Tag Archive for: neck problems

morning neck pain

Three Causes of Morning Neck Pain and What to Do

Waking up with morning neck pain puts a huge damper on your day right from the start. While neck pain may not be at the top of the list when it comes to debilitating musculoskeletal problems (aka people tend to just “live” with it) – it still impacts between 10-20% of the population at any given time – so it’s worth discussing. 

One of the most common problems I see with those suffering from neck issues is that seemingly out of nowhere they can go to bed feeling great – but wake up with a stiff and painful neck that can last up to a day or two. When this pattern starts to repeat itself and goes on for too long – you can end up with a chronic neck problem that doesn’t just show up in the morning – but will start to impact your day-to-day life and get in the way of things you love to do.

Here are Three Common Causes of Morning Neck Pain and What you can Do:

1. Sleeping position

Any joint – including those that make up your neck – will feel strained after being in a prolonged position for too long. In a healthy, uncompromised neck – this is fine if it happens on occasion. But if it’s happening once per month or more – it’s time to address your sleeping position.

Those that like to sleep on their stomachs, or with multiple pillows under their head, are going to have the biggest problems. When you sleep, you want to get your neck as close to what I call a “neutral spine” as possible. That means your neck feels relaxed, maintains its natural curves, and your ears, neck, and shoulder will be aligned on top of one another.  I find the best way to achieve this is by sleeping on your side – or on your back with just one pillow. If you’re a multi-pillow type of person – make sure you’re using the second pillow to hug and support your arm – or in between your legs – not underneath your head.

2. Clenching Your Teeth

While many people tend to associate clenching your teeth with TMJ – or jaw dysfunction, it can cause neck problems as well. When you clench your teeth, you’re also tensing the muscles around your neck. If you do this every night, and for prolonged periods, your neck is going to become very unhappy and start to have problems of its own.

Many folks are unaware they are clenching their teeth at night. But some signs this could be happening to you  include tense or fatigued jaw muscles in the morning, walking up with headaches, or a stiff and painful neck and shoulder when you first wake up. Clenching teeth is often a reaction to stress – so having a good end of day routine could really help with this problem. Be sure to shut off TV and electronics at least one hour before bedtime. Practicing some meditation and/or relaxation breathing just before bed could help too. If all else feels, a night guard could help as well. It won’t stop you from clenching completely, but it will protect your teeth and could minimize your neck pain.

3. A Bulging Disc

This isn’t spoken about too often, but if you’ve got a bulging or problematic disc in your neck – this could be the reason you’re waking up with a stiff and painful neck in the morning. When you lie down and “unload” your spine for a period of time – such as at night while sleeping – our intervertebral discs hydrate and actually get larger. If you wake up with a sudden movement – this could be all it takes to “pinch” that disc and cause your neck to feel “locked up” and with sudden pain.

Now, don’t feel like you need to go running to the doctor for an MRI to figure this out. It’s not necessary. Most people have bulging dics occurring normally as they age throughout their entire spine. They only become a problem when you don’t take care of your spine. When it comes to your neck, the biggest risk factors for turning a normal bulging disc into a painful and problematic one include behaviors such as looking down at your phone, tablet, or computer for too long and not being respectful of the fact that a healthy neck needs to move in all directions – not just forward and down. Doing some simple chin tucks frequently throughout the day and making sure your upper back stays flexible can go a long way in preventing (normal) bulging discs from becoming a problem.

I hope these tips help shed some light on why you might be waking up with morning neck pain and most importantly – what you can do about it. If you try some of these remedies and still find yourself unsuccessful – then it’s time to talk to a mechanical pain expert. There’s no need to rely on pain pills or expensive tests and procedures to resolve morning neck pain. Most of the time, problems like I’ve just described can 100% be resolved naturally and with the right “movement therapy”.

Are you local to 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!

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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 one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Neck Pain

Tech neck: What it is and How to Cure it

Tech neck – also known as text neck – is a commonly used term to describe neck pain that results from overuse of various electronic devices. If you’re looking down at your cell phone or iPad too much, or sitting in front of your computer too long – and you feel pain in your neck – you are likely suffering from tech neck.

So what’s the big deal? Is this even a real syndrome?

