Tag Archive for: nh physical therapy

tendinitis and tendinosis

Six Tips for Managing Knee Pain without Medication

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When you’re suffering from lingering knee pain that just won’t go away, it can deeply affect your day-to-day life.

And when this happens – it’s easy to become desperate and resort to daily medication – or “quick fix” procedures or surgery. But there’s good news – there are plenty of natural, non-medicated ways to manage knee pain successfully and improve how you feel – even if you’ve been dealing with knee pain for years. You don’t always need medication or invasive treatments to find relief – despite what the medical community tells you.

Here are six effective tips to help you manage knee pain naturally:

1. Strengthen Your Hips and Core

Your hips and core play a crucial role in providing stability and support for your knees, as these muscles work together to ensure proper alignment of your entire lower body. When these muscle groups are weak or unbalanced, your knees bear the brunt of poor mechanics during movements like walking, running, and squatting. This leads to unnecessary strain, which can worsen knee pain over time. By strengthening your hips and core, you can improve your overall body mechanics, reduce stress on your knees, and promote long-term joint health. Over time, not only will this help alleviate current knee pain, but it will also significantly reduce the risk of recurrence. Incorporating exercises such as glute bridges, side leg lifts, and planks into your routine can make a noticeable difference in your strength and stability.

2. Improve your Flexibility

Mobility comes before stability when it comes to joint health. Stiff joints force surrounding muscles to overcompensate, which can lead to even more discomfort and inefficiency in movement. Improving your flexibility – particularly in the hips, hamstrings, and quadriceps – helps distribute forces evenly through your body and reduce strain on your knees. Regular stretching, yoga, and specific mobility exercises are great ways to maintain flexibility and keep your knee joints moving freely. A regular mobility practice is essential for reducing chronic knee pain and discomfort, preventing injuries, and enhancing overall athletic performance, balance, and coordination in your daily activities and exercise routines.

3. Don’t Sit too Long

Sitting for extended periods can cause stiffness in your knees and reduce circulation, which can lead to more pain. Additionally, knee pain might stem from your back or hips, even if you don’t feel pain there, and sitting for too long accentuates problems in these areas as well. By standing up and moving regularly throughout the day, you can prevent the muscles around your knees from tightening up and maintain better alignment. Simple actions like standing every 30 minutes, doing some light stretches, or walking around your space can make a big difference. Even if you don’t have knee pain right now – this is a good practice to get into – because it will go a long way in preventing it.

4. Stay Active

Regular, low-impact exercise is one of the best ways to manage knee pain naturally. Activities like swimming, cycling, and walking increase blood flow, which helps reduce inflammation and promotes joint lubrication. Movement also releases endorphins – your body’s natural pain relievers. If arthritis is a concern, consider activities that build strength without overloading the knee, like Pilates or resistance band exercises. Movement is key, but be sure to avoid high-impact exercises that could exacerbate your pain. Focus on activities that maintain flexibility, balance, and muscle endurance for overall joint support in your knee..

5. Wear Supportive Footwear

Footwear is often overlooked when it comes to knee pain, but wearing shoes that provide adequate support and cushioning can make a huge difference. Shoes that don’t support your feet properly can cause poor alignment, which translates to extra stress on your knees. Opt for shoes that prioritize comfort, good arch support, and alignment to help reduce the impact on your knees. If necessary, consider custom orthotics to improve foot and knee mechanics, as well as periodically replacing worn-out shoes to maintain optimal support and prevent further strain.

6. Optimize Your Balance

Good balance is about more than just preventing falls – it helps your knees by reducing strain during movement. When your body is well-balanced, the load is distributed evenly across your muscles and joints. Poor balance, on the other hand, can cause your knees to overcompensate, leading to pain and increased wear and tear. Simple exercises like standing on one leg, using a balance board, or practicing yoga can improve your balance and take the pressure off your knees. Incorporating these exercises into your routine can also enhance coordination, prevent injuries, and promote overall stability for the rest of your body as well.

If you’ve been dealing with knee pain for a while and haven’t incorporated any of these tips yet, now is a great time to start. Try these first before resorting to something invasive – or accepting a life on daily pain medication. Additionally, it’s a good idea to consult with a physical therapy specialist who is an expert in natural treatments for knee pain.

Are you a local to Portsmouth, NH?

