Tag Archive for: movement

Pickleball

Six Reasons to Try Pickleball this Father’s Day

If you’re looking for something fun and active to do this Father’s Day – why not try a game of Pickleball?

If you haven’t yet heard of pickleball – it’s quickly become one of the most popular racket sports in the country. It’s a paddle sport that combines elements of tennis, badminton, and ping-pong. Since the rules are fairly straightforward, it tends to attract people of all ages and skill levels – but it’s been a huge hit in the over-50 crowd. You can find both outdoor and indoor courts just about anywhere – and it provides a fantastic opportunity for the whole family to engage in a fun-filled day of friendly competition – while also honoring your favorite active dad.

Pickle ball also comes with a ton of health benefits. 

Here are 6 of my favorite reasons why pickleball is good for your health – and why I think you should give it a try this Father’s Day:

1. Get’s the Heart Pumping:

Since Pickleball is a dynamic sport – it keeps you on the move – making it an excellent cardiovascular workout. When you play pickleball regularly – it can improve heart health, increase endurance, and strengthen your cardiovascular system. Pickleball consists of both aerobic exercises as well as bursts of anaerobic activity – such as quick sprints and lunging on the court. This helps to elevate your heart rate in a way that is great for promoting overall hearth health and cardiovascular fitness.

2. Weight Management:

Everyone knows you need both diet and exercise to effectively manage your weight. When it comes to exercise – why not pick something fun that you know you’re more likely to do because it’s enjoyable. The continuous movement involved in the sport of pickleball helps to burn calories and increase your metabolic rate. But it’s not just cardio that pickleball is known for – there is a strength component too. This combination of both strength and cardio only adds to your calorie-burning – making it not only fun – but an efficient way to manage your weight.

3. Improved Balance and Coordination:

Pickleball requires you to move quickly, change direction, and react to the ball’s trajectory. These dynamic movements help to improve balance and coordination because they force the engagement of multiple muscle groups at once. When you have to anticipate shots from any angle, pivot at a moment’s notice, and reach for the ball – this helps to enhance something called proprioception – your body’s ability to sense position in space. Since pickleball is super popular with the over 50 crowd, anything that works on balance and coordination is something I support – since these two areas only tend to decline as you age.

4. Increased Strength and Endurance:

When you play pickleball – you have to do everything from swing the paddle, lunge at the ball, and reach for shots. These varied physical movements help to engage just about all the muscles in your body – particularly your arms, shoulders, legs, and core. When you play pickleball regularly – it’s going to lead to improved muscular strength and endurance. Plus, pickleball is generally low-impact – so you get to improve your strength and endurance while not having a huge negative impact on your joints.

5. Cognitive and Mental Benefits:

The strategic aspects of pickleball – such as shot placement, anticipating your opponent’s moves, and the adaptation to different playing styles – challenges your brain and enhances mental agility in a fun and active way. For example, just the hand-eye coordination required to track the ball and make split-second decisions sharpens your cognitive skills and improves your reaction time to things. When you play pickleball regularly – you’ll find that your focus, concentration, and overall mental well-being will simply improve.

6. Social Interaction and Emotional Well-being:

This is probably my most favorite health benefit of pickleball. For the younger crowd (30’s and 40’s) – it’s quickly becoming one of the hottest business and networking events out there. And for everyone else, it’s a fabulous social sport that encourages interaction and camaraderie. Regardless of who you play with – whether it be friends, family, or in a community league – pickleball fosters a sense of belonging and enhances social connections. Plus, the positive connections you find on the court can easily extend off the court – so it becomes a fun and active way to quickly expand your social circles and overall well-being. Your new pickleball buddy could suddenly double as your gym and walking buddy too.

So there you have it – six healthy reasons to try Pickleball if haven’t already.

And why not use Father’s Day as the perfect excuse to to make it a family affair. With any new activity, there’s always a risk of injury, so make sure you warm-up properly and go into  it with ease – especially if it’s your first time. And if you’re currently suffering from an injury that is keeping you from wanting to even try this super fun and accessible sport – consider talking to a movement or mechanical pain expert who can help you sort out what’s going on.

Are you local Portsmouth, NH?

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

CLICK HERE to request a Free Discovery Session 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. To get in touch, or request a free copy of one of her guides to back, knee, neck or shoulder pain, visit her website www.cjphysicaltherapy.com or call 603-605-0402

tendinosis

Why the Difference between Tendinitis and Tendinosis Matters

Tendinitis and Tendinosis: Why the Difference between them Matters.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sciatica

Suffering from Sciatica? The Do’s and Dont’s

Four out of five people will experience a debilitating back pain and Sciatica episode at one point during their lives. Sometimes this looks like severe back pain that lasts a few days and eventually goes away on its own.