I’ll be honest. I had my doubts at first. I’ve been a physical therapist for 20 years and when I first heard this term I thought it was a joke. But over the last 12-15 years I’ve seen more and more cases pop up and I can tell you with certainty that tech neck is, indeed, a real problem for people.

Tech neck – when allowed to go unaddressed – can result in headaches, tension into your upper shoulders, or even pain and tingling into your arms and hands.

The good news – it’s not only entirely possible to get rid of it – but you can learn how to prevent it all together.

So what can you do about tech neck? Here are three simple tips:

1. Be mindful of your posture

When you’re constantly looking down or hunching forward – it eventually wreaks havoc on your neck. Being mindful of your posture is not only the number one way to cure tech neck – but it’s the best way to prevent it.

The biggest problem with poor posture is that you don’t know it’s a problem until it’s too late. Postural problems take a lot of time to reveal themselves. The changes in your soft tissue and the wear and tear on your spinal joints that occur from being positioned poorly and repeatedly don’t happen overnight – and you rarely notice them when they are first happening.

Truth be told, “bad posture” on occasion is not bad for you and should not cause you any major problems. Poor posture all the time is where you get in trouble. That’s why simply being mindful of how you’re positioned when using your favorite electronic devices can go a long way.

2. Use headphones

Our spines crave movement but also alignment. But we don’t want alignment at the expense of other joints – namely – our shoulders. It’s not always comfortable to hold your phone or iPad in front of your face – which is what you need to do if you want to maintain optimal neck alignment when using your device. While great for your neck – this position can cause strain and tension in your upper shoulders.

For this reason I highly recommend using headphones. Especially wireless headphones. This allows you to keep your phone or iPad on your desk while freely sitting upright and talking. Headphones also allow you to use the speak to text feature quite easily so you don’t have to strain your thumbs or shoulders when talking to your friends, kids, or grandkids.

3. Interrupt your sitting and standing

Prolonged posture in any form is not great for you. Our bodies – especially our spines – crave movement. We hear a lot about the detrimental effects of sitting all the time – but standing all the time isn’t great either. When it comes to sitting, your lower back tends to hunch over time which forces your neck into that “forward head” posture when you’ve been sitting for more than 20 min or so. When you add an electronic device to the mix the effects are even worse.

Because of this – standing desks have become much more common over the past few years. But I see folks having problems from standing too long also. If you don’t have great core engagement, for example, which is important when you’re standing for prolonged periods, you might hold tension in your jaw or neck to compensate. This can create unwanted tension and stiffness in your neck muscles.

How do you combat all this?

Simply interrupt your position. Try not to stay sitting – or standing – longer than 30 min at one time. Your body – and especially your neck – will thank you.

Recognizing tech neck early is crucial and if you catch it in time – it’s very easy to cure on your own.

The problem is that it’s something that tends to creep up over time and not addressed until it’s too late. If you’re suffering from chronic headaches, or symptoms down your arms or into your hands – the tips I’ve given you here may not be enough to address the problem.

Don’t worry – you can still get help with these symptoms naturally and without pills and procedures – you will likely need some expert help.

Talk to someone who understands posture and the importance of healthy movement in your spine – they are the best people to help you cure and prevent tech neck.

Local to Portsmouth, NH?

Consider talking to one of our specialists free. They’ll let you know if you’re a good fit for what we do and get you on our schedule as quickly as possible! CLICK HERE to request a free Discovery Call with someone from my client success team.

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 neck and shoulder 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.

Why your Cortisone Injection Failed You

Why your Cortisone Injection Failed You

When you have joint pain that won’t go away, especially after trying lots of physical therapy, your doctor might recommend you get a cortisone shot.

Cortisone shots are often prescribed for things like back pain, bursitis, bulging discs, cartilage tears, osteoarthritis, tendonitis, and many other conditions that are perceived to be inflammatory in nature. While every single one of these conditions can cause things to be inflamed, it doesn’t mean that inflammation is your underlying problem. If something else is causing any of these structures to get irritated and inflamed, then your cortisone injection won’t work. At the very best it will provide you temporary relief, but the problem will ultimately come back in about 6-12 months time.

Cortisone shots also come with many potential problems and side effects. So you really want to be sure that it’s necessary before you get one.