If so, CLICK HERE to speak to one of my specialists. They can help you figure out which strategies will successfully get you back to all the activities you love – while avoiding medications and procedures.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free copy of her guide: 7 Easy Ways to Get Rid of Knee Pain – CLICK HERE.

Hiking with Bidue

Three Lessons Learned from Hiking with my Pup

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I have a 10.5-year-old Black Lab/Hound-mix rescue pup (named Bodie) who I bring with me everywhere when I’m allowed. But our favorite place to hang out? Hiking trails.

Bodie and I have been slowly working on finishing our “NH48”. For those of you not familiar – we’re trying to hike all of the NH White Mountain peaks that are over 4000 feet in elevation – and there are 48 of them. This past weekend we hiked Owl’s Head, which was number 31, and the weekend before, we checked off Mount Zealand for number 30. If you’ve ever hiked these peaks, then you already know these two hikes are pretty long – especially as day hikes. Owl’s Head was 17 miles, and Zealand was 12. And we did them back-to-back weekends!

I planned to hike again this weekend, but after watching and learning from Bodie over the years, I’ve realized some powerful lessons that I wanted to share with you that can absolutely be carried over into everyday life.

Here are three Lessons I’ve Learned from Hiking with my Pup:

1. Nature is the ultimate natural remedy for anxiety.

Bodie can be a bit anxious, and when he doesn’t get outdoors enough, it gets worse. Spending extended time in nature is one of the most powerful and natural anxiety remedies I’ve experienced – and I see it in Bodie. After our hikes, he’s much calmer and even barks less at neighborhood dogs. 

Bodie is also my mirror – when I’m anxious and haven’t spent enough time outside – he notices and mirrors my energy. Have you noticed this in your life? If so, try getting out in nature more – it works wonders. Bodie and I keep ourselves pretty active – but there’s just something about hitting those trails that is magical. Bodie reminds me daily to spend quality time moving outdoors.

2. Bodie knows how to listen to his body.

It’s remarkable to watch Bodie on the trails – he knows exactly what his body can handle and when to rest. Can you imagine if we all had that kind of awareness? Life would be so different.

As a PT specialist for over 22 years, I’ve learned how to listen to my body, and it’s one of the most important skills I’ve taught clients over the years. When you truly understand what your body is telling you, you can challenge it without being reckless. This is important because we only improve when we appropriately challenge ourselves.

Shying away from every ache and pain can actually teach your nervous system to fear pain, which does more harm than good.

Watching Bodie, I realize this instinct is built into him. His nervous system is so in tune – it just knows. While we may not have the same instincts,it is possible to improve our relationship with our nervous systems, which will help us do more of the activities we love and prevent injuries. If you struggle with recurring injuries or fear of movement because of pain, I highly recommend working with a movement expert who can help you work through this. Your body awareness will improve and your nervous system will thank you.

3. Recovery is critically underrated.

Bodie is a pro at recovery. After every hike, he takes a day or two to rest – lounging around, sleeping more, and letting his body recover. It’s a reminder that recovery is just as important as the effort we put in. Whether it’s hiking, exercising, or going through daily routines, our bodies need time to repair and strengthen. I take this lesson from Bodie and make sure I’m giving my body the rest it needs.

Recovery is key to maintaining strength, mobility, and long-term health – not to mention injury prevention. 

If you’re struggling with recovery or feel like your body isn’t bouncing back after adequate, it could be a sign of a bigger issue. I recommend working with a movement specialist who can help you. You don’t have to let stubborn aches, pain, or injury linger or keep you from doing what you love.

We’d love to help you figure that out!

Work with someone who specializes in finding natural ways to get rid of pain – and who can help you to keep it gone – so you can keep enjoying all of the activities you love to do. For me and Bodie – that’s hiking.

All you have to do is request a free appointment with one of our specialists to see if we can help and if you’re a good fit for what we do 🙂


Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE or call 603-380-7902.

Man getting knee pain treatment

Four Surprising Contributors to Lingering Knee Pain

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Approximately 25% of adults suffer from lingering, chronic knee pain without any clear reason why.  For some, aging and arthritis is to blame, and it’s something to just “live” with. For others, they’re told it’s due to “wear and tear”. Yet despite one or more surgeries to “clean out the knee” – the pain lingers and persists. 

So why then, do some folks age, get arthritis, and put tons of wear and tear on their knees without any issue – where others suffer from chronic knee pain? The answers may surprise you. 

Let’s look at four lesser-known (and often overlooked) contributors that cause knee pain to linger and not go away.

