Tag Archive for: pain

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6 Reasons Your Muscles Are the Secret to Staying Young

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When most people think about anti-aging, they picture creams, supplements, or the latest medical breakthroughs.

But one of the most powerful tools for staying young is something you’re born with – your muscles. Everyone knows muscles are key for strength and appearance, but research shows they do far more than that. Muscles act like living medicine inside your body. Every time they contract, they send out chemical signals that influence your brain, heart, bones, and immune system. In fact, researchers now recognize that maintaining muscle may be one of the most effective ways to protect your health, preserve independence, and extend your life.

So – what exactly makes building muscle such a potent anti-aging secret?

Here are six important ways your muscles act like medicine:

1. Muscles Fight Inflammation

One of the hallmarks of aging is something scientists call “inflammaging” – chronic, low-grade inflammation that damages tissues and raises the risk of cardiovascular disease, arthritis, and Alzheimer’s. But here’s what’s fascinating… When your muscles contract during exercise, they release anti-inflammatory chemicals known as myokines. One of the best studied is interleukin-6 (IL-6). Unlike the IL-6 produced by fat tissue, which fuels inflammation – muscle-derived IL-6 helps regulate the immune system and suppress harmful inflammatory signals.

This helps explain why U.S. studies, such as the long-running Alameda County Study, have consistently shown that physically active adults live longer and age with fewer health problems. In other words – every time you use your muscles – you’re helping your body reverse damaging inflammation.

2. Muscles Stabilize Blood Sugar

Muscle is the largest site of glucose disposal in your body. The more muscle you have – and the more you use it – the more efficiently your body processes sugar. Resistance training improves insulin sensitivity, which means your muscles can absorb glucose from the bloodstream more effectively.

A 2024 meta-analysis found that structured resistance training reduced HbA1c, a long-term marker of blood sugar control, by about half a percentage point – an effect comparable to some common diabetes drugs. For millions of Americans at risk for diabetes, maintaining and building muscle is one of the most powerful ways to keep blood sugar steady and prevent disease.

3. Muscles Strengthen Bones

Strong muscles don’t just move your body – they help to strengthen bone. Every time muscles contract against bone, they stimulate bone growth and increase bone density. This is one of the most effective natural defenses against osteoporosis, a disease that affects more than 10 million Americans and dramatically raises fracture risk.

As we age, fractures can mean the loss of independence. But by strengthening muscles through regular resistance training – you also strengthen the bones they attach to – creating a double layer of protection.

4. Muscles Protect Your Brain

Healthy muscles send protective signals to your brain. As previously mentioned – when you exercise and contract muscles – they release myokines. In addition to IL-6, myokines such as irisin and brain-derived neurotrophic factor (BDNF) stimulate the growth of new neurons, strengthen existing connections, and improve brain plasticity.

The benefits are measurable. Studies of older American adults have shown that maintaining muscle strength later in life is associated with sharper memory, slower cognitive decline, and reduced risk of dementia. Exercise also boosts endorphins, which elevate mood and help combat depression and anxiety. Keeping your muscles active is one of the most reliable ways to keep both your body and mind young.

5. Muscles Support Heart Health

We often think of walking or jogging as the best ways to support cardiovascular health. But research now shows that strength training deserves equal credit. Resistance exercise improves circulation, reduces arterial stiffness, and lowers blood pressure.

In a massive U.S. study of more than 116,000 adults – those who consistently met or exceeded physical activity guidelines – including strength training – had up to a 31 percent lower risk of death from any cause – and up to a 38 percent lower risk of dying from cardiovascular disease. These findings echo results from the British Journal of Sports Medicine, which showed that just 30 to 60 minutes of strength training per week reduced risk of chronic disease and early death. When it comes to your heart, strong muscles really are medicine.

6. Muscles Extend Longevity

Perhaps the most compelling evidence for the concept of “muscles are medicine” is its impact on survival. Studies consistently show that muscle mass and strength are stronger predictors of longevity than body weight or BMI. One U.S. study of college alumni found that those who maintained higher activity levels in midlife had significantly lower risks of heart disease and lived longer lives.

Muscle also serves as a critical protein reserve. When illness, surgery, or trauma strikes – your body draws on muscle stores to support healing, immune function, and tissue repair. People with greater muscle mass not only live longer but also recover more quickly when health challenges arise. Stronger muscles simply mean greater resilience.

