Tag Archive for: New Hampshire pilates

Sciatica

Why Cortisone Shots Don’t Work for Sciatica

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If you’ve ever suffered from sciatica – then you don’t need me to tell you how debilitating the condition can be.

From shooting and searing pain into your buttocks that can run all the way down to your foot – to numbness, tingling and loss of strength… sciatica has the ability to significantly impact your quality of life. What’s worse? It typically comes out of nowhere – making this condition even more frustrating to deal with.

It’s no wonder that a majority of people resort to “quick fixes” like cortisone shots – in hopes it will put an end to their back pain and sciatica suffering. According to the American Academy of Family Physicians (AAFP), epidural steroid injections (a type of cortisone shot) are among the most common interventions for chronic low back pain and sciatica. In a study published in The Spine Journal in 2015 – it was reported that approximately 50% of patients with sciatica opted for cortisone shots for pain relief as part of their treatment plan. 

But just because cortisone shots for sciatica are popular and considered “standard” – it doesn’t mean they are best practice.

First of all – even if a cortisone shot “works” (almost 50% of the time they don’t) – the results are typically temporary.  Only 20-30% of patients have been able to report sustained relief past a few month’s time. Everyone else reports anywhere from a few weeks to 3 months relief. The problem with the majority of people only experiencing temporary relief from cortisone shots in their spine – is that  you risk “chasing the pain” with more cortisone shots (or prescription meds), acceptance of your condition and continued suffering (I call it “bad back syndrome”), or opting for spine surgery, that in most cases, is totally preventable.

OK – statistics aside – why exactly don’t cortisone shots work for sciatica?

The reason cortisone shots don’t work is because they are attacking symptoms instead of the root cause of your sciatica. Cortisone shots are great when you have an out of control inflammatory reaction to an injury. This presentation is distinct and rare. We call it “chemical  pain” and it’s essentially the result of your body’s natural inflammatory process going a bit haywire.

What makes chemical pain distinct from mechanical pain (which accounts for 80% of all sciatica/low back pain) is that most “mechanical” sciatica will come and go throughout the day – and will be better or worse during certain activities and positions. For a simple example – your sciatica may “scream” at you if you’ve been sitting for too long – but will ease up and feel better if you stand up and stretch. This is a classic presentation of mechanical sciatica.

Chemical pain does not behave like that. It literally hurts all the time and the only thing to relieve it is drugs.

And even that is temporary – thus – justifying the more invasive cortisone shot when accurately diagnosed. The tricky thing about mechanical sciatica/low back pain is that it occurs slowly over time and is the result of abnormal stress and strain on your discs and spinal nerves. It’s a “lifestyle” and movement condition at its root – not an inflammatory condition. While the cortisone shot may succeed in temporarily getting rid of the inflammation – it won’t ever get rid of the mechanical cause – which means you’re more likely to prolong the true problem over time. A cortisone shot, at its best, puts a bandaid on your sciatica. And this is the number one reason why so many people end up in a vicious cycle of treatments, and end up getting both unnecessary and preventable spine surgery.

So what should you do for your sciatica instead of a cortisone shot?

First, trust the research and evidence – which says there’s an 80% chance your sciatica has a mechanical root cause – and that the inflammation you’re experiencing is instead – a symptom. Research aside, I can vouch for this over the 22 years I’ve been helping people get rid of sciatica naturally. 

Second, medical doctors (unfortunately) are not trained in recognizing, diagnosing, or even treating mechanical pain. You need a mechanical pain specialist to help diagnose and get rid of mechanical sciatica – if you want it done the right way and for the long term. Plus – the best thing about working with a properly trained mechanical pain expert first – is that it’s fool-proof. If it’s not a mechanical cause – and it indeed is an inflammatory process “gone wrong” inside your spine – they will rule it out quickly – and refer you for a cortisone shot (appropriately).

So here’s the good news…

There’s an 80% chance your back pain or sciatica is a mechanical problem at its source. Which means that when working with the right medical professional(s) – you can successfully get rid of it naturally – and avoid cortisone shots altogether. I’m a huge advocate of natural, DIY treatment approaches whenever possible – because although small – there are real risks associated with invasive procedures like cortisone/epidural injections. And when those adverse reactions occur – they are often irreversible. 

Why not give yourself the shot at a natural approach to your sciatica before diving into an invasive one?

I’m not talking YouTube exercises and Google – I’m talking actually mechanical pain specialists. I know a lot of them. So if you’re struggling to find one in your area – please reach out. I’d love to help.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media group. To get in touch, or grab a seat in her upcoming Masterclass: “Put an end to back pain naturally – without surgery, procedures, or pills – CLICK HERE.

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].

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. And during the pandemic, we saw more people becoming generally less active, falling off their routines, and working from home in less than optimal “work stations”. It’s no surprise that people are suffering from more neck pain than usual.

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

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

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

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

 

1. Your neck problem is disguised as shoulder pain:

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

2. Your core is weak:

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

3. The Wrong Neck Exercises:

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

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

 

Ready to get rid of your neck pain?

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