But for some – especially those that have experienced more than one debilitating back pain episode over the course of their lifetime – they experience searing pain down their leg that may or may not persist over a period of time.

When you experience back pain followed by radiating leg pain – this is known as “sciatica”.

Sometimes the pain will only go to your knee, or be a dull ache in the side of your hip and leg. But other times it can manifest all the way down to your foot and be accompanied by numbness, tingling and a loss of strength.

The good news is that there is plenty you can do on your own to help yourself recover from sciatica naturally. But there’s just as much you can do – unknowingly – to make your situation worse.

Here are some Do’s and Don’ts when it comes to sciatica.

The Dont’s:

1. Avoid resting in bed or on the couch.

While it may feel better in the moment – lying in bed or on the couch will ultimately aggravate your sciatica. Sciatica is caused by pinching or irritation of the nerves in your lower back. When you lie in a slouched posture (such as in bed or on the couch) you will put unwanted pressure on these nerves, thus aggravating your symptoms.

The trickiest part about this is that you typically won’t notice the aggravation when you’re resting. You’ll notice it after the fact when you stand up or try to move around, and mistakenly assume the movement is what’s aggravating you instead of the relaxed posture you were just in.

2. Avoid child’s pose and stretching forward.

This is another big misconception about sciatica because it tends to feel really good when you’re “in the moment” and stretching your back forward. Not always, but often, sciatica is caused by a bulging or herniated disc that is pinching your nerve.

The position of bending forward does temporarily relieve pressure on your nerves – which is why it feels good at first – but it doesn’t last.

Stretching forward also opens up the space between your vertebrae. This can influence the protrusion (bulging) of your disc. If you allow your disc bulge to protrude more onto that nerve – your nerve will become more angry and aggravated – as will your sciatica.

3. Don’t let your MRI decide treatment.

As I mentioned in our first two examples, sciatica often involves bulging discs and irritated nerves. And an MRI will typically confirm this. But here’s the thing – tons of people out there have bulging discs showing up on their MRI’s and no symptoms at all.

What matters is whether or not your bulging disc is interacting negatively with your nerve – and that is typically influenced by poor movement strategies.In other words, if you learn how to move better, you can actually make your bulging disc inconsequential and your sciatica will dissipate.

So you should never let your MRI, alone, determine your treatment protocol when you’re suffering from sciatica. What’s more important is how your sciatica symptoms behave during movement. Research has shown this to be more reliable than imaging alone because it tells us in real time what’s happening to your nerves.

The Do’s:

1. Keep moving.

While it may seem counterintuitive to move when you’ve got pain running down your leg – it’s one of the best things you can do.

Try to stand and walk upright as much as you can and pay close attention to what happens in your leg. If the symptoms in your leg start to subside, then you’ll know that your body is enjoying that particular movement and that it’s helping your sciatica.

But here’s the catch – make sure the relief lasts. Lasting relief (vs temporary) is what we’re looking for and it tells us if the movement you’re doing is a good thing for your sciatica.

2. Watch your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. Remember that sciatica typically involves a pinched or irritated nerve – and irritated nerves are highly sensitive to postural changes in your lower back (especially slouched postures).

Whether you’re standing, sitting, or lying down – be sure to maintain a small curve in your lower back to minimize your slouch. This helps to keep pressure off your discs and already aggravated nerves.

3. Talk to a Movement Specialist.

While it’s entirely possible to rid yourself of debilitating sciatica without pain pills, procedures, or surgery, you’ll find it easier to do so under the guidance of a movement specialist who specializes in understanding back pain and sciatica.

Yes – you can get an MRI and go see a surgeon – but they aren’t movement specialists. They are surgical specialists. In order to get rid of your sciatica the natural way (with corrective movement strategies) – you need to work with someone who’s an expert in this.

Have you been dealing with back pain or sciatica? Or do you know someone who is?

If you”re local Portsmouth, NH, and you want help NOW for your back pain – Request a Free Discovery Session from one of my specialists. They’ll tell you if we can help and get you set up on a treatment plan right away!

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].

