Tag Archive for: New Hampshire physical therapy

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Do Cortisone Shots Work on Herniated Discs?

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Do Cortisone Shots Work on Herniated Discs?

A recent conversation with someone regarding whether or not they should get a cortisone shot in their back to help a herniated disc inspired me to write this article. Why? Because in speaking with her, I realized how misinformed she was about when you should and shouldn’t get a cortisone shot, and what they are and aren’t good for. And I hate to see people getting procedures or injections when they don’t actually need one.

So when is a cortisone shot a good idea?

Cortisone shots work really well when the primary source of your pain in a targeted area is inflammatory or “chemical”. When you’ve got pain that is of chemical origin – then chemical drugs (like a cortisone shot) will work well to get rid of it. So what is “chemical pain” and how is it different? Chemical pain is the result of your body’s natural inflammatory response in response to injury – which produces an influx of chemicals and other nutrients in your blood to heal the injured area. Since this process creates inflammation and swelling – you feel pain. When the inflammatory process is working correctly, these chemicals naturally dissipate as the tissue heals. But on occasion, the process can get out of hand and get dysfunctional. The painful chemicals linger and create an almost constant state of pain that really doesn’t respond to any kind of movement or even rest.  In the case of back pain due to a herniated disc, typically you’ll find that you can relieve it temporarily by changing positions, moving, or going for a walk. But if it’s chemical pain – your back will hurt constantly – it will feel hot and inflamed – and nothing will seem to touch it. While rare, if your herniated disc is causing this type of pain response, then you’ll likely benefit from a cortisone shot. You need to get rid of those chemicals and the cortisone shot will do just that

But most cases of back pain – even those involving a herniated disc – are instead considered “mechanical” in origin.

Mechanical pain is responsible for 70-80% of all musculoskeletal injuries and it has to do with your mobility and movement patterns. Unlike chemical pain – mechanical pain does respond to changes in movement and position. It’s why most people suffering from herniated discs will feel better when they walk, move, or exercise. They can also temporarily relieve their back or leg pain by standing up (for example) after having been sat for a long time. The key recovery tool for mechanical pain is movement – identifying where your mobility restrictions are and where your faulty movement patterns or habits exist. Once you figure this out – the structural component (aka the herniated disc) is irrelevant and you can live with it for years to come without issue. If you’re suffering from back pain or sciatica, and have been told you have a herniated disc, and what I’ve just described is your typical pain pattern – you will likely not benefit from a cortisone shot and instead need a proper movement/mechanical assessment from someone who’s an expert in this sort of thing.

Now here’s where things get confusing…

If you’ve got a herniated disc – it has the ability to irritate the structures surrounding it – everything from muscles to nerves. I’ve seen people aggravate a herniated disc by simply sneezing or coughing. When your herniated disc gets “angry” and irritates the surrounding structures, you will experience localized inflammation. But it’s different from the dysfunctional inflammatory pattern I described previously. It’s still possible to make this inflammation go away on its own – without drugs – because it’s not in a permanent “chemical” state. But when you’ve got a highly sensitive and painful herniated disc it’s very tempting to get a cortisone shot to relieve the pain.

But here’s why I urge you to think twice… The cortisone shot may provide you with temporary relief – but it will be a bandaid.

Because at the end of the day – the cortisone shot will not address the root cause – the underlying mechanical problem that is causing that herniated disc to keep getting angry. What you risk is that during those periods of “pain relief” – you continue to do things that make that herniated disc worse – because you can’t feel what’s going on. If you keep masking the pain pattern with cortisone shots, and keep unknowingly making your herniated disc worse, you may get to the point where you can’t fix it naturally anymore and will be looking at a surgical fix instead.

Ok – so that was a lot of information and scientific terms thrown at you. But at the end of the day – here’s what I want you to remember and think about if you’re considering getting a cortisone shot for your herniated disc… 

If you can influence your back pain with any sort of movement or activity – then it’s not the type of pain that warrants a cortisone shot. Cortisone shots do nothing to affect a structure (aka herniated disc) – they only eliminate chemicals that are causing pain. And the short-term pain relief from the cortisone shot will not outweigh the potential long-term and harmful consequences you could experience by not addressing the root cause. But if you’re experiencing the sort of back pain that is hot, inflammatory, and not responsive at all to movement, activity, or positional changes – then you’ve got a situation where a cortisone shot might be beneficial – and could get you over the hump that is needed for movement and activity to actually help.