1. “Hyper” mobility is lacking

I remember early on in my career (22 years ago) when “hyper” mobility was considered a bad thing. But since then, both research and experience have proven me wrong. If you’ve followed me for a while – then you know one of my favorite sayings is “mobility before stability”. That’s because a joint that moves fully and freely feels and functions better – and allows the muscles around that joint to work at their best. Too often, people mistakenly look at muscular strength first as the solution to solving pain, when they should be looking a bit deeper.  Regarding knees, you need a bit of what we call “hyper-extension”. But most practitioners tend to focus only on how well a knee is bending. For knees – just getting to straight isn’t good enough. You need a certain amount of “more than straight” – otherwise known as hyperextension. I see this problem most in knees that have had surgery.  If their full knee extension (hyperextension) wasn’t restored properly during rehab, or perhaps they didn’t have any rehab at all (common practice now after most arthroscopic knee surgeries), knee pain will persist. And it won’t go away no matter how much you try and strengthen it. Moral of this story – make sure you have full knee extension – which includes a bit of hyperextension – and that it matches your other knee. This could be a reason your knee pain isn’t going away.

2. It’s really a back problem

Did you know that 40% of the time, an extremity problem (aka: knee, shoulder, etc) comes from the spine – even when you don’t have any neck or back pain? It’s more common than you think for knee pain to be caused from your lower back, and when this gets missed, it’s a huge reason for lingering knee pain that never seems to get resolved. With a true knee problem, your symptoms tend to be pretty specific and localized to just your knee joint. But if your pain tends to move around your knee, or travels up and down your leg, there’s a good chance your knee pain is coming from your back. If you’ve been treating your knee for months (or years) – and it’s not going away –  consider that your knee problem is actually a back problem. This could be especially true if you’ve had cortisone injections and/or various procedures done to your knee with little or no effect.

3. Poor core strength

When it comes to core strength, most people associate it with something that’s important for resolving and preventing back pain. But good core strength is vital to good knee health as well. Your abdominals, low back muscles, hips, and glutes all make up what we call your “powerhouse” – otherwise known as your core. Your powerhouse – specifically your hips and glutes – have a huge influence on how well your lower extremities function. If your core is weak, your legs will need to work harder and eventually overcompensate. And knee joints often take the brunt of all this. The truth is, although your knees require a certain amount of stability to function well – they aren’t designed to be a stabilizing joint. That’s what your hips and ankles are for. If your core is weak (particularly hips and glutes), and your knees start trying to help out as an extra stabilizer, this could be the reason why they keep hurting. If you haven’t yet gotten your core strength properly assessed – do it – this could be the culprit.

4. Weak ankles

As I alluded to above – if your ankles aren’t strong enough to stabilize your foot and lower leg, your knees will kick in to help. If this pattern is allowed to continue – your knees will start to hurt – and will keep hurting until the pattern is discovered and fixed. Another interesting phenomenon that can occur in any joint (not just your ankles) is that when a joint lacks strength or stability – it will stiffen up to compensate. So in terms of your ankles – if they lack range of motion on top of being weak – your knees will really pay the price. This is particularly evident during activities such as running, hiking, pickleball, or tennis. You need really good mobility and stability of your ankles for these activities – or your knees will suffer in response. If you’ve got lingering knee pain and haven’t yet taken a look at your ankles – I recommend doing so – they could be the overlooked issue. 

Knee pain can be tricky to figure out – especially if it’s chronic. The key to successfully getting rid of knee pain starts with correctly identifying the cause. And from my experience – arthritis, age, and wear and tear serve as “excuses” when a practitioner doesn’t know where to look. If you’re suffering from chronic knee pain and haven’t yet explored any of the four lesser-known contributors I mentioned in this article – talk to a specialist who knows how to look at the big picture instead of just your knee – because the true cause could be elsewhere.

Are you local to Portsmouth, NH?

CLICK HERE to speak with one of my specialists for free.

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

4 Spine-saving tips for less pain during Holiday Travel

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For many, Holidays mean traveling to visit family and friends. Or perhaps you’re a New England resident and just want to get away from the cold for a few days. Either way, hours in the car, hours on a plane, and sleeping on mattresses you’re not used to can wreak havoc on your spine.