Active and Mobile

Five Easy Ways to Stay Active and Mobile this Thanksgiving

Thanksgiving is one of my favorite Holidays and it’s right around the corner. Rest and relaxation might be top of mind for you. But, it’s still important to stay active and mobile throughout the day. 

Our spine and joints don’t like to be sedentary for prolonged periods. And that’s especially true if you’ve got arthritis, back or knee pain.

You may not notice any pain while you’re sitting or relaxing, but you will pay for it the next day if you don’t find ways to keep moving.

So here are five very easy ways to help you stay active and mobile this Thanksgiving:

  1. Interrupt Your Sitting.

Our bodies were not designed to sit for prolonged periods, so getting up frequently is an easy way to not only incorporate movement throughout your day, but to help keep away back and knee stiffness. I recommend standing up at least once every 30 min.

This could be a fun assignment to give a young child. Make them accountable for watching the clock and remind you to stand up. This is quite possibly the easiest and most effective strategy to keep your knees, hips, and spine from getting painful and stiff throughout Turkey Day.

  1. Do a Turkey Trot.

Thanksgiving Turkey Trots are a popular event in most towns and it can be a really fun event for the whole family. Turkey Trots are typically 5K’s – or 3.2 miles. If you’re not able to sign up for an actual race, grab your friends and family and create your own Turkey Trot within your neighborhood.

If you can’t coordinate a time to do this in a group, take a virtual trot together and stay connected via your smartphone. Either way, whether you walk or jog, it will feel great to get your Thanksgiving Day started with lubricated joints and blood flowing. 

  1. Stretch During Commercials.

Whether it’s the Macy’s Day parade, football, or both – it’s easy to find yourself sitting for hours on a soft sofa or recliner. A very easy way to keep yourself from sitting or slouching too much and to incorporate some healthy movement into your day is to get up during commercials.

It’s the perfect opportunity to do a quick 2 min exercise or stretch.  It doesn’t have to be complicated. Choose from a quick set of squats, heel raises, planks, or back stretches. You can alternate through these during each commercial break and your body will thank you for it.

  1. Walk Your Dessert Off.

Just because you did that Turkey Trot in the morning doesn’t mean you have to be done for the day. Rather than feeling like you need to skip dessert – just plan to walk it off afterwards.

Walking is one of the best and most natural exercises you can do. And it gives you many of the same benefits of running (only slower).

Walking is very functional, and it’s good for your hips, back and knees. Since we tend to sit and bend so much during the day, walking is a very natural and active way to get some much needed lengthening and stretching into our bodies before we settle in for the evening. 

  1. Help With Cleaning Up.

Don’t be shamed into “just sit down and relax” because you’re a guest. Helping with clean-up (or set-up) is an easy and effective way to keep moving during your Thanksgiving Holiday.

Not only will your Thanksgiving host love you – but your body will too.

If you’re suffering from back problems, be careful bending and leaning over – especially if it’s repetitive – when you’re collecting or washing dishes. But otherwise, carrying heavy plates, moving chairs, and wiping down tables can burn quite a few calories and it’s good for your body.

There you have it – if you don’t want your Thanksgiving Day to be sedentary – you now have five easy ways to stay active and mobile.

I hope you have a wonderful Holiday and get to spend it with those you love most.

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

When You Can’t Feel Your Abs

I’ve been a physical therapist for 20 years, a Pilates instructor for 11, and have been specializing in back pain for the past 10 years of my career. When it comes to core strength and preventing back pain, I am an expert in my field. Yet for some reason this morning, during my Pilates workout, I just couldn’t feel my abs. I teach people how to do this every single day yet this morning, I couldn’t seem to access my own.

What was happening?

And more importantly – if it can happen to someone like me – it can certainly happen to someone with less training than I have. I started to think about all the reasons this could be happening to me. Had I gotten enough sleep? What had I eaten the day before? Could it be stress?

And then it hit me.

I had just come back from a 2-day course where I’d been sitting far more than usual. I sat for 8 hours straight. Two days in a row. Not to mention all the very cramped sitting I did on the plane to and from this course. When one of my clients is about to have a few days like this, this is what I recommend. Get up from your chair and stretch backwards as frequently as possible every few hours.

But guess what – I didn’t follow any of my own advice. The result? A stiff back and sleepy abs upon my return.

Our bodies are highly intelligent and have every capacity to heal themselves when given the right environment. Conversely, when in the wrong environment, our bodies will also do what it takes to naturally protect from harm and injury. In my case, I came home from this course with a stiff lower back.