The Bottom Line

Your muscles do far more than help you look fit or lift heavy things. They fight inflammation, regulate blood sugar, strengthen bones, protect your brain, support your heart, and extend your life. Best of all, you don’t need hours in the gym to see these benefits. Just 30 to 60 minutes of strength training per week, combined with regular movement, can produce profound results.

But if pain or injury is holding you back, don’t ignore it. The longer you wait, the harder it can be to bounce back – and the more you miss out on this natural anti-aging tool. If back, knee, hip, neck, or shoulder pain is keeping you from building muscle, talk to a physical therapy specialist who can help you return safely. With the right guidance, you can overcome those barriers and put your muscles to work – as they are your best-kept secret to staying young.

Looking for help and local to Portsmouth NH? Consider speaking to one of my specialists by clicking HERE.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Arthritis Pain Isn’t the End – How to Stay Active for the Long Haul

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Arthritis is one of the most common conditions I see in my clinic – and one of the most misunderstood.

Many people assume it’s just an inevitable part of aging, but what’s often overlooked is how much can actually be done to manage it naturally and effectively.

What frustrates me most is the message many people still hear – that arthritis pain is something you just have to “live with,” managed only through pills, injections, or eventually surgery. But the truth is that while arthritis may not be something you can erase or reverse – there are countless ways to manage your symptoms naturally, safely, and effectively – without becoming dependent on quick fixes that often backfire in the long run.

Here are just a few of the approaches I recommend to my patients who want to stay active and independent well into their later years – even with arthritis.

Move Every Day (Even When You Don’t Feel Like It)

When your joints ache, movement is usually the last thing you want to do. But ironically, it’s one of the best things you can do. Gentle, consistent exercise increases circulation, nourishes your cartilage, and keeps inflammation from settling in. Walking, biking, or swimming are excellent choices because they don’t put excess stress on your joints. Practices like yoga or Pilates improve balance and mobility, making daily activities easier and reducing the strain on your joints. And strength training – despite what many believe – is actually good for arthritis because it takes pressure off your joints by making the muscles around them stronger.

Even five to ten minutes of daily activity can mean the difference between feeling stiff all day or moving with more freedom. The less you move, the worse arthritis tends to get – so finding ways to stay active is one of the best investments you can make in your future health.

Fuel Your Body With Anti-Inflammatory Foods

What you eat matters. An anti-inflammatory diet can help reduce the swelling and stiffness that drive arthritis pain. Omega-3 rich foods like salmon or flax seeds, antioxidant-packed fruits and vegetables, and spices such as turmeric and ginger all have powerful healing effects. At the same time, cutting back on processed foods, refined sugars, and fried items can significantly improve how your joints feel – and it brings benefits for your overall health as well.

Think of food as medicine, because for arthritis it truly can be. Many of my patients notice a big difference in their pain levels and energy simply by reducing sugar and processed foods while adding more colorful fruits, vegetables, and healthy fats.

Prioritize Weight and Posture

Every extra pound you carry puts additional strain on your hips, knees, and back. Even small amounts of weight loss can dramatically reduce pressure on your joints and give you noticeable relief. But here’s something many people miss – posture can play just as big a role.

When you sit, stand, or walk with poor posture, you create uneven forces through your joints. Over time, this increases wear and tear, and can be aggravating to an already arthritic joint. Learning how to align your body correctly can protect your joints just as effectively as losing weight. The way you move every day, whether you’re getting out of a chair or bending to pick something up, can either help your arthritis or make it worse.

Don’t Let MRIs or X-rays Dictate Your Treatment

One of the biggest mistakes I see is when people let imaging results control their decisions. While MRIs and X-rays are useful in certain situations, they are not the whole story. Numerous studies have shown that people with severe degenerative changes on their scans often have no pain at all. In fact, research suggests that as many as 60–70% of people over the age of 50 show some level of arthritis or disc degeneration on imaging – even if they feel perfectly fine.

This matters because once you’re told your pain is due to what’s seen on a scan, you’re far more likely to be funneled toward procedures you may not need. Cortisone injections, for example, only mask pain and actually weaken tissue when used repeatedly. Arthroscopic surgery for knee arthritis has been shown to accelerate the very degenerative changes it’s supposed to help.