The good news is there are some simple and easy things you can do to help prevent this. Here are 5 of my top tips to save your spine during holiday travel:

Tip #1: Interrupt your sitting

The biggest strain on your body while traveling is undoubtedly the prolonged periods of sitting. Our bodies are made to move continuously throughout the day. Too much sitting puts extra load and compression on your spine, and can trigger an underlying problem you weren’t even aware of. On road trips or long plane rides, getting out of your seat is critical for keeping your neck and back healthy. In a car, plan extra time in your trip to pull over at rest stops and walk around. On a plane, choose an aisle seat so it’s easy to get up and stretch. I recommend interrupting your sitting every 30 min for good neck and back health whenever you’re able. Keeping up with that frequency while traveling can be difficult, but something is better than nothing.

Tip #2: Use a lumbar pillow

While sitting, a proper lumbar pillow is not only essential for good lower back alignment, but also for proper neck alignment. We have natural curves in our spine that are designed to absorb shock and disperse load. Ever heard of the dreaded “forward head”? That’s the posture your neck assumes when it needs to compensate for lower back slouching. When your spinal curves are not maintained, such as when sitting or slouching for prolonged periods, you get abnormal and unwanted forces throughout your spine, resulting in pain and stiffness that can occur in both your neck and lower back. When purchasing or making your own lumbar pillow – you want to make sure the roll is thick enough to maintain the natural curve (lordosis) in your lower back without much effort while you sit. The built-in lumbar supports that you can adjust in your car are typically not adequate enough – so don’t rely on those. Have a small pillow or roll handy to compensate.

Tip #3: Maintain a neutral spine while you sleep

When traveling and facing various mattresses that might not align with your typical sleeping setup, there are ways to compensate to prevent neck and back pain. Start by packing a portable travel pillow that offers adequate support for your neck’s natural curve. If the mattress is too firm, consider using extra blankets or folded clothes strategically placed under specific body parts, like your hips or shoulders, to create a more cushioned surface. If the mattress is too soft, try placing a firm object, like a folded towel or a small pillow, beneath your lower back for added support. Sleeping on mattresses you’re not accustomed to while traveling can be challenging – and you’re never quite sure what you’ll be getting into. The name of the game is to position yourself in a way so that you’re sleeping in a neutral position – where your head, neck, and spine all align.. It might take a bit of trial and error, but adapting your sleeping setup while traveling can significantly reduce discomfort and ensure less pain and strain in your neck and back.

Tip #4: Stay Hydrated

Staying hydrated during holiday travel plays a crucial role in preventing neck and back pain due to its impact on overall bodily function. Adequate hydration supports the elasticity of spinal discs, which act as cushions between vertebrae, preventing them from becoming stiff and compressed. Dehydration can exacerbate muscle tension and reduce flexibility, increasing the likelihood of discomfort and stiffness in the neck and back. By drinking enough water, you help maintain proper circulation, delivering essential nutrients to muscles and tissues, promoting their relaxation, and reducing the risk of cramping or spasms that often contribute to neck and back pain during long journeys. Plus – hydration supports your body’s ability to recover and repair – so when you’ve got those travel-related strains on your spine that are ultimately inevitable no matter how careful you are – you’ll simply feel better faster.

Traveling any time of year, especially during the Holidays, comes with its own set of challenges and problems. There is no need to add unwanted neck and back pain to that list. Implementing even just one of these spine-saving tips next time you travel can make a real difference in alleviating neck and back pain – and allow you to focus on your destination instead.

Are you local to Portsmouth, NH and looking for help?

Request a free discovery visit by clicking here. We will ask you all about what’s been going on and see if we would be the best fit to help 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]

5 Ways Regenerative Shockwave Therapy Speeds Healing and Boosts Mobility for people aged 50+

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Regenerative Shockwave Therapy

Arthritis, degenerative joint disease, and general wear and tear of our bodies are all a normal part of aging – and these things tend to become more problematic once we get into our 50’s and beyond.

A lot of people falsely believe that as these ailments start to rear their ugly heads, it means you need to slow down, or even cease, some of your favorite activities. This couldn’t be farther from the truth. But as you get older, what is true is that you’re probably going to need some aid and assistance to keep doing all the activities you love – especially if you’ve had an injury.