Back stiffness is the first sign that your back is not happy. This means your chances of tweaking it or exacerbating an old back injury are higher. When any joint is stiff and not moving well the muscles surrounding that joint will become naturally inhibited or weakened. This occurs on purpose as a protection mechanism. Your body doesn’t want a fully contracted muscle compressing an unhappy joint. In the case of your lower back, the muscles that can get inhibited when your back is not happy include your abdominals as well as back muscles.

So what can you do when you feel less core strength?

The good news is I’ve already helped you with step one: awareness. Inhibited muscles are not the same as weak muscles. In my case, I do have strong abdominals. My weekly routine consists of a regular Pilates practice, lifting weights, and I perform activities like hiking and running that engage my core. Yet despite all this, my abs were simply not having it this particular morning. They were not set up for a successful workout.

The combination of my stiff back and having sat for several days just meant that I needed to do something different to prepare my lower back and abdominals for this workout – so that I wouldn’t injure myself. My sleepy abs and stiff back were, in effect, trying to tell me just that.

All I needed to do was have the awareness this was happening so I could take appropriate action.

It’s no different than when you go on vacation and you get off your routine by eating more than usual. You might return a bit bloated and not feeling your best self. This kind of feeling we are accustomed to. And might respond by getting a bit strict with our diets until feeling back on track. Our joints can react similarly to a change in routine – we’re just not as accustomed to the signs and symptoms that let us know. But once you are – you can easily manage this and avoid injury. Had I pushed through my Pilates routine as normal this morning despite sensing that my back and abdominal function was off – there’s a good chance I’d be sitting here writing to you with full on back pain instead of just some lingering stiffness.

If you’re reading this, and you’re over the age of 40, odds are pretty good that you’ve experienced back pain at some point in your life. The odds are also pretty good that you’ve experienced back pain more than once.

If this is a recurring pattern for you, your abdominals and deep core may not be functioning at their best.

You could be caught in a vicious cycle of trying to improve your core strength only to keep hurting your back.

The missing solution for you might be that nobody has fully examined your back in a way to ensure that it’s moving fully and freely like it should. Once your back moves well, you can usually start to strengthen your abdominals without a problem.

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

The take home point here is that if you keep experiencing weakness in a particular area despite trying to strengthen it consistently, it’s possible you could have a problem in your joints that is keeping your muscles from fully activating like they should.

Talk to one of my specialists about it.

Someone from my client success team will call you right away and see if you are a good fit for what we do. At the end of the day – we’re here to help.

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

Sciatica_Therapy_Portsmouth_NH_2

3 Reasons You Need PT After Minimally Invasive Spine Surgery

Minimally invasive spine surgery (MISS) started to take off in the 1990’s. It has since become far more common for spinal conditions. Some being degenerative disc disease, herniated discs, spinal stenosis, scoliosis, spinal infections, spondylolisthesis, compression fractures, and spinal tumors.

Minimally Invasive Spine Surgery is a far better alternative to open-spine surgery.

You can expect less anesthesia and less blood loss during surgery. Along with a reduced risk of infection, less pain after surgery, less pain medication needed, smaller scars, shorter hospital stays, faster recovery time, and quicker return to daily activities and work.

But don’t confuse the term “minimally invasive” with minimal risk.

With MISS – you’re still at risk for many of the same consequences of open-spine surgery should things go wrong. Therefore, you want to make sure you really need spine surgery before you go “under the knife” – even if it’s a tiny one.

There are some risks of MISS:

  • Bad reactions to anesthesia
  • Pneumonia after surgery
  • Blood clots in your legs that could travel to your lungs
  • Infection (although this is significantly minimized with MISS)
  • Blood loss during surgery requiring a transfusion
  • Injury to the nerves of your spinal cord

While rare, these are very real risks and they do happen. Risks like this don’t occur with conservative treatment – such as specialized physical therapy.

It’s why I’m a huge advocate of folks not undergoing surgery until all conservative approaches have been exhausted. Or if you’ve got what we call a progressive neurological deficit occurring. Such as quick deterioration in your muscle strength, ability to walk, or ability to control your bowel/bladder.

All that being said – assuming you really do need surgery and will benefit from MISS – you still need physical therapy.

I’m amazed at how many surgeons no longer prescribe rehab after a minimally invasive procedure. Just because recovery time is reduced – doesn’t mean you don’t need a specialist to help you recover properly.