The list includes problems such as: cartilage damage, death of nearby bone, joint infection, nerve damage, temporary facial flushing, temporary flare of pain and inflammation in the joint, temporary increase in blood sugar, tendon weakening or rupture, thinning of nearby bone (osteoporosis), thinning of skin and soft tissue around the injection site, and whitening or lightening of the skin around the injection site. And none of these side effects account for human error with the procedure. If your doctor is “off” with his/her injection – you could end up with unnecessary tissue trauma and pain because your shot wasn’t injected correctly.

So when it comes to cortisone shots, you really want to make sure that 1) the root source of your problem is inflammation and 2) you actually need one.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the actual pain you are experiencing might be due to inflammation, the underlying cause leading to the inflammation could be something else entirely. Cortisone shots are used to address inflammation. But 80% of the time the musculoskeletal pain you’re experiencing is due to a mechanical or movement problem. So while the symptoms you’re experiencing could be due to inflammation, the root cause of your issue could be due to something else. In this case, the cortisone shot will not help – or worse – provide you with temporary relief that leads you to think it did.

Let me explain with a bit of scientific research.

Studies show that 70-80% of people over the age of 50 have a bulging disc on their MRI. 60% have a meniscus tear in their knee. These findings are considered normal as you age. The research also says that not all of these people experience pain. So you can have two people with the exact same MRI findings and one person will be perfectly fine while the other can barely walk. This is how we know that “the finding” (a bulging disc or meniscus tear for example) isn’t necessarily the problem.

The source of the problem is what is causing that bulge or tear to get annoyed.

About 80% of the time it’s going to be something like a faulty movement pattern or “mechanical issue,” such as poor mobility or stability, leading to some compensatory movement strategies in your body. When you don’t move well, structures like normally occurring disc bulges and meniscus tears can get irritated.

For example, let’s say you have a bulging disc in your back. If you sit for most of the day, travel a lot for work, or have a job that involves a lot of repetitive lifting, these types of activities are known to really aggravate a bulging disc. If all you do is inject cortisone to calm down the irritation, you won’t be fixing the real problem… which in this case is your daily movement habits. After about 6 months of returning to all these activities again, the pain WILL come back.

The good news is that there are ways to solve this type of problem (and others) naturally, and without a cortisone injection. But the important thing for you to realize here is that if you did get a cortisone shot recently and it appears to have “failed,” the last thing you want to do is get another one or resort to an even more invasive procedure. It’s possible you didn’t need it in the first place, so you want to make sure that is uncovered first.

So, if you’ve recently had a cortisone shot and it didn’t work, it could very well be that you never actually needed it… or that the wrong problem (inflammation) was being addressed instead of the underlying cause.

If you are considering something like a cortisone shot, it’s always a good idea to get a second opinion to make certain you really need it and that it’s the best course of action for your problem. And if you’ve already had one and it didn’t work, don’t worry, odds are good that there is still a solution out there for you… and it doesn’t have to involve more procedures.

It could be as simple as learning how to move better!

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you avoid quick fixes like cortisone shots and get long lasting results. 

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.

Shoulder Pain

Neck Pain Not Going Away? 3 Reasons Why

Over 30% of people report they have neck pain, and of those, 50% will continue to have problems without any real answers or solutions. And during the pandemic, we saw more people becoming generally less active, falling off their routines, and working from home in less than optimal “work stations”. It’s no surprise that people are suffering from more neck pain than usual.

Having been a mechanical spine pain specialist for the last 10 years – and a physical therapist for just over 20 – I can tell you that resolving neck pain is trickier than resolving back pain.

And there are some good reasons for that. Your neck is the most mobile area of your spine – which makes it more complicated to manage – and the muscles in your neck are a bit more fragile than some of the bigger muscles in your lower back. The way you strengthen muscles in your neck can’t be approached in the same manner you might tackle your lower back – for example.

If you suffer from persistent neck pain – there could be several explanations as to why it’s not going away. But the biggest culprit I have found is an inaccurate diagnosis. Without the correct diagnosis – your neck pain treatment fails – and it’s more likely you’ll be prescribed injections or pills to relieve your neck pain and get stuck with this treatment regimen for the long-term.

