s say you’re suffering from low back pain and terrible sciatica. Most people in this situation want to get an MRI. And it will reveal anything from a bulging disc, to stenosis, to arthritis, to degenerative discs. Whichever one of these “ailments” shows up on your MRI will typically get blamed as the source of your problem. From there – you’ll typically be prescribed some type of procedure (or surgery) to “fix” said ailment.

Sound familiar?

Well… here’s the thing… research has shown over and over that these so-called ailments appear in the MRI’s of just about everyone over the age of 50. In a 2015 study by Brinkjiki et al – they did MRI’s on over 3000 people who had NO back pain. And you know what they found? For people in their 60’s – they found that 70% of them had disc bulges – 88% had disc degeneration – and 50% had facet degeneration (something you often see with arthritis). And as the age groups increased – so did these ailments!  

The meaning of this and other studies like it is profound…

It means that you absolutely can NOT rely on your MRI to diagnose your problem.

It also means that many people are getting procedures on these normally occurring structural ailments when it’s not even the root cause of the problem.

So what IS the root cause of the problem?

 Typically – it’s “mechanical” – meaning your problem has to do with the way you move, bad postural habits learned over the years, muscular and joint imbalances, or “wear and tear” issues. It’s also why we tend to see more mechanical problems show up in people once they hit age 40 and beyond – because these problems take awhile to manifest.

Although the pain you experience may be coming from one of those ailments we spoke about earlier (for example – a bulging disc irritating your nerve route – a meniscus tear irritating your knee when it moves) – the root cause is how your movement habits are irritating the structure. When you fix the movement problem – the structural issue becomes irrelevant – at least 80% of the time.

If you’re confused – I don’t blame you.

Most medical doctors are not trained in what mechanical pain truly is or what it means. They are trained to diagnose problems using images such as Xrays and MRIs. Nothing wrong with that of course – but it can become a problem when you do an MRI too soon – without first ruling out if your pain is due to a mechanical cause.

If you’re currently suffering from back, neck, hip, knee, shoulder, ankle pain, etc… and you’ve been told you need an MRI to “figure out what’s going on” – hold that thought!

Why don’t you first consult with a mechanical pain specialist. There’s an 80% chance your problem will fall into this category. And you can save yourself from unnecessary treatments that might not work.

You can talk to one of our mechanical pain specialists for free by clicking HERE. It’s a completely free, no-obligation appointment that will give you all the information you need to make the best decision for YOUR health – whether that’s working with us or not!

Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Pain Expert, and owner of CJ Physical Therapy & Pilates in Portsmouth, NH. To get in touch – or inquire about getting help – CLICK HERE or call 603-380-7902

Physical therapist helping patient with natural knee pain relief in Portsmouth NH

Why Cortisone Shots Often Fail in the Knee

/in , /by

When you’ve got nagging, persistent knee pain, it’s common for doctors to recommend a cortisone shot in the knee.

A cortisone shot in the knee, also known as corticosteroid injections, or “steroid shots”, works by reducing inflammation in your knee joint in an effort to alleviate pain. Sounds pretty straightforward, right?  Well… not so fast.

Assuming your knee pain is truly due to inflammation, then yes, a cortisone shot can be a successful treatment option. For example, it’s often used as a pain management strategy when you’re awaiting a major joint replacement surgery.

Advanced osteoarthritis is a common cause of knee inflammation.  The only real “cure” for this is joint replacement. Periodic cortisone shots may help give you the pain relief you need to pass the time until surgery. But this is a very specific and not common circumstance.

What we see more often than not is cortisone shots either working temporarily, or not working at all in your knee joint.

Patients are often told they need up to three cortisone shots to see results. There’s a problem with this approach. Every time you get a cortisone shot, you risk damaging the cartilage and tissue in your knee joint. This not only leads to irreversible joint damage, but more persistent pain in your joint that gets harder and harder to fix.

So when it comes to whether or not you should get a cortisone shot in your knee – you really want to make sure that the root source of your problem is inflammation.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the knee pain you are experiencing might be due to inflammation, the underlying cause leading to that inflammation could be something else entirely. Eight percent of the time the knee pain you’re experiencing is due to a mechanical or movement problem.

So while the symptoms you’re experiencing could be inflammatory in nature, the root cause of your issue is not. A cortisone shot is not going to help your knee in this case. Or worse, you’ll get temporary relief that fools you into thinking it worked. This only delays treatment that will give you the long-lasting relief you’re looking for.

If cortisone shots aren’t working for you, find out how we can help relieve your pain.

So how do you know if you have a true inflammatory problem in your knee?

Let me explain.

Let’s say you have some arthritis and general wear and tear in your knee joint. You have good days and bad days. The pain comes and goes. Certain movements and exercises make your knee feel better while others seem to really aggravate it.

This is a pretty classic presentation of a mechanical knee problem. The mechanical issue (aka movement problem) in your knee can irritate certain structures within your knee joint (like a meniscus or ligament) and cause it to be inflamed.

If you go ahead and just inject cortisone into this knee, it might relieve the inflammation for a short time. It won’t help the underlying movement problem. It’s only a matter of time before the cortisone wears off and the structures in your knee feel irritated again. Not only have you masked the problem, but now you risk creating actual damage to those structures from the cortisone. Studies have shown that repeatedly injecting cortisone into your knee (or any joint) can advance the formation of osteoarthritis.

Another interesting statistic is that 41% of knee pain has been shown to be coming from your spine – even when there is no back pain present.