Here are 3 reasons you need PT after minimally invasive spine surgery:

1. Proper scar management

Minimally invasive procedures already do a great job of reducing scar formation. The incisions are smaller and less invasive, but there is still an incision. And the incision with MISS is deep because you have to get to the layers of the spinal nerves, vertebrae, and discs. Because the scars are small, people mistakenly assume they will heal without issue. The truth is they might. But the odds of your scar healing properly are much better with professional scar management. Scar mobilization should begin about 2 wks after MISS.

A specially trained physical therapist will not only help you manage your scar healing, but teach you how to do it on your own. You’ll improve blood flow to the area of the incision (which promotes healing), increase soft tissue mobility, and help reduce any swelling that formed in the area.

2. Restore pre-existing impairments

Odds are pretty good you didn’t end up with spontaneous MISS. You likely had a long road leading to your surgery. It’s critical you go back and address all of the problems that occurred prior to your procedure.

This includes everything from muscle weakness, to poor compensatory movement strategies your body adapted to deal with pain, immobility that occurred either because of pain or to protect you from pain, and residual numbness and/or radiating pain that is still in your legs. MISS might do a great job of quickly getting rid of your back pain, but something led to that pain to begin with.

The absence of pain does not equal the absence of a problem. Now is the perfect time to work with a specialist who will help you not only optimize your recovery from MISS – but make sure the problems/impairments that led you to the operating table to begin with don’t come back.

3. Restore deep core strength

Chronic pain tends to inhibit the ability for muscles to work properly. If you’ve been suffering from back pain for awhile – odds are pretty good your deep core strength is not where it needs to be.

Plus, good core strength is critical for the prevention of future back problems (yes – you can still get back pain after back surgery). Ideally, now that your minimally invasive procedure has either eliminated or significantly reduced your back pain, it’s more critical than ever to work with a specialist who can help you restore your deep core strength. They’ll know how to do it safely and effectively – to not only help you recover from your MISS faster – but keep the original problem from coming back – because it can.

If you’re considering any type of surgery – but especially back surgery – I always advocate getting a second opinion first – even if the procedure is minimally invasive. Eighty percent of the time – back problems can be resolved without surgical procedures.

CLICK HERE to get a second opinion from one of my specialists.

If you truly want to avoid surgery – and we think we can help you do that – we’ll let you know and get you scheduled with us as quickly as possible.

However, if you’ve recently undergone MISS, ask your doctor to refer you to physical therapy. Many surgeons won’t. It’s going to help you recover optimally and faster – and will set you up for the best possible future success when it comes to back problems.

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

How to Prevent Knee Pain When Hiking

Hiking is a popular way to stay active during the summer months – but it can also wreak havoc on your knees.

Personally, I love to hike. My pup (Bodie) and I are currently in the process of conquering the 48 4K footers of the White Mountains – and the very last thing I want is for knee pain to get in the way of that journey.

The good news is that there is quite a bit you can do to prevent knee pain when hiking. So when one of my readers asked this week – “How do I prevent knee pain when hiking?” – I couldn’t wait to answer it.

Here are 4 of my top tips to help you prevent knee pain when hiking.

 

1. Strengthen your hips and core

Your hips and core provide much needed support for your knee joint to function properly. The large bone in your thigh, called your femur, makes up your knee joint on the bottom, and your hip joint on the top. Your hip joint is connected to your pelvis, which houses major core muscles groups like your glutes.

Let’s say your glutes (part of your core) and hip muscles aren’t as strong as they could be. When you’re trying to climb up a large rock or steep trail, for example, your glutes and hip muscles are supposed to stabilize your pelvis so that your femur can easily extend your hip. When not strong enough, your pelvis will tilt to compensate – which impacts the alignment of your femur – and ultimately the alignment of your knee.

When I hike a 4k footer – I get in approximately 27,000 steps. If your knee is compensating for every one of those steps – it’s eventually going to hurt. If hiking is something you love to do, it’s critical that you strengthen your hips and core.

2. Keep your knees mobile

One of the biggest mistakes I see when it comes to knee problems is a lack of full mobility. Your knee shouldn’t just straighten, it should be able to hyperextend a little bit. When you bend your knee, you should be able to tolerate a full deep squat without any pain. These full end range movements are pretty essential to have when it comes to hiking. Your knee needs to be able to squat, pivot, and tolerate stress on those uneven trails. When you lack full mobility, it impacts your knee’s ability to tolerate these micro-stresses and over time – your knees will ache.