At the end of the day, before you consider any kind of injection or procedure, be sure you’re well-informed and have asked all the questions necessary to be sure that a natural alternative is not still available and worth trying.

If you are local to Portsmouth, NH – consider speaking to one of my specialists. We will ask you all about what’s been going on and see if we would be the best fit to help you. Click here to request to speak with a specialist.

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

Holiday Stress

3 Tips to Avoid Unwanted Aches and Pain from Holiday Stress

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3 Tips to Avoid Unwanted Aches and Pain from Holiday Stress

The holiday season is a time of celebration, joy, and cherished moments with loved ones. However, it often brings with it a flurry of activities, responsibilities, and – unfortunately – stress. While the holidays are meant to be a time of relaxation and enjoyment, the reality for many is quite different. The pressure to create the perfect holiday experience – coupled with the hustle and bustle of shopping, cooking, and entertaining – can lead to elevated stress levels. What’s more, this heightened stress can manifest physically in the form of aches and pains, making it essential to manage both our mental and physical well-being during this season.

Here are three of my top recommendations for reducing stress during the Holidays (or any time of the year), to help you avoid unwanted physical aches and pain.

3 Tips to Avoid Holiday Stress:

  1. Prioritize Intentional Breathing

Breathing is one of the most powerful tools at your disposal for rapidly reducing and interrupting stress. The act of taking a deep breath sends a signal to your brain to calm down and relax. This simple yet effective technique can have a dramatic impact on your stress levels in as little as 30 seconds. The beauty of intentional breathing is that you can do it anywhere and at any time—whether you’re stuck in traffic, at your desk, in a crowded store, or even in the privacy of your bathroom.

The premise behind intentional breathing is to interrupt the accumulation of stress. By doing so, you decrease the overall toll it takes on both your body and mind. When stress builds up, it can manifest physically, leading to muscle tension, headaches, and even neck and back pain. Therefore, taking a moment to practice intentional deep breathing can make a significant difference in how you feel during the holiday season.

  1. Practicing Gratitude

Gratitude is a powerful antidote to stress. Studies have shown that practicing gratitude can lower cortisol levels in the body by approximately 23 percent. Cortisol, often referred to as the stress hormone, is responsible for many of the negative effects of chronic stress, including high blood pressure and an increased risk of heart disease.  Chronic stress can also be responsible for unwanted muscle tension – especially in areas like your neck, back, and hips.

When we focus on things we appreciate and practice gratitude, we activate the parasympathetic nervous system, which is responsible for calming the body and returning it to its natural rhythm. By consciously practicing gratitude, you actively lower your stress levels. This not only benefits your mental well-being but also has a positive impact on your physical health. Reduced stress can lead to lower blood pressure, improved sleep quality, and decreased muscle tension.

  1. Incorporate Physical Activity

Physical activity is a powerful stress-reduction tool with numerous benefits for both body and mind. Engaging in regular exercise helps boost your mood by releasing endorphins, the body’s natural stress and pain relievers. Additionally, physical activity helps put an end to the “fight or flight” response triggered by stress.

In ancient times, our fight or flight response served to protect us from immediate danger, such as being chased by a predator (aka Lion). Physical movement, like running, signaled the end of the stress cycle by telling the brain that we were safe. In the modern world, stress triggers may not be as obvious, but they can still activate these ancient systems. When stress becomes chronic and prolonged, it can have detrimental effects on your physical and mental well-being.

Purposeful movement, even something as simple as a brisk walk, can help break the cycle of stress in your body. Engaging in simple activities like jumping jacks, push ups, or even dancing in your living room can elevate your heart rate just enough to signal the end of the fight or flight response.

