Tag Archive for: New Hampshire physical therapy

Why Strengthening your Core Won’t Cure your Back Pain

/in /by

As a back pain expert, I talk to folks numerous times per day about the best things they can do to get rid of their back pain. The most common topic that comes up? Core Strengthening. Everyone wants to learn how to strengthen their core properly and more effectively – in hopes that it will put an end to their back pain.

Unfortunately, getting rid of back pain is not as simple as strengthening your core.

I wish it was. Don’t get me wrong – strengthening your core does have its role in both helping and preventing back pain – but core strengthening alone is rarely enough. In fact, sometimes, it can even make your back pain worse, especially if introduced too soon

So why isn’t core strengthening enough? Even when your Medical Doctor, Google, and YouTube all seem to allude that it should be?

Because 80% of the time, your back pain is due to something we call “mechanical” – meaning the source is way underneath all of those core muscles. While strengthening your core muscles will often make you feel better, and may even temporarily relieve your back pain, strengthening your core muscles will never address the mechanical problem underneath. And it will continue to rear its ugly head until it’s finally resolved.

So how do you solve mechanical low back pain so that core strengthening can actually do its job?

First… Let’s talk about what mechanical low back pain is… and isn’t.

Mechanical low back pain is caused by poor postural habits and repetitive movements and stress that occur slowly over time – and eventually lead to movement dysfunction within the spine. It arises from things like having a job where you sit for 8 hours a day, 5 days per week. Perhaps you’re a new mom and are constantly bending over to care for your new baby. You love to garden, or you’re an avid golfer, and have been doing these things for years. All of these “lifestyle” habits and requirements can be responsible for mechanical low back pain.

But what back pain is often blamed on are structures. Things like herniated or bulging discs, arthritis, stenosis, and pinched nerves. What you have to understand is that most of these ailments occur normally as you age. The majority of the population over the age of 50 will have one or more of these “abnormalities” show up on an MRI – even when they don’t have any back pain. But when you’ve got a mechanical back pain problem – one where your spine isn’t moving as well or as normally as it should – these structures become susceptible for irritation. So yes, the structures cause the pain, but the underlying mechanical problem is what’s responsible for irritating the structures.

If you’re confused – I don’t blame you. All you need to understand is that strengthening muscles of any kind – including your core muscles – will not resolve a mechanical back pain problem. You have to address the mechanical “fault” with very specialized and corrective movements that are prescribed to you. They aren’t cookie-cutter and you can’t find them on YouTube.

So when should you focus on strengthening your core?

After the mechanical back problem is identified and resolved. You’ll need to work with a mechanical back pain specialist to do this. But once you do – core strengthening plays a critical role in keeping you strong, healthy, and balanced. A good core strengthening regimen helps you prevent the mechanical back problem from coming back.

Moral of this story – if you’ve been at core strengthening for awhile now and disappointed that it hasn’t yet “cured” your back pain – then you must consider that you’re in the 80% and have a mechanical back pain problem. Fix what’s underneath first – and then strengthen away.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Back Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or reserve a seat in her upcoming Masterclass for Back Pain & Sciatica Sufferers – click here.

5 Expert Tips to Treat Back Pain Naturally and on your Own

/in /by

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 minimize abnormal forces on your spine so you can avoid procedures and 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’re currently suffering from back pain and want to avoid having to resort to medication, procedures or surgery – then give these tips a try. But if you’ve tried these tips and you continue to struggle – then consider consulting with a mechanical back pain expert who can help you get rid of back pain naturally – and with corrective movement and lifestyle strategies.

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].

Is Exercising Hurting Your Back? 5 Reasons Why.

/in /by

Is Exercising Hurting Your Back? 5 Reasons Why.

The research continues to show that the best “treatment” for back pain is exercise. But what do you do when exercising hurts your back instead of helps? 

This is one of the most common frustrations I hear from my clients. The doctor looks at their back and takes an X-ray. He or she only sees something like arthritis or degenerative disc disease. Surgery doesn’t make sense – so the advice is to go exercise – and specifically to strengthen their core. But when it doesn’t work they are at a loss.