Aside from mastering the basics… drink plenty of water, get adequate sleep, fuel your body with wholesome nutritious food, and exercise/move daily… There is something else I’ve found that can really make a difference in how active and mobile you’re able to get (and stay) once you’ve hit your fifties. It’s called regenerative shockwave therapy – a treatment that utilizes high-energy “shock waves” (or soundwaves) to trigger a biological response that helps to aid and accelerate the healing process of your soft tissue (anything that isn’t bone). I only came across this revolutionary technology a few months ago. And while I was initially skeptical – I’ve since become a huge fan. Why? It’s safe and non-invasive, it aids the body’s natural healing process, it’s backed by research, and I’ve seen it work remarkably well to help with pain relief and soft tissue healing. 

Here are 5 ways that regenerative shockwave therapy is helping injured people (especially those aged 50+) heal faster and boost their mobility:

1. Pain Management:

One of the main reasons people reduce their physical activity is due to pain. But movement and exercise are actually an essential component (in most cases) for pain relief. But let’s face it, when you hurt, you’re just not as motivated to move. This is where regenerative shockwave therapy comes in. It quickly penetrates deep into your soft tissue to help bring blood flow and healing properties to a targeted area to reduce pain. And it keeps working even after the treatment is over. As your pain reduces, you feel more confident to move and resume your favorite physical activities faster.

2. Improved Mobility:

As you approach age 50 and beyond – you may notice your joints naturally becoming stiffer. Stiffness on its own might not seem like a big deal – but it becomes a problem when it leads to compensatory movement patterns – which can eventually lead to pain. Shockwave therapy helps to promote collagen production, the protein responsible for maintaining the suppleness and flexibility of your soft tissue. Good mobility helps you move better and feel better – and shockwave therapy can be a valuable companion in this process.

3. Blood Flow Stimulation:

Good blood flow and circulation are essential components to quick healing of any soft tissue injury. Shockwave therapy aids in this process with vasodilation – ensuring that the injured or degenerated tissue receives a higher influx of nutrients – which speeds up the recovery process. As we get older, the integrity of our soft tissue can suffer, so anything that can stimulate blood flow is going to help you heal – and get you back to your favorite activities faster.

4. Reduces Scar Tissue:

It’s not uncommon to meet folks in their 50’s (and beyond) with at least one or two orthopedic surgeries under their belt. While I consistently advocate against resorting to surgery, there are times when it’s necessary and beneficial. But a mismanaged scar can ruin everything. Scars don’t act like your original tissue and if they aren’t managed properly – will cause mobility restrictions that worsen over time. Shockwave therapy can help to break down scar tissue and stimulate the production of new, healthy tissue – which can restore any discomfort or dysfunction that the scar was causing – getting you back to your activities faster.

5. Accelerated Recovery:

At the end of the day, and for all the reasons already stated, shockwave therapy helps to speed up your body’s own natural healing process and thus – recovery. Consider it a companion and “best friend” to any rehabilitation protocol. With increased blood flow, reduction of scar tissue, and improved pain and mobility – you tolerate things with more ease and can progress more quickly. When you’re younger – you have a lot of this naturally on your side already. But as we age, everything slows down, including our body’s natural recovery processes. Shockwave therapy steps in to fill this gap so you don’t have to miss out for too long on your favorite physical activities.

If you’re currently injured and avoiding exercise – consider adding regenerative shockwave therapy into the mix to help reduce your pain, improve your mobility, and get you back to your favorite activities faster.

To learn more about Regenerative Shockwave Therapy and other benefits, CLICK HERE. Who knows, it could be the missing link to your healing that you didn’t even know existed.

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] or CLICK HERE to talk to one of our specialists.

orthopedic surgery

Three Science-backed Reasons not to Rely on Imaging for Orthopedic Surgery

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Approximately 7 million people undergo an orthopedic surgery each year in the United States. Topping this list are elective procedures (meaning they are not life threatening or urgent) such as ACL reconstruction, total hip and knee replacements, arthroscopic surgery (meniscus repairs, shoulder decompression, etc), and spinal fusions.

Now, what if I told you that of the top 10 elective orthopedic surgeries performed, only one (carpal tunnel syndrome) has real evidence to support that surgery will have a better outcome than conservative care. A recent study published by scientists in the UK hospital system and National Health service reviewed thousands of published studies in an effort to find out if orthopedic surgery was truly better than conservative care or placebo procedures. They found that sadly, thousands of patients are undergoing invasive procedures every year with known associated risks and complications. All while there was an equal or better alternative.