While the three essential tips outlined above can be highly effective in managing holiday stress, they may not be suitable for everyone, especially if you’re dealing with pain or injury. If you’re feeling overwhelmed by stress and physical pain this time of year, consider reaching out to a qualified specialist for guidance.

Are you local to Portsmouth, NH?

See if you could qualify for a free discovery visit with a specialist by clicking HERE.

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].

Osteoporosis

5 Ways Pilates can help Manage Osteoporosis

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Osteoporosis is a “silent” disease of the bones that makes them weaker and far more susceptible to breaking.

The Bone Health & Osteoporosis Foundation estimates that approximately 10 million Americans suffer from this disease, and another 44 million have low bone density. Osteoporosis affects one in two women and one in four men. A woman’s risk of breaking a bone when she has osteoporosis is equal to her combined risk of breast, uterine and ovarian cancer. For men, they are more likely to break a bone than get prostate cancer. Hip fractures are common with osteoporosis, and of the nearly 300,000 folks who fall and break their hips, 25% end up in nursing homes and never get back to their previous function.

If these statistics don’t scare you, they should. But the good news is there are plenty of things you can do – starting right now – to help protect yourself from this condition. When you research osteoporosis, diet and exercise consistently come up as key prevention strategies. When it comes to exercise, you want to make sure it focuses on healthy resistance exercises, mobility, flexibility, and balance. 

Well… there happens to be one exercise system that accomplished all of this. It’s called Pilates.

Here are 5 Ways Pilates can help manage your Osteoporosis:



1. It’s a weight bearing exercise

One of the primary recommendations for preventing and managing osteoporosis is to engage in weight-bearing exercises. Well here’s the amazing thing about Pilates – the entire exercise system is based on bearing your own weight through various movements. Pilates gradually progresses you through postures of lying, kneeling, and standing – on both hands and feet – allowing you to bear weight through multiple planes and postures. This makes Pilates an excellent choice for those wanting to better manage their osteoporosis.


2. It improves muscle strength

You might be wondering… how does improving muscle strength help with bone strength? As your muscles become stronger, they pull harder on your bones, which helps improve the inherent strength of your bone. Plus, stronger muscles provide more support to your skeletal system as a whole, putting you at less risk of a fracture. Pilates in particular focuses on core strength – which is key for providing support to all your other muscles. And when you use the Pilates equipment to enhance your practice, you’ve got the resistance of springs putting special focus on all your tiny muscles, which helps strengthen areas of your body that might be inaccessible via traditional strength training methods.

3. It enhances flexibility and range of motion

It’s quite common for your joints to get stiffer and your flexibility to be impacted when you’ve got osteoporosis. You may think this is inconsequential – but stiffness and immobility can actually create more stress on your bones – which is what we’re trying to avoid. Pilates exercises emphasize the stretching and elongation of muscles, which inherently improves your range of motion. This will not only make you feel better – but makes doing everyday tasks a lot easier and they’ll feel less stressful on your body – which is important when you’re dealing with osteoporosis.


4. It encourages proper alignment and posture

Over time, osteoporosis can lead to unwanted changes in your spine, such as a stooped or kyphotic posture. Not only will these changes make it more difficult and uncomfortable to sit upright and move around, but they can make the bones (vertebrae) in these deformed areas of your spine more susceptible to damage. Pilates can help prevent and reverse these changes. Pilates emphasizes lengthened and proper spinal alignment and helps you to become more aware of your posture during the day. If you want to avoid (or even reverse) a slumped and kyphotic posture – with or without osteoporosis – Pilates can help.

5. It helps improve your balance and stability

Fall prevention is critical for those living with osteoporosis. And one of the best ways to prevent falls is to work on your balance. One might not think of Pilates as playing a key factor in this, however, Pilates is an exercise system that not only focuses on your core, but your feet as well. Everyone knows that a stronger core is going to make your whole body feel more stable. But when you’ve got feet that are more mobile and more in-tune with the ground – it dramatically improves your balance – making Pilates a safe and healthy way to not only improve your balance but decrease your risk of falling.