So why would exercise hurt your back – when the research overwhelmingly shows that it’s supposed to help?  

Here are 5 reasons why your exercise routine might be causing your back pain instead of helping it:


1. It’s the wrong type of exercise

While the research isn’t wrong about exercising and back pain – it doesn’t always reveal the specifics on the type of exercise that’s being done. For example, walking is considered one of the best activities for back pain sufferers, and for the majority it will help significantly. But I also have clients who get worse just walking to their mailbox at the end of the driveway. What the research is really saying is that movement – not necessarily “exercise” – is what’s really good for back pain – even acute back pain. But you need to make sure it’s the right type of movement for your specific type of back pain. If you get the type of exercise or movement wrong – you’ll feel worse – and it’s one reason why exercise will sometimes hurt your back instead of help.

2. Stability training is introduced too soon

Stability training is an important part of back pain recovery – but I often see it introduced too soon. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. You want to make sure you explore that fully and get the spine moving the way it should be before you begin stabilizing or strengthening it. Every now and then I stabilize first, but it’s rare. More often than not I see that people with long standing back pain are suffering from a mobility problem that was missed. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You want to figure that out first before jumping ahead to stability training of your core and spine.

3. Your aren’t activating your core

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your 6-pack abs are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or performing complicated movements that require good coordination, you’re setting yourself up for injury.

The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. Pilates (when done properly and with a well-trained instructor) is a type of exercise that can accomplish this quite well. If you’re constantly having back pain every time you exercise or try to strengthen your core, it could be that you lack the ability to activate it when it counts.

4. You aren’t breathing properly

Not breathing properly, or not breathing at all, can significantly impact the effectiveness of your exercise routine. This directly impedes your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise. In order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, your deep back muscles, your pelvic floor, and your diaphragm. Your diaphragm is what controls your breathing.

Let’s say you hold your breath when you exercise. When this happens it means your diaphragm isn’t expanding or contracting in the way it needs to for your deep core to be fully functional. Additionally, when your diaphragm doesn’t work like it should, it adds unnecessary strain and work to your back muscles. This is one reason why you might not be able to activate your core properly – and why exercise might be hurting your back.

5. You’re using improper form

The last and most common reason why exercising might be hurting your back is because you aren’t doing it right. There’s a lot of people out there who think posture and form don’t really matter. But they do. If you’re lifting weights – especially when frequently and repetitively – you want your spine to be in good alignment. It might not hurt the first time you lift with improper form, but it will hurt when you get to your 100th rep.

Same goes for body weight exercises. Just because you aren’t adding load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. That’s really where people get in trouble. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture or it’s going to catch up to you and cause you unnecessary back pain.

If exercising is currently hurting your back – it could be due to one of these five reasons. Get expert help to figure out which one it might be – because at the end of the day – exercise really is good for your back. You just might need some expert guidance from a back pain specialist who “gets” this stuff to get there.

Are you 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 a good fit to help you. Book your free Discovery Visit here.

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].

Vestibular Therapy: The Safer, More Cost-Effective Treatment for Vertigo Sufferers

/in /by

If you’ve ever suffered from an episode of vertigo, then you know how debilitating and scary it can be: Room spinning, loss of balance, barely able to walk or move… The traditional route of treatment is to get yourself rushed to the emergency room (ER), undergo a myriad of diagnostic tests to rule out anything serious (like a stroke or heart attack), and then, if they can’t find a “cause”, you’re typically sent on your way with medication and a referral to a specialist. 

Medications typically don’t do anything to resolve your vertigo but they will mask your symptoms.

And it can often take months to get an appointment with either a neurologist or ears, nose, throat (ENT) doctor. If, after this whole ordeal, you’re still suffering from dizziness/vertigo – you’re not alone. ER’s are notoriously bad at diagnosing and managing dizziness. Not only that, but it’s expensive. According to Dr. Newman-Toker, researcher and professor of neurology at John Hopkins University, the cost of emergency room visits due to dizziness now exceeds $10 billion per year. And almost half (43%) of all dizziness-related ER diagnoses are wrong. They are corrected once you get to a specialist who knows how to properly diagnose you.