And then there’s the dreaded phrase: “bone-on-bone.” While this sounds scary, it does not automatically mean you need a joint replacement. Many people live full, active lives with joints that appear “bone-on-bone” on imaging, as long as they are moving well and keeping their surrounding muscles strong. If you rely only on what the picture shows, you risk missing out on safe, natural solutions that can help you stay mobile and independent.

Explore Longevity Treatments that Boost Healing

One of the most exciting developments in arthritis care right now is the rise of non-invasive therapies that actually help your joints heal and last longer. The combination of Shockwave Therapy (ESWT) and EMTT (Extracorporeal Magnetotransduction Therapy), for example, helps to stimulate blood flow, reduce inflammation, and restore mobility at the cellular level deep inside your joint.

Unlike cortisone shots, which only provide temporary relief while weakening tissue, these therapies encourage your body’s natural ability to repair itself. Many of my patients have experienced less pain, more mobility, and faster recovery – without downtime or drugs. Instead of masking symptoms, these treatments support long-term joint health and help you stay active well into the future.

A Final Word of Encouragement

If you live with arthritis – it doesn’t mean you are destined for a life of pain or dependence on invasive treatments or pills. Your body has an amazing capacity to heal when given the right environment. Whether it’s moving a little more each day, adjusting your diet, improving your posture, questioning unnecessary procedures, or exploring longevity treatments – there are always steps you can take to improve your quality of life.

Arthritis may be common, but it doesn’t have to define you or your future.

With the right strategies, you can stay active, independent, and doing the things you love for years to come. Local to Portsmouth, NH and looking for help?

Consider speaking to one of my specialists. CLICK HERE to book a free discovery visit.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help, request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

Plantar Fasciitis

How to Survive Flip-Flop Season Without Wrecking Your Feet

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Flip-flop season is here – which means sunshine, beach days, and pool time. But it can also mean extra foot pain. And every summer around this time, we see an influx of people dealing with aching arches and stabbing heel pain – most commonly known as “plantar fasciitis”

What is Plantar Fasciitis?

Quite simply, it’s inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot. Your plantar fascia runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot, enabling you to propel yourself during walking and running. When you land on your foot, your arch falls or flattens – this is called pronation. In response, your foot then stiffens or supinates, providing the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked, leading to what we call “plantar fasciitis”.

How Do Flip-Flops Contribute?

Footwear can either “protect” your arch or cause it to overwork. Technically, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. However, due to prolonged sitting and limited barefoot walking, the bottoms of our feet are not as conditioned as they should be. This is the real problem – not so much what you put on your feet. If you’re used to wearing supportive and cushioned shoes and then suddenly switch to flatter, less supportive flip-flops, it can shock your foot. And if you’re already prone to plantar fasciitis, it will flare up easily and quickly.

What Can You Do?

The good news is you don’t have to give up your favorite summer footwear entirely – you just need to be smart about how you wear them and how you care for your feet. Here are five simple tips and strategies to help you get through flip-flop season without completely wrecking your feet.

1. Choose Supportive Styles

Not all flip-flops are created equal. Those flat, flimsy styles you can pick up at the drugstore for five bucks? Probably not doing your feet any favors. They offer little to no support, and if your foot mechanics aren’t perfect, you’re asking a lot of your plantar fascia every time you take a step. A better choice is a flip-flop that gives you a bit of arch support and structure. Look for ones with a cushioned sole, some contouring through the arch, and even a slight heel cup to help stabilize your foot and keep it from sliding around. The right pair makes a big difference – a key factor for enjoying flip-flops pain-free.

2. Save Them for Short Distances

Even the most supportive flip-flop has its limits. They’re not designed for long walks, hours of standing, or sightseeing on vacation. Think of them like you would a slipper – something you wear for convenience or comfort in short bursts, not as your all-day shoe. If you’re going out for a full day of walking, or standing at an outdoor event, it’s better to switch to something more structured that supports your foot and ankle. Use your flip-flops strategically – around the house, to and from the pool, or for short errands. Giving your feet the right support when it matters most can go a long way in keeping them pain-free.