Here are three reasons why the root cause of your neck pain might be getting missed – and why your neck pain just isn’t going away:

 

1. Your neck problem is disguised as shoulder pain:

Shoulder problems are confused with neck problems more often than you would think. If this happens – you risk spending weeks (or months) trying to resolve shoulder pain that is actually a neck problem. Not only will your shoulder pain not fully resolve – your neck pain won’t either – and could actually become worse. Because your neck is so mobile, it’s easy for nerves in your neck to get irritated and refer pain into the middle of your shoulder blade, top of your shoulder, or down the side of your arm. When you consider this, it makes sense why neck problems are so easily mis-diagnosed as shoulder problems. It’s a very common scenario that not only results in neck pain not going away – but persistent shoulder problems too. My general rule of thumb – if you’ve been working on a particular problem persistently and consistently for 2-3 weeks or more without significant improvement – something is missing. You’re either treating the wrong thing or have the wrong treatment approach. It happens a lot with neck pain so be sure to pay attention to this common error – especially if you’ve got coinciding shoulder pain.

2. Your core is weak:

Lack of core strength is commonly associated with back problems – but believe it or not – it can have a lot to do with neck pain too. Most people are familiar with how muscles and joints are connected – but did you know your muscles and organs are connected as well? They’re connected by a web of tissue called fascia – and this connection is often referred to as myofascial. “Myofascially speaking” – your deep neck muscles are connected to your core. If your core isn’t functioning properly – your neck will try to compensate and it will result in neck pain. Do you consistently feel neck pain or tightness every time you do a core workout? This could be a sign that your neck is compensating for your core – and there’s a good chance proper core strengthening is what’s missing. It could explain why your neck pain isn’t going away no matter how aggressively you treat it.

3. The Wrong Neck Exercises:

The anatomy of your neck, more so than the rest of your spine, is fairly intricate and quite mobile. Not only does this require special care and accuracy when it comes to examining your neck, it makes it easy for someone who is not expertly trained to miss things. For example, one of the most common things I see is someone thinking that full range of motion has been restored in your neck when it hasn’t. If you start strengthening your neck when it doesn’t have full mobility, you can run into problems later on that result in persistent pain. Additionally, strengthening the muscles in your neck, especially in a neck that hurts, needs to be done carefully. The muscles in your neck were designed for stability – which is very different from say – the muscles in your legs – which are designed for power. You can’t approach strengthening them in the same way. All too often I see neck strengthening exercises that are too aggressive for the small muscles in your neck. This results in unnecessary neck tension – and delayed resolution of neck pain.

Generally speaking – if you’ve been suffering from neck pain for a while now – and you’ve tried lots of different treatments without any success – there’s a really good chance you’ve been misdiagnosed and have the wrong treatment plan. Don’t settle for relying on pills or injections for the rest of your life. And don’t undergo any kind of surgery or procedure until you’ve truly exhausted all possible causes of your neck pain. Ideally, find a mechanical pain expert who understands the intricacies of neck problems and work with them. If diagnosed properly, it’s not only possible to get rid of your neck pain naturally, but you can learn to keep it gone all on your own.

 

Ready to get rid of your neck pain?

Download 7 Easy Ways to Get rid of Neck & Shoulder Pain written by Dr. Carrie Jose – leading physical therapy specialist and mechanical pain expert in Portsmouth, NH

5 Signs Your Core is Weak – And What You Should Do About It!

A strong, healthy core is important for our health and posture. When your core is strong and working properly, you will have less back pain, better posture, and will move with more ease and endurance.  But how do you know if your core strength is where it needs to be? 

Here are five signs that might indicate your core is weak and what you can do about it:

1. Your Back Hurts

The most common side effect of a weak core is back pain. Your core’s job is to support your spine and act as the center from which all movement stems. If those muscles are not properly conditioned – meaning, if they aren’t conditioned to engage when they are supposed to – your spine is at risk for being overworked and muscular strain and tension is inevitable. 

What can you do? When it comes to back pain, it’s really important that you talk to an expert about how to properly strengthen your core. Don’t go at it haphazardly. A lot of people jump to core strengthening to fix their back pain when there are other things that need to be addressed first. Without proper guidance, you could make your back worse doing the very thing that is meant to help you.