If you’ve got pain or stiffness in your knee in either direction of movement – it’s important to try and push that movement and work through it rather than avoid it – even if your knee seems painful at first. More often than not, the more you move your knee joint, the better it will feel. If that doesn’t happen – then you know it’s time to talk to an expert about it and have them take a closer look at your knee.

3. Work on your balance

Hiking can involve everything from uneven terrain, water crossings, and rock hopping. Good balance is essential for these activities and without it – your knees will suffer.

So how do you work on your balance?

Aside from the obvious (practicing balance exercises), it’s also important to look at a few other things – namely – the mobility of your toes, foot and ankle joints as well as the strength of your arch (plantar fascia). These structures all play a role in how well you’re going to be able to balance. You can do all the balancing exercises in the world, but if you’ve got faulty mobility in your ankle, for example, or a flat, weakened arch – balance is always going to be really difficult for you.

Perform regular stretching of your ankle and calf muscles, Be sure to move those toes – can you lift your big toe up by itself when you’re standing? And use a small ball to regularly massage the arch of your foot to keep it flexible. These small activities can play a huge role in helping you to be able to balance with more ease – especially on the trials.

4. Use Trekking Poles

Even if you implement every single tip I mentioned above, depending on your overall level of fitness, and the condition of your knees prior to when you decided to get into hiking, you could still have some knee pain despite doing “everything right”.

Trekking poles can be a real life saver – or should I say knee-saver.

They help take away some of the stress from your knees and lower legs – especially on really long hikes and technically challenging trails. Plus, if you’re carrying a backpack, trekking poles help to disperse that extra weight away from your knees and into your arms. And added bonus – hiking with poles gives your arms a little extra workout at the same time and keeps your hands and fingers from getting puffy on those extra hot and humid days.

If you love hiking as much as Bodie and I do – then I know the last thing you want is for knee pain to keep you from hiking. I hope these tips help you to ease any knee pain you might currently have as well as prevent future knee pain on the trails.

Do you love to hike but knee pain is currently getting in the way? CLICK HERE to talk to one of our specialists. 

They’ll let you know if we can help – and if you’re a good fit for what we do – they’ll get you on our schedule right away.

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].

Physical Therapist

Piriformis syndrome and Sciatica – PT not working?

I recently polled my readers regarding their most important concerns when it comes to their musculoskeletal health. In other words, what questions were they desperately seeking answers for related to back, neck, knee, hip, shoulder, or ankle pain?

Here is a great question I received from John:

“I’m getting Physical Therapy for lower back pain and sciatica that is said to be from my piriformis. My PT treatment has consisted of various exercises and some massage. Eight sessions in and no change at all. I’m still having pain when sitting or walking a distance. What now?  Do I need an Ultrasound or MRI to see if there is any damage or tear to my piriformis?”

First, John, I’m so sorry to hear you’re still having pain and not seeing any change after a good amount of physical therapy. When it comes to back pain and sciatica, it’s critical that you receive a thorough mechanical and movement examination by your PT before any treatment begins. This should involve repeated testing and retesting of movement and range of motion to determine:

1) where your pain is coming from and

2) what movement patterns trigger and relieve your symptoms

Without this first critical step, you risk missing the root cause of your pain and treating just symptoms. This type of testing is also essential to determine if physical therapy can even resolve your problem. If your physical therapist simply read the prescription from your doctor and dove into generalized treatment protocols – there’s your first problem right there – and it could explain why after 8 sessions you’re seeing no change in your condition.

In your case, it sounds like the massage is intended to treat your symptoms – perhaps your tight, tender piriformis that is believed to be causing your back pain and sciatica. This is perfectly appropriate, however, it’s important to incorporate targeted, therapeutic movement to make the most of what your manual therapy (massage) just did.

In other words, movement is the real “medicine”. Manual therapy is designed to enhance blood flow to and prepare your soft tissue (muscles and ligaments) to be better equipped to tolerate and perform the movement/exercise that is going to have a long-lasting effect.

If the massage and exercise are not done in a specific and targeted way – they aren’t going to have their intended effect. It’s possible this could be happening to you. If you’re not totally clear on what your exercise is for and what the intended effect is – chances are high your exercises haven’t been prescribed to you properly. If you suspect this to be the case, it’s worth your while to try for a different, perhaps more specialized physical therapist before you go jumping into diagnostic tests that could lead you down a rabbit hole of unnecessary procedures or surgery.