So… if going to the ER when you’re suffering from a debilitating episode of dizziness/vertigo is not the best or most cost-effective treatment option… then what should you do? Enter Vestibular Therapy. It’s safer, more cost-effective, and it leads to long-term solutions that help you resolve your dizziness without medications or procedures. It’s not something a lot of people know about or fully understand – so let’s go through it to see if this is a treatment option you need and/or what’s been missing for you.

First – what exactly is vertigo – and how do you know if it can be treated with vestibular therapy?

Vertigo is a collection of symptoms, and not its own diagnosis. The symptoms you experience (dizziness, room spinning, disorientation, loss of balance) are the result of disturbances within your vestibular system, which is responsible for helping you maintain balance and spatial orientation. There are two distinct categories of vertigo: peripheral and central. Peripheral vertigo occurs when the peripheral components (located in your inner ear) of your vestibular system are affected. It’s caused by conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere’s disease – and can lead to sudden episodes of dizziness, nausea, and imbalance. Central vertigo, on the other hand, arises from problems within your central nervous system (aka brain). Causes of central vertigo include things like stroke, multiple sclerosis, or tumors – and it manifests as a more sustained form of dizziness, typically accompanied by neurological symptoms. You need the correct diagnosis of vertigo in order for treatment to work. But the good news is that 80% of all vertigo is peripheral – and can be treated naturally with vestibular therapy. Plus, when you’re first examined by a vestibular therapy specialist, they will rule in or out any vertigo that could have a central cause, and you’ll be referred to the correct medical specialist immediately.

So what is vestibular therapy and how does it work?

Vestibular therapy is a specialized form of physical therapy designed to address specific components of peripheral vertigo within your inner ear , as well as enhance the communication between your brain and vestibular system to improve your overall balance. Vestibular therapy starts with an examination (by a trained vestibular physical therapy specialist) that includes various maneuvers and specialized vision and balance tests to determine the exact type of peripheral vertigo you’re dealing with. From there, the correct treatment plan can be developed. For those that are vaguely familiar with vestibular therapy, it’s often associated with full body maneuvers such as the Epley, Semont, or Foster – which can be scary and ineffective if you haven’t been examined properly. It’s important to note there are many more components to vestibular therapy – so if you’ve tried and failed at one of these in the past – there is still hope. A good vestibular therapy specialist will incorporate interventions to work on all three of your balance systems, as well as give you additional strategies for home, lifestyle, and diet – all aimed at improving the areas of your balance and coordination system that might not be working as well as they could be. 

Vertigo is a common condition that many people are forced to face alone and without proper treatment, primarily because the education and awareness around vertigo is so limited. If you or someone you know wants to avoid medications and procedures (that typically don’t work), and treat vertigo naturally and in a more holistic way – then vestibular therapy might be exactly what you’re looking for. If you need help finding a qualified vestibular therapy specialist, don’t hesitate to reach out.

If you are local to Portsmouth, NH – click here to speak with a vestibular 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, email her at [email protected].

syringe

Do Cortisone Shots Work on Herniated Discs?

/in /by

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

/in /by

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].

6 Reasons Your Back Surgery Failed

/in /by

Back surgery, often viewed as a last resort for those suffering from debilitating back pain, has become increasingly common in the last 15 years.

A quick Google search reveals that an estimated 1.5 million spinal fusions are performed annually in the United States alone. When you consider that 70-80% of all back pain is considered “non-specific” and does not require surgery – that number is staggering. Additionally, it’s been well documented that 20-40% of all back surgeries fail, resulting in what we call “Failed Back Surgery Syndrome”. So why then – do we continue to operate?

If you or a loved one is considering back surgery – I highly recommend you do your due diligence and research first.