2. You Have Poor Balance

Believe it or not, it’s not just your feet and ankles that help you balance. Your core strength plays a huge role in this as well. Your core muscles surround your pelvis and help to stabilize it – if those muscles are weak – particularly your hips and glutes – your balance will undoubtedly be affected. 

What can you do? Work your core in a functional manner. If you’re already practicing balance exercises, don’t just hope for sheer luck. Actively focus on the connection between your foot and your deep core. You’ll be surprised at what this visualization will do for both your balance and core activation. If you struggle with this – then it’s a good idea to work with an expert who can help you.

3. You slouch all the time

If you’re struggling to maintain good posture – you might have a weak core. Observe your posture right now. Are your shoulders rolled forward? Is your low back missing its natural curve? Is your head poked forward? When you go to correct your posture – does it feel difficult or tiresome to maintain? If so, your core might need some endurance-training.  

What can you do? This is a situation where consistent core training will carry over into your sitting posture. Your postural stabilizers are what allow you to sustain prolonged sitting and standing postures. The more accustomed they are to being activated and working – the more likely they will naturally kick in when you’re standing and sitting. Over time, it will become easier to maintain good posture and with a lot less effort.

4. Your feet and wrists hurt

When you have a weak core – and lack the proper central support and stability you need – your outer muscles and joints will eventually suffer. We already talked about balance. If your core isn’t working to help you stay more stable, your feet will have to work harder, resulting in overtaxing of the tissue on the bottom of your foot. If your middle back can’t support you when you’re pushing or pulling, your wrists will take the brunt and this can result in stiffness or pain over time. If you’ve got any chronic problem that isn’t getting resolved over time, something is missing. In the case of your wrists and feet – it could be a weak or underfunctioning core.

What can you do? If you’ve been trying to resolve your foot or wrist pain for a while and aren’t getting the results you hoped for – consider shifting your focus to deep core training. I’m not talking sit-ups and crunches, I’m talking about deep stability training that is going to result in a better balanced body – where your wrists, core, and feet are all connected and working together. Something like Pilates can help you achieve this – provided you’re working with a highly skilled instructor. Pilates is specifically designed to strengthen your core in a way that emphasizes full body strength.

5. You’re always holding your breath 

If you’re always being reminded to breathe when you move or exercise, it’s a sign your core might not be working properly. Your deep core is made up in part by your diaphragm, which is your main breathing muscle.  When your core lacks stability, or in most cases, doesn’t know how to engage in the right way, your diaphragm will contract to compensate.  One of the most tell-tale signs that this is happening is that you always hold your breath during exercise. 

What can you do? I always say – when in doubt – just breathe. If you’re breathing through every movement then your diaphragm can’t stay contracted. Start here. If you notice that other things start to get tight and uncomfortable as a result – namely your hips and your neck – then it means you’re now using those muscles instead of your diaphragm to compensate for your weak core. In that case – consider getting expert help because these movement patterns are hard to break on your own. 

If any of these signs sound familiar to you, then you might want to start paying more attention to your core strength!

There’s so much more to a strong core than 6-pack abs and the ability to hold a plank for days. Pay attention to the more subtle signs I’ve just outlined for you. If you’re noticing one or more – it could be a sign that your core needs some extra love and attention – and the you need to learn how to strengthen it properly. 

Are you local to Portsmouth, NH? 

Check out our Pilates offerings and other services here. We have specialists who may be able to help you strengthen your core properly – from the inside out.

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].

Are your Back MRI results reliable? Research says otherwise.

Are your Back MRI results reliable? Research says otherwise.

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.

 

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

 

 

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

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

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

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

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

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

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

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

1. Stop sitting so much

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

2. Walk more 


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

3. Vary your posture

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

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

4. Strengthen your core

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

5. Educate yourself 

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

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

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Shoulder Injuries after Vaccination? What to look for

Shoulder injuries related to vaccine administration (otherwise known as “SIRVA”) is a rare, but possible occurrence when you get any vaccine.

SIRVA happens when a vaccine is injected into the capsule of your shoulder joint instead of your deltoid muscle. It can also occur if the needle being used is not the correct length for you, or if it’s administered too high or too deeply into your muscle. SIRVA is essentially a shoulder injury that occurs due to an improperly administered vaccine – not from the vaccine itself.