Now, let’s assume for a moment that you did receive targeted and high-quality physical therapy treatment and it’s simply not working. This does happen from time to time – but it should only be approximately 20% of the time for the majority of musculoskeletal problems such as back pain and sciatica. And in my opinion, it should be caught well before 8 sessions. In my experience, it takes about 5-6 (quality) PT sessions to figure out if a problem can be resolved with movement and natural means. If not, then a referral to another specialty is necessary.

Are you there yet? I can’t be certain.

But to answer your question about whether or not you need an MRI or Ultrasound… 

If quality, targeted physical therapy has been truly exhausted then yes – either of these diagnostic tests would be the next step in providing valuable information as to what more might be going on.

Ultrasound is a non-invasive diagnostic tool designed to visualize both organs and soft tissue. It could be a good option for examining your piriformis if you are certain that is where your problem is coming from. But piriformis syndrome only accounts for about 30% of all sciatica cases. And typically a tear in your piriformis will not cause pain to radiate down your leg. Most of the time, sciatica is caused by nerve impingement occuring in your lumbar spine (low back). If conservative treatment, like physical therapy, has been fully explored – an MRI could be helpful to see how badly a nerve is being pinched or irritated and whether or not a procedure or surgery is warranted. But in general, the research has shown time and time again that spine surgery is really only successful when you’ve got serious and progressive neurological deficits and symptoms.

In other words, you might have symptoms like foot drop, and your leg is getting weaker and numb by the minute. Otherwise, physical therapy – although it may be slower to work – has equal if not better results compared to surgery and it’s a lot safer.

The caveat, however, is you need to find a good physical therapist.

I hope this helps answer your question. Most importantly – don’t give up hope!

For the next few months I’ll be answering questions like these each week in my articles. If you’ve got your own questions regarding musculoskeletal aches or pains that you want answers for, reach out via the information below.

Local to Portsmouth and feeling frustrated with your current physical therapy treatment just like John?

Reach out – we’d be happy to provide a second opinion. CLICK HERE to request a Free Discovery call 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. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

tendinosis

The Number One Reason your Shoulder Pain isn’t Going Away

Statistics show that shoulder pain impacts approximately 15.4% of men and 24.9% of women. The prevalence of shoulder pain also tends to increase and become more severe as we age, especially for folks in their 50’s.

There are many reasons why we get shoulder pain. It’s the most mobile joint in your body, making it more susceptible to injury. But why – for some – does it seem to just linger and not go away?

The number one reason is mis-diagnosis. Here are a few examples of what that looks like.

  • Your MRI says you have a rotator cuff tear – so you get surgery – yet the pain comes back or doesn’t fully resolve like they told you it would.
  • You’re told you have impingement syndrome – so you get arthroscopic decompression surgery – no success.
  • Perhaps you’ve been told you have tendonitis in your shoulder and need a cortisone shot – followed by physical therapy. Nope, that didn’t work either.

When it comes to shoulder pain, it’s critical that you know for certain the pain in your shoulder is actually coming from your shoulder. If not, you’re going to waste your time fixing the wrong problem and are more likely to get an unnecessary procedure or surgery. 

So – if your shoulder pain isn’t coming from your shoulder – then where is it coming from? 

The most common culprit is your neck or mid-back. In fact, studies have shown that 40% of the time extremity pain (including shoulder pain) comes from a source in your spine – even when you don’t feel any pain in your spine. 

Here are a few key signs and considerations to help you figure out if your shoulder pain has been misdiagnosed:

1. Where is your pain located?

When your pain is coming from your shoulder, the pain will be localized to your shoulder joint. True shoulder pain is felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But it will never go below your elbow. If the pain goes past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area), or if you feel pain deep inside of your shoulder blade into your mid-back – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem. 

2. Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening – it’s likely coming from your neck – and could be due to something like a bulging disc – or a restricted/faulty movement pattern that is irritating nerve roots in your neck. You might feel symptoms in your shoulder, shoulder blade, or even down into your arm. What’s particularly misleading is that it’s entirely possible to feel all these nerve symptoms in your shoulder or arm – and not actually feel anything in your neck. If you’ve got more pain in your arm than you do your shoulder, be sure to get your neck fully checked out. This is a huge area of mis-diagnosis for those suffering with long-standing shoulder pain.

3. How is your posture?

Poor posture can wreak havoc on your shoulder joint – without you even knowing it. If you’ve got a really curved middle back, combined with a “forward head” posture, you’re just setting your shoulder up for failure. Chronic, poor posture will crowd the tendons and structures in your shoulder joint over time. Every time you raise your arm overhead, or try to lift something with an outstretched arm – there will be implications if you’ve got poor posture.