The best management of osteoporosis requires a multifaceted approach – and factors such as diet, nutrition, and exercise modifications must all be considered. Pilates is just one factor in the mix. But I like it because it hits on so many areas that are critical for the successful management of osteoporosis. If you’ve never tried Pilates before, I’d highly recommend giving it a whirl.

But be sure to get approval from your doctor first, and enlist the help of a movement specialist who understands how to work with someone suffering with osteoporosis.

Local to Portsmouth, NH? Consider speaking with one of my specialists by clicking HERE.

 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 enroll in her upcoming OsteoCore Strong Bones Program – visit her website www.cjphysicaltherapy.com or call 603-605-0402

pain

Your Pains Location May Not be it’s Source

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Pain is both a confusing and scary topic.

There’s lots of advice out there on what to do when you experience pain and it’s hard to know who to listen to. Should you rest – exercise – apply heat – apply ice – see a doctor – get an MRI – or just wait it out to see if it goes away on its own? Any or all of this advice could be right – but it’s irrelevant until you accurately determine where your pain is coming from.

For example, if you have pain in your knee, and it’s coming from your back, the best knee treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the most common reasons why so many people suffer longer than they need to, and it’s one of the biggest contributors to unnecessary procedures and surgery. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain, alone, is not a reliable way to figure that out.

Let me explain.

I’ve met people who’ve suffered from unrelenting tennis elbow for years – despite treatment protocol after treatment protocol – only to find out it was coming from their neck. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, they found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms, even when there wasn’t any spine pain. In other words, the pain they were feeling in their knee, elbow, or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you.

But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 40% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear. But what most people don’t realize is that these findings are quite normal and happen naturally as you age.

Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite the science proving this over and over – doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery – they let images and an inaccurate diagnosis lead the way.

Whenever I meet someone with isolated extremity pain, especially if it came on suddenly and out of nowhere, I always consider that it could be coming from their spine.

How can you figure this out?

Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time if it’s not addressed.

Moral of this story… If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source, and that where your pain is may not be where your problem is. And if you’re considering some kind of surgery or procedure, you definitely want to rule out that the problem could be elsewhere.

Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your elbow, knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

Looking for help and local to Portsmouth, NH? Click here to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get one of her free guides to knee and back pain, visit www.cjphysicaltherapy.com or email [email protected].

The Right and Wrong Way to Strengthen Your Core

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Good core strength is an important and vital component to life long health. Everyone knows that it’s an important factor in preventing low back pain, but having good core strength also helps you with your balance, overall stability, posture, and it can be crucial in helping you prevent injuries. Not only that, but when you have good core strength, you simply feel better, and have more confidence to do all the activities you love.

But when it comes to core strength, there’s a right and a wrong way about it.

And when you get it wrong, you’re looking at more back problems, pelvic health issues, and even neck and shoulder pain.

Here are some of the most common ways I see people getting core strength wrong – and what you can do to make it right:

 

1. All you do is crunches

Crunches are often considered to be a staple exercise when it comes to core strengthening. But growing evidence tells us that too many crunches may actually be detrimental to the health of your spine. When you perform an abdominal crunch – it typically involves lying on your back, bending your knees, and lifting your shoulders off the ground towards your knees.

This movement puts a lot of stress on your spine – especially when done incorrectly. If your core strengthening routine consists entirely of crunching – the repeated flexion of your spine will eventually lead to wear and tear on the discs in both your back and your neck.

What to do instead…

First – crunches aren’t “bad” for you. The problem is that people inherently do them wrong. I’ve been a back pain expert for over 10 years and I constantly see people doing this exercise incorrectly. If you’re going to incorporate crunches into your core strengthening routine – make sure you are doing them with proper form, proper technique, and with proper breathing. But even if you are doing crunches perfectly, you still need to include other exercises into your core strengthening routine. You have to balance out the forces on your spine and target other muscle groups that are equally important to a good, strong core.

Exercises such as planks, bird dogs, and bridges are some of my favorites. These exercises target your glutes and back muscles, and will reverse some of the stress caused by over-flexing of your spine.