One of the biggest reasons this happens is because people rely on imaging (X-rays, MRI’s, CT scans) to determine whether or not they need surgery. Don’t get me wrong, this incredible technology has revolutionized the field of medicine and orthopedics. The problems occur when we fail to look at the full picture (no pun intended) and rely on images alone to make important decisions about our musculoskeletal health.

Here are three science-backed reasons not to rely on imaging alone when considering orthopedic surgery:

 

1. Imaging does not always correlate with symptoms

One of the most fundamental reasons why imaging alone should not dictate your decision to get orthopedic surgery is the well-documented lack of correlation between image findings and actual symptoms. 

Studies have shown that 20-25% of all people will show a bulging disc in their spine on MRI. This happens even when they don’t have any back pain. At least 50% of adults over the age of 50 will show torn meniscus or cartilage in their knees and feel completely fine. In 2013, The New England Journal of Medicine published a study that found one-third of participants with no knee pain had “abnormal” results in their imaging. This was while one-half of the participants who actually experienced knee pain had completely clear scans. 

We have to start normalizing what aging actually looks like on a scan. Just because you’ve got a bulging disc, torn cartilage, or even “bone on bone” arthritis – it doesn’t mean you need to rush into the operating room.

2. Risk of Over-diagnosis and Overtreatment

Overdiagnosis refers to the identification of conditions that aren’t actually causing symptoms or harming a patient. The biggest culprits here include spinal stenosis, joint arthritis, and degenerative joint conditions. One notable study from 2017 published in PLUS ONE, a peer-reviewed mega journal, found that at least 20% of arthroscopic knee surgeries were overdiagnosed and subsequently overtreated. How did they now? Because even though their scans showed things like “wear and tear” and torn cartilage, they had no relevant dysfunction or clinical findings. The only thing indicating they needed surgery was the overdiagnosis of normal aging in their knee.

A particularly sad story comes to mind as I write about this. I recall treating a man with spinal stenosis who was told by his doctor he needed steroid injections to calm the inflammation in his back. He had 6 weeks until his injections, and during that time, we were able to decrease his pain by about 80%. Since it’s impossible to reverse or stop spinal stenosis without surgery (because it’s related to wear and tear as you age), I knew that his pain was being caused by other unrelated factors. But following doctor’s orders, he still went through with the injections. Unfortunately, he had a bad reaction to the injections that left him worse off than when he started with me. His over-diagnosis of spinal stenosis led to a cascade of over-treatment and worse pain than when he started. 

3. Non-surgical treatments can be equally effective (if not better)

Orthopedic surgery should really only be considered as a last resort. No matter how routine or “non-invasive” the surgery is, there are still risks of infection and complication, and you want to avoid those at all costs. The problem with conservative treatment is that it takes longer to get to the same (or better) result. And let’s face it, we live in a quick fix world and rarely have patience for this, especially when you’ve got a scan that seems to say otherwise.

Study after study shows that arthroscopic knee surgery (in particular) has the same or better results when treated conservatively (physical therapy and exercise). In fact, when you get arthroscopic surgery on your knee, it increases the likelihood you’ll need a total knee replacement. With back surgery, we know that in the first year or two, your pain will be better or gone. But by year 2-3, if your symptoms haven’t crept back in yet, you’ll feel just as good as your peers who forewent surgery. But after year three, your back pain symptoms tend to return, and you’ll often feel worse than your friends who decided to take the conservative approach from the get-go.

The research continues to support that 70-80% of all musculoskeletal pain is mechanical in nature. Mechanical problems have to do with movement dysfunction and lifestyle/postural habits. They don’t show up in a scan, and they are best treated conservatively. When you see something on an image, it’s better to assume it’s irrelevant and that you fall into the 70-80%. This will protect you from being overdiagnosed and help you avoid potentially unnecessary procedures and surgery. Pay attention to your pain, symptoms, and overall function – they tell a much better story than your images.

Are you local to Portsmouth, NH?

Consider seeing one of my Specialists – they’re experts in mechanical pain. In a free Discovery Visit you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health. Whether that’s working with us or not!

CLICK HERE to request a Free Discovery Visit.

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].

Sciatica_Therapy_Portsmouth_NH_2

3 Reasons You Need PT After Minimally Invasive Spine Surgery

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

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

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

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

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

There are some risks of MISS:

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

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

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

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

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

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

1. Proper scar management

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

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

2. Restore pre-existing impairments

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

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

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

3. Restore deep core strength

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

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

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

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

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

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

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

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.