In this case, your knee could really hurt and appear to be inflamed. If a doctor can’t find any real explanation for this from an X-ray or an MRI (because the real problem is coming from your spine), he or she may assume it’s just inflammation from wear and tear and suggest a cortisone shot. This is not going to help your knee. Once again you risk causing real damage to an otherwise healthy knee joint.

These are just a few examples of where cortisone shots are unnecessary and can go wrong when incorrectly prescribed.

Have you recently had a cortisone shot in your knee and it didn’t work? It could  be that you never actually needed it. Or that the symptoms (inflammation) was being addressed instead of the underlying cause.

If you are considering a cortisone shot in your knee, it’s always a good idea to get a second opinion to make certain you really need it. A mechanical pain expert can tell you whether or not your knee pain is truly due to inflammation. If your knee pain is due to a movement problem (80% of time it is) then a proper movement prescription is your answer.

Are you local to Portsmouth, NH and looking for help with your knee pain NOW?

Consider speaking to one of my specialists.

Tell them about your knee pain and they’ll see if we would be a good fit to help you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. Request a free copy of her Knee Pain Free Report or to get in touch, email her at [email protected].

physical_therapy_seacoast_nh_91

How MRI’s Lead Back Pain Sufferers to Unnecessary Procedures

/in , /by

Have you ever had back pain and wondered…Do I need an MRI to figure it out? One popular questions I get from clients is if they need an MRI when experiencing back pain or sciatica. It’s pretty standard protocol when you go see a doctor – but is it necessary?

In most cases… NO.

About 70-80% 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 can NOT be diagnosed by an MRI. 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 people 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. In fact, he says: “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.”

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

If you’re confused, I don’t blame you.

CLICK HERE to speak with one of my specialists for free. They will figure out the right treatment plan for you. And at the very least give you some helpful tips moving forward.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

/in , /by

Nagging pain in your shoulder can be extremely annoying. But when it starts to interfere with things you love to do – you can’t help but wonder – Will a Cortisone Shot Help Your Nagging Shoulder Pain?

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast.

Just because cortisone shots are extremely routine and popular – it doesn’t mean they are the best or right thing to do.

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action.

But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom?

This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – it’s a problem if you keep getting cortisone shots when you don’t actually need them.

Why?

Well overuse of cortisone shots can cause degeneration of your tendons and joint structures. So you only want to get one when you know: 1) it’s going to help and 2) if it’s necessary.

But how do you know? The key is in understanding the source of your pain. With chemical sources of pain, the source is inflammation and a cortisone shot is a good idea. But when it comes to mechanical pain, inflammation may exist but it’s not the source of your shoulder problem. In these cases, cortisone is either not helpful – or worse – it “works” but then masks your problem, sometimes for years.  

Let’s talk about the two sources of Shoulder pain to help you understand.

 

“Chemical Pain”

Chemical pain is the result of your body’s natural inflammatory response to injury. It’s a complex chemical reaction that occurs after tissue damage that involves the releasing of chemicals from your blood and other cells to “flush out” the area and start the healing process.

A good example of this is when you fall and sprain something. The sprain causes temporary tissue damage so your body creates inflammation to heal it. Normally this process only lasts a few days, your pain subsides, and you’re back to normal in no time. But sometimes this inflammatory process lingers longer than it should.

For various reasons the accumulation of toxic chemicals sticks around and the result is constant irritation to the nerves and surrounding tissues. Constant, dull pain, even at rest, that tends to be very sensitive to any and all movement is often a tell-tale sign that you’re dealing with pain that is chemical in nature. In this case, a cortisone injection could be a good course of action for you.

“Mechanical Pain”

Mechanical pain does not need a cortisone shot and it won’t respond well to it. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. Eighty percent of all musculoskeletal problems – including shoulder pain – are mechanical in nature.

Now, the real problem is that whether or not your pain is mechanical, a cortisone shot often does take away your pain. Not only is this confusing – but many people question why they should even be concerned about this. Well – when the pain and inflammation you’re experiencing is secondary – which is often the case with mechanical pain.

 You never actually treat the true source of your shoulder pain when you “cover it up” with a cortisone shot.

For example, you might have an irritated rotator cuff tendon or arthritis that is exacerbated because of poor posture or immobility in your shoulder joint. If you inject cortisone into your tendon or joint, the pain will likely be relieved. But this will only be temporary. It’s only a matter of time before your poor posture and movement habits cause irritation and pain again. This is the vicious cycle I see a lot of folks get themselves into. You risk never fixing the real problem. And irreversible damage to your tendon that might eventually need to be fixed surgically. 

Moral of this story… don’t rush to get a cortisone shot just because you’ve been told you have inflammation.

You must figure out the source of your inflammation first. Cortisone shots are not necessary if your pain is mechanical in nature. And it might actually prolong your problem. If your pain comes and goes, or you have good days and bad days, this is a classic sign that your pain is likely coming from a mechanical source.

Your best course of action is to work with someone who understands and specializes in this. I’ve seen many cases where getting a cortisone shot provides a false sense of hope, and as a consequence, delays quality treatment that you should be getting instead. 

Are you local to Portsmouth, NH?

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.

If you can’t wait for the call  – get our free guide to neck and shoulder pain now. 

This totally free guide – written by leading back pain specialist, physical therapist, and movement expert, Dr. Carrie Jose – reveals seven easy ways (plus a bonus section!) that are PROVEN to help you ease neck and shoulder pain quickly – without pain medication, procedures, or surgery.

Click here to download the guide!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch email her at [email protected] or call 603-605-0402