2. You’re not breathing

You can’t activate your deep core if you don’t breathe properly. Your deep core consists of four parts: your deepest abdominal muscles; pelvic floor muscles, deepest back muscles, and your diaphragm. These four muscle groups work together to control intra-abdominal pressure – which is essential to facilitating a strong deep core connection. If something is off in this system, your intra-abdominal pressure will be distorted, which can create more pressure on structures such as your lumbar discs and pelvic floor region. Also, your bigger core muscles (like your outer abdominals, psoas, larger back muscles, and hips) will overwork or not work correctly.

What to do instead…

While there are good, better, and best ways to breathe when performing core exercises – I always say that when in doubt – just breathe. If you’re breathing, you give your deep core a fighting chance at activating properly. The reason being is because your diaphragm is your main breathing muscle. It relaxes and contracts with normal breath. When you hold your breath, your diaphragm stays contracted. That’s part of what disrupts the intra-abdominal pressure in your deep core. It’s also a good idea to incorporate Yoga or Pilates into your core routine. Both of these exercise practices emphasize breath as a central component and it can teach you how to breathe properly when exercising.

3. You aren’t incorporating rotational movements

Our bodies don’t interact with the world via straight-planed motions. We are constantly twisting, turning, and reacting to our environment in a variety of different ways. One of the biggest mistakes I see when it comes to core training is that people keep it very straight forward (no pun intended) and too simple. You can have a perfectly planned core strengthening routine that hits every muscle group but if you don’t challenge those muscle groups with different angles and combined multi-plane movements, your body gets lazy.

What to do instead…

Well, the obvious answer is to add rotational movements into your core routine.

But what does that look like?

You can add rotation as a challenge to almost anything. If you’re in a plank – rotate to your side and twist your arm up to the ceiling in between each rep. When you’re doing crunches – add cross body reaches each time you lift your head and chest. Rotational movements can also be incorporated into balance work – which inherently works your core.

Once you’ve mastered single leg activities – whether it be standing, stepping up, or lunging – you can add a twist or a reach to the end posture as you hold the movement. The possibilities are quite endless and you can get really creative. The point here is to not be “square”, and add variety to your core strengthening routine so that you mimic real life.

So how does your core strength training routine measure up? Have you been doing it right or wrong?

Here at CJPT & Pilates our favorite way to strengthen the core and whole body is through Pilates. If you’re struggling with pain or just getting started, I recommend consulting with an expert. They’ll be able to guide you in the right direction and set you up for success.

Are you local to Portsmouth, NH and interested in trying Pilates? CLICK HERE to schedule a call with one of my specialists. Learn more about Pilates and see if you would be a good fit!

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].

Holiday Stress

3 Tips to Decrease Stress around the Holidays

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The Holidays are fast approaching and although this is meant to be a joyous time of year – Holiday Stress can sometimes get the best of you.

Why is stress so harmful?

Besides the obvious mental toll that increased stress levels tend to cause, it also has an impact on virtually all systems of your body. Prolonged, unhealthy stress puts your nervous systems on high alert – otherwise known as “fight or flight”.

If not regulated, this can lead to problems such as high blood pressure, shortness of breath, unwanted muscle tension, increased cortisol production, an unhappy gut, and more neck and back pain. The good news is that there are some easy, practical ways to combat the stress of Holidays all on your own.

Here are three of my favorite tips for decreasing stress around the Holidays (or any time of year).

 

1. Breathe Intentionally

Breathing is one of your best friends when it comes to quickly reducing and interrupting holiday stress. As little as 30 seconds can have dramatic effects.

When you breathe deeply it sends a message to your brain to calm down and relax. The best part is you can do this anywhere — in the car, at the office, while shopping, or in the bathroom. Although breathing may not eliminate stress permanently, it does interrupt it. And interruption is key when it comes to managing stress — both emotional and musculoskeletal.

When you interrupt the ability for the forces of stress to accumulate, you decrease the overall toll it can have on both your body and brain.

2. Practice Gratitude

Did you know that gratitude helps lower cortisol levels in our bodies by about 23 percent?