The tricky part about this scenario is that you really will have pain in your shoulder. You’ll have wear and tear of your rotator cuff, and you’re more likely to have degeneration in your shoulder joint that might cause it to feel weak. The confusion here is that the shoulder “problems” are actually symptoms. The real cause is your posture and it’s either been missed or not addressed. The good news is that if you address your posture, most of these “wear and tear” shoulder problems will go away naturally, and you can avoid unnecessary procedures and surgery. This problem flies so under the radar that it’s overlooked all the time.

If you’ve got a true shoulder problem and it’s been diagnosed correctly – it should go away with proper treatment.

If that’s not happening, it’s worth considering that the true source of your shoulder pain has been missed. Start by getting a thorough check of your spine.

Don’t know where to start?

You can request a free Discovery Call with someone from my client success team. They’ll let you know if we can help – tell you if you’re a good fit for what we do – and get you on your way to living pain free. CLICK HERE to request a free Discovery Call.

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.

Traveling

4 Tips to Avoid Neck and Back Pain When Traveling

4 Tips to Avoid Neck and Back Pain When Traveling

Memorial Day weekend is the “unofficial” start of summer – and AAA estimates that 39.2 million people will travel this weekend. That’s 8.3% more than last year, and it’s going to mean the exacerbation of neck and back pain for a lot of folks out there – especially the over 40 crowd.

So why does traveling wreak such havoc on our spines? 

Road trips, planes and trains typically involve lots of sitting and driving, which necks and backs just don’t like when done frequently and for prolonged periods. You’re typically off your routine when you travel, and sleep on surfaces you’re not accustomed to.  Any one of these things – but especially when combined together – can flare up old patterns of neck and back pain.

The good news is there are lots of things you can do when traveling to ease neck and back pain. Here are 4 of my top tips:

 

1. Use 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. Whenever possible, getting out of your seat often 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 min. 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, when not supported. While it’s perfectly acceptable to sit like this for small increments of time, it will start to cause problems after several hours. Prolonged curvature of your low back puts unwanted stress on the discs, ligaments, and muscles in your spine.

Your neck also responds to this posture by assuming a position we call “forward head”. This can give you headaches, neck pain, and cause extra tension to occur in your mid back and upper shoulders. One of the best things you can do is use a cylindrical lumbar roll to help maintain the natural curve in your low back. If you’re driving, the lumbar support in your seat usually isn’t enough. Take a small towel roll, sweatshirt, or pillow and place it at the small of your back any time you’re sitting. You’ll find it’s easier to maintain the natural curves in your spine – and you’ll have a lot less strain on your neck and back.

3. Bring your own pillow

Sleeping on surfaces we’re not accustomed to can not only ruin a vacation but set us up for unwanted neck and back pain. If possible – bring your favorite pillow from home – or ask for extra pillows wherever you’re staying. If a mattress is too firm for you – you can use pillows to cushion areas of your body like hips and shoulders so that you don’t wake up sore. Conversely, if a mattress is too soft, you can use extra pillows to build up the surface under your waist if you’re a side sleeper, under the small of your back if you’re a back sleeper, and under your belly if you’re a stomach sleeper.

Lastly, if a pillow is too fluffy or too flat – your neck will end up paying for it. When you’re sleeping – the goal is to position yourself in a way that allows your spine to stay in neutral alignment. You don’t want your head tilted down or up – it’s the fastest way to stir up an old neck injury or wake up with a tension headache.

4. Extend instead of bend

Did you know that the average person bends or flexes forward between three and five thousand times per day? When you’re traveling – you’re going to be on the upper end of that metric. Our spines crave balance. And because of the disproportionate amount of time we spend bent over – we need to make a concerted effort to move our spines in the opposite direction. When you’re traveling – look for opportunities to be upright and mobile.

Walking is an excellent, therapeutic activity for your spine – plus – it’s a great way to see the sights wherever you’re going. When you’re practicing the 30 min rule, give your back and neck a nice stretch backwards each time you stand to interrupt your sitting. But probably more important than what you do during travel is what you do when you’re back home. Be cautious when jumping back into your typical gym or exercise routine. All the sitting and bending that comes with travel makes your spine vulnerable for injury. It’s very common to get injured a week or two after you’re home – seemingly “out of nowhere”.

 

Looking for more help with your neck and back pain?

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you get rid of your neck and back pain for good.

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.