To give you a head start – here are 6 reasons why back surgery often fails:

1. Incorrect Diagnosis

If the wrong diagnosis leads you to an unnecessary surgery – then your back surgery is going to fail. How does this happen? All too often we blame aging structures in the spine as the main source of our pain. But what many fail to understand is that arthritis and degenerating discs (for example) are a normal part of aging. Everyone has it – but not everyone has back pain. An aging spine is not a reason to get back surgery – so be cautious anytime someone blames arthritis or disc degeneration for your pain. It’s typically not the full story.

2. Surgical Complications

Surgical complications are a risk when you undergo any type of surgery – even when it’s coined “minimally invasive”. From anesthesia reactions, to accidentally nicking a nerve, to the possibility of infection – complications can occur – and some of them irreversible. Conservative therapy and natural treatments involving movement and exercise come with virtually no risk – and have better outcomes than surgery according to research. You want to make absolutely certain that a back surgery is warranted before you put yourself at risk for complications.

3. Scar Tissue

Scar tissue is an unavoidable consequence of any surgery and a necessary part of the healing process – but its impact is significantly underestimated. For some, scarring can get out of control and be excessive, manifesting itself similar to an auto-immune condition. For others, they simply have no clue that scars need to be managed and mobilized. Unmanaged scar tissue will become adhesive and may cause problems with your nerves, fascia, and general mobility. While there are treatments such as Shockwave therapy that can help regenerate damaged soft tissue from scarring – unmanaged scar tissue can be one reason your pain doesn’t resolve after back surgery.

4. False Expectations

A lot of folks go into back surgery with false expectations. They think they’ll be out of pain and back to their activities in no time. But proper healing from back surgery is deceivingly long. While most incisions will technically heal in about 2 weeks – your body has a different timeline. Most people grossly underestimate the impact their condition prior to surgery will have on their recovery. Your pain may be gone after surgery, but all of the underlying, compensatory problems that developed leading up to your surgery have not magically disappeared.

For example, it takes a minimum of 6-8 weeks to build and retrain muscle. If you had nerve impingement that was inhibiting a muscle from performing properly, it’s going to take several months to get that strength back. When this is not considered, and you jump back into activities too soon, you’re asking for trouble.

False or mismanaged expectations about recovery after back surgery is a big reason for poor outcomes.

5. Images are Misleading

X-rays and MRI’s do not tell the full story when it comes to back pain. And in most cases, they are misleading and can result in an incorrect diagnosis. For example, I already mentioned to you that most things you see in your images – such as arthritis, degenerative disc disease, and even bulging discs – occur naturally as you age.

But they don’t always lead to back pain.

Studies have shown that 60% of folks in their 50’s will have bulging discs on X-ray and 80% will have disc degeneration – regardless of whether back pain is present or not. These statistics only increase with age. If you allow your imaging alone to dictate your decision to get back surgery – you’re increasing your risk of it failing because it may not have been necessary in the first place.

6. Back Surgery Makes Money

At the end of the day, healthcare is a business. And back surgeries are among the most lucrative procedures in the medical industry. According to studies and statistical data, common back surgeries like lumbar fusion cost anywhere from $50,000 to $90,000. But it only costs hospitals a fraction of that amount to actually administer. Plus, despite its unethical nature, some surgeons have been reported to receive kickbacks for using certain medical devices and performing more surgeries. While this is an indirect reason for your back surgery failing, it’s not something you can ignore. The profitability of back surgery naturally lends itself to being overutilized when there could be better, natural solutions instead.


After all this, I hope you can see that back surgery isn’t a decision you should take lightly, and a good outcome should not be assumed.

Consider the statistics. Anywhere from 20-40% of all back surgeries fail and it could be due to any of the reasons we just looked at. Most back pain (70-80% to be exact) is considered non-specific and mechanical in nature, and can be resolved naturally with prescriptive exercises, lifestyle changes, and corrective movement strategies. It’s worth exhausting all of these options first before jumping into a surgical procedure that has a good chance of failing you.

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].

Osteoporosis

5 Ways Pilates can help Manage Osteoporosis

/in /by

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

/in /by

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

/in , /by

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].