Prolonged stress causes elevated cortisol levels, which causes lots of different health problems such as heart disease and high blood pressure. Research shows that when we think about something we appreciate (i.e. practice gratitude), the parasympathetic nervous system (the calming one) is triggered.

Our parasympathetic nervous system is responsible for returning the body to its automatic and natural rhythm. So when the parasympathetic nervous system is activated, your heart rate and cortisol levels lower. Your sympathetic and parasympathetic nervous systems can’t both be “in charge” simultaneously – so when you consciously practice gratitude – you actively lower your stress.

3. Get Moving

Any kind of movement is going to help you control holiday stress for a few reasons…

First, it gets your blood flowing which contains endorphins — natural chemicals of the body designed to decrease pain and stress.

Second, movement helps to end the “flight or fight” response of your body.

In ancient times, our fight or flight response protected us from danger (like a lion chasing us), by triggering us to run away. Running away (movement) would signal the end of the fight or flight stress cycle by letting the brain know we were safe and out of danger. In our modern world, triggers of stress are not as obvious as a lion trying to eat us, but they still activate the same ancient systems.

In current times, the end of the stress cycle is not always as clear as the final escape from a lion, therefore, it can become prolonged and chronic. Purposeful movement can help decrease stress by physiologically inducing an end to your body’s fight or flight response.

Something as simple as fast walking can do the trick. But even jumping jacks or dancing in your living room can feel good and get your heart rate up enough to end the fight or flight cycle

If you’re feeling stressed this time of year – I hope these tips help. A little bit of stress is normal – but chronic, unregulated stress is not. Give these easy and practical tips a try and see how you do. If they don’t help, then please seek out a professional to talk to.

Cheers to a healthy and stress-free Holiday Season!

If you’re experiencing any kind of back, knee, hip, or neck pain is adding to your stress this season – we’re here to help.

If you’re local to Portsmouth, NH- CLICK HERE to request a Free Discovery Session with us if you’re local to Portsmouth, NH.

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].

 

 

tendinosis

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

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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.

Hip Flexors Always Tight? Maybe stop stretching.

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When it comes to chronically stiff muscles – tight hip flexors are the second most common complaint I hear after tight hamstrings. Tight hip flexors are annoying, achy, and they often contribute to lower back pain. When your hips are always tight, it can interfere with your ability to enjoy walking, running, golfing, and just exercise in general.

Typically – the recommended treatment for tight hip flexors is to stretch – right along with advice to foam roll and massage. But what do you do when none of that works? What if no matter how often you stretch, the tightness just keeps coming back?

First, you need to make sure that the tightness you feel in your hips is actually due to tight hip flexors. Just because your muscles feel tight – doesn’t mean they are tight. 

Let me explain.

Your hip flexors (or any muscle for that matter) can feel tight for different reasons. They can literally be shortened and constricted – in which case – they need stretching – and lots of it. But they can also feel tight due to weakness or being overworked. If your hip flexors are weak, they are going to feel strained when you use them, which can create a sensation of tightness. If your hip flexors are compensating for another underperforming muscle group – say your deep core – then a sensation of tightness may occur because they are simply tired and overworked.

So the first and most important thing you need to figure out is what is causing the sensation of tightness in your hips. Are they actually short and tight? Are they weak? Or do they simply need a break?

Let’s do a quick anatomy review of your hip flexors to help you figure this out…

Your hip flexors consist of the muscle group located in the front of your hip and groin. They are responsible for bending (flexing) your thigh up and toward your chest. But they also play a role in stabilizing your pelvis and lower back – and this is where I see a lot of problems and confusion. The rectus femoris, part of your quadriceps muscle group, and your psoas, part of your deep abdominal muscle group, are the two major hip flexors. Your rectus muscle is the one primarily responsible for lifting (flexing) your thigh. When you are walking or running, and repetitively flexing your leg, this is the muscle primarily at play. Your psoas, on the other hand, is much shorter and has a connection to your lower back. Because of this, it has more of a stability role. When functioning properly, it will assist in exercises like the crunch or sit up, and also work alongside your deep abdominals and glute muscles to help you have good upright posture when you’re sitting or standing.