Now, it should be noted that this condition is very rare. However, due to the sheer volume of vaccines being administered right now – we have seen a slight uptick in unresolved shoulder problems here in our office. Anywhere from weeks to months after vaccination. For most, the shoulder pain is very mild and it goes away on its own. But for a select few, their shoulder pain has persisted and manifested into a more severe problem. This could be a sign you have SIRVA.

Since the signs and symptoms don’t show up right away, I thought it would be helpful to go over with you what is considered “normal” versus not normal shoulder pain after you get a vaccine.

You’ve likely heard of the “Moderna arm” by now. This is a mild skin irritation specifically related to the Moderna vaccine for COVID-19 that typically involves a mild rash and skin sensitivity after your second shot. It usually lasts about 3-5 days and can be easily treated with topical anti-inflammatories. Moderna arm is not considered to be anything serious, and although it’s not normal to experience this after most traditional vaccines, it is considered a common reaction to the Moderna vaccine. If you’ve recently had your second Moderna shot and are experiencing what you think could be Moderna arm, speak with your doctor or dermatologist if symptoms continue to persist past 5 days, just to make sure there isn’t something else going on.

Localized shoulder pain at the site of your vaccine injection is also normal.

We see this with any type of injection or vaccine into your arm, not just with Covid vaccines. The pain you feel is from the mild trauma caused by the needle being inserted into the soft tissue (muscle) of your arm. It often feels like a bruise, and you may experience a little bit of swelling. It will typically go away after 2-3 days. Even though your arm can be quite sore, the important distinction here is that you’ll still have full, normal function of your arm. In other words, despite the soreness, you can still move your arm freely up and down if you had to without restriction. Your arm soreness will go away with time, but gently massaging the area of pain, and even some easy movement or exercise can help the soreness go away a little faster. 

The symptoms of SIRVA are different, and typically more severe than what I’ve just described above.

If not addressed, some of these symptoms could lead to long lasting shoulder problems. As I alluded to above, one of the main distinctions between “normal” shoulder pain after vaccination and SIRVA is how well your arm functions.

If the needle was accidentally inserted into your joint capsule, for example, you will notice limited mobility and possibly limited strength. When left unaddressed, symptoms like this can manifest into more serious shoulder problems down the line, such as adhesive capsulitis or frozen shoulder.

If the needle was inserted too high or too deeply, you can end up with shoulder bursitis, which means the needle was inserted beyond your muscular layer and directly into the bursa (a cushiony fluid-filled sack), causing it to become inflamed. Your mobility may or may not be impacted when this happens, but what you’ll notice is that your shoulder pain will take a lot longer than 2-3 days to subside. Bursitis is actually a really simple injury to treat, but where I see most things go wrong is that you can end up with compensatory problems in places like your neck, shoulder blade or elbow the longer it is allowed to persist.

The last thing you might see from an improperly injected needle is rotator cuff tendonitis. What you’ll notice with this is that you’ll likely have full mobility in your shoulder, but it will be very painful and weak to exert force in your arm.  Much like bursitis, this is not a complicated injury to rehabilitate, but if not rehabilitated properly, it leads to other problems that do become more difficult to treat down the line.

So to summarize, your shoulder WILL hurt after getting a vaccine.

And with the Moderna vaccine in particular, you may notice some skin sensitivity, mild swelling, and even a rash.

But these symptoms should go away after a few days.

If you have shoulder pain that persists, and especially if you’re noticing limited mobility, it’s something worth getting checked out.  The last thing you want is for these symptoms to go on longer than needed, or turn into compensatory, long lasting problems. The good news is that even with SIRVA, these problems and symptoms can be successfully treated naturally, and without medications or procedures. We’ve been successfully helping people right here in our office. If you’re worried about a potential shoulder problem after the vaccine and not sure where to turn – reach out. You can schedule a FREE Discovery Session with one of our specialists right here!

 

Why Proper Breathing is Essential for Good Core Strength

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

Why is this important?

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

Let me explain…

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

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

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

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

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

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

1. Chest breathing

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

2. Your neck feels tight

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

3. You hold your breath when you exercise

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

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

Remember that good core strength starts with your breath!

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