3. Strengthen Your Feet (and Your Core)

One of the best ways to prevent plantar fasciitis – or keep it from coming back – is to strengthen the muscles that support your arch and stabilize your entire lower body. Most people don’t think about exercising their feet, but they absolutely should. Working on things like toe strength, arch activation, ankle mobility, and balance helps condition your feet so they can handle different surfaces and demands. But don’t stop at your feet – your core matters too. The way your pelvis and deep abdominal muscles function has a direct impact on how forces move through your body when you walk. A weak or poorly functioning core can lead to poor movement patterns that put extra stress on your feet. Strengthening both your feet and your core can transform the way you move – and reduce the load on your plantar fascia dramatically.

4. Stretch and Massage Regularly

One of the most underrated things you can do to prevent or treat plantar fasciitis is to stretch and massage your feet on a regular basis. Tight calves, stiff ankles, and tension through the soles of your feet can all contribute to pain and inflammation. A few minutes of daily stretching – focusing on your calves and toes – combined with massage using your hands, a lacrosse ball, or a mobility tool, can make a huge difference. This kind of soft tissue work helps relieve tension, improves circulation, and keeps your plantar fascia mobile and healthy. 

5. Don’t Ignore Persistent Pain – Treat It Early

If you’re already feeling pain in your heel or arch that just won’t go away, don’t wait around hoping it gets better on its own. Plantar fasciitis becomes harder to treat the longer it sticks around, and it can quickly go from annoying to chronic. When that happens, exercise and stretching might not be enough to get you out of pain – and that’s where regenerative therapy comes in. Shockwave therapy (EPAT) is a non-invasive treatment that uses high-energy sound waves to stimulate blood flow and break up tight, inflamed tissue. It helps jumpstart healing in a way that rest and stretching can’t. EMTT (Extracorporeal Magnetotransduction Therapy) takes this even further. It uses pulsed magnetic fields to penetrate deeper into tissues and promote healing at the cellular level. Together, shockwave and EMTT are incredibly effective at reducing pain, accelerating recovery, and allowing you to tolerate the exercises and movement you need to fully resolve your plantar fascitis.

Bottom Line

Flip-flops don’t have to be the enemy. But if you’re not taking care of your feet, wearing them can easily lead to pain and frustration. By choosing the right styles, wearing them in moderation, and taking the time to strengthen and care for your feet – you can enjoy them all summer long without paying the price. And if foot pain does creep in, don’t ignore it. Get the right help early. Treatments like shockwave and EMTT, combined with expert-guided movement and strengthening, could be exactly what you need to survive flip-flop season pain-free – and keep your feet happy long after summer ends.

6 Tips to Protect Your Back When Shoveling Snow

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6 Tips to Protect Your Back When Shoveling Snow

We’re finally getting some winter weather here on the seacoast. And although it’s beautiful – and the skiers are rejoicing – someone still has to shovel that snow and clear it out of the way. If that someone is you – then you’ll want to keep reading. Because repetitive bending and twisting of your back (the primary movement in shoveling) is the perfect recipe for unwanted back pain.

Here are 6 tips to protect your back when shoveling snow:

1. Warm Up First

Most people wouldn’t start a heavy workout without warming up first, yet when it comes to shoveling, we tend to just grab the shovel and go. That’s a mistake. Shoveling is a full-body activity that engages your legs, core, and upper body. If you don’t prepare your muscles, you’re more likely to strain something – especially your back.

Take five to ten minutes to warm up with light movements. Marching in place or jumping jacks help get blood flowing, while torso twists and squats loosen up your spine and legs. And don’t forget your upper body. Arm circles are a great way to warm up your shoulders  – which can also get quite achy when shoveling. Taking just 10-15 min to warm up your body and lubricate your joints before shoveling can go a long way toward protecting your back.

2. Use Your Legs

Our spines weren’t designed to lift heavy things – that’s what our legs are for. Your spine’s main job is to provide structural support and stability so you can stand upright and move freely. When lifting or shoveling, your legs should be doing the work – not your back.

To ensure your legs are driving the power – it’s essential that you use proper lifting mechanics. Instead of bending or curving at your waist – hinge at your hips and bend your knees. From there, engage your hamstrings and glutes to lift the snow and use your core muscles to throw it away. Even with perfect form – your back might still get sore. That’s totally normal. But it’s far less likely to get injured – and that is what we’re trying to avoid.

3. Pivot Instead of Twist

One of the most vulnerable movements for your lower back is repetitive bending and twisting. The