Let’s talk about the psoas for a moment, because this is where many folks I speak with are misinformed. The psoas gets blamed for a lot of things – most notably – tilting your pelvis forward and being the cause of low back pain. The theory is that if you stretch, massage, and “release” your psoas muscle, then you will balance out your pelvis and your back pain will disappear. Sadly, this is rarely the case. Most of the time, your psoas feels tight because it’s either too weak and not able to keep up with what it’s being tasked to do, or it’s overworking to compensate for your deep abdominals not working properly. Either way, the result will be an angry psoas that retaliates against you by feeling tight and achy. And stretching it over and over again will simply not work.

Now sometimes your hip flexors – particularly your rectus femoris – can get deconditioned from not being used enough – and this can result in actual constriction of your muscle tissue. This typically happens slowly over time, and is more likely to occur if you sit too much and aren’t very active. In this case, you actually do need stretching to fix the problem – but one of the reasons it doesn’t work – is because you aren’t doing it properly. When your muscle tissue is actually constricted – it requires a very specific stretching protocol to work. The days of holding a stretch for 30 sec and repeating it 3x are long over. If your muscle fibers have actually become constricted – the only way for them to improve their length is to remodel. They need a lot of stress to remodel (aka get longer) and the only way to accomplish this is to stretch repeatedly and often.

At the end of the day, if you’ve got chronically tight hip flexors and you’re stretching all the time, you’re either doing it wrong or shouldn’t be doing it at all. Perhaps you need to strengthen your hip flexors so they don’t feel so tense all the time? Or maybe your core isn’t kicking in and you need to strengthen that instead? Don’t stress yourself trying to figure it out on your own.

Talk to an expert who gets this.

Stretching a muscle that feels tight isn’t always your answer, and you’ll know this because stretching over and over just isn’t fixing the problem. 

Request to speak to one of my specialists to see if we are the right fit to help get to the root cause of your tight hip flexors. CLICK HERE to request a Free Discovery.

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

Shoulder Pain

Neck Pain Not Going Away? 3 Reasons Why

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Over 30% of people report they have neck pain, and of those, 50% will continue to have problems without any real answers or solutions. The last 2 years of the pandemic saw 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.

While there are several reasons for your neck pain not going away – the biggest culprit I have found is inaccurate diagnosis. Without an accurate 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. Not working with an expert:

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 despite trying lots of different treatments you’re still having problems – there’s a really good chance you’ve got the wrong treatment approach because you’ve been misdiagnosed. 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 neck pain expert and work with them, particularly one who prioritizes natural, movement-based solutions over pills and procedures. If diagnosed properly, it’s not only possible to get rid of your neck pain naturally, but learn to keep it gone all on your own.

 

Ready to get rid of your neck pain?

Check out this totally free guide on 7 Easy Ways to Get rid of Neck & Shoulder Pain to learn easy tips that are PROVEN to help your neck and shoulder pain – without pills, procedure, or surgery. CLICK HERE to get the free guide.

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

pain

Shoulder Impingement Syndrome – Treating the cause over symptoms

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If you’ve ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge, or place grocery bags on the counter – you were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade. This can occur for a number of reasons… You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder – and if this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation, and you may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions. This is more commonly known as shoulder impingement.
With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally. The tempting and easy fix is to get a cortisone shot to calm the inflammation. But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good. While the cortisone will temporarily mask your problem, it will eventually cause damage to your tendon if you keep getting injections.

Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better – but unless you address the reason for the crowded space – your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back. For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned. With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time – or more quickly if you’ve got something like arthritis where that space might have naturally already narrowed. Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury – and the result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back first.

If there are poor postural habits there, your shoulder will undoubtedly be impacted. If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon). Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it. None of these solutions will give you the long-term solution you’re looking for. The very last thing you want to do is choose passive treatment interventions that either mask the pain or prolong the problem because they only address symptoms. You want to do everything possible to preserve the integrity of your tendon – and the best way to do that is by optimizing the mobility and strength around your shoulder joint first – before resorting to more aggressive measures like cortisone or surgery.

Ready to get help with your pain or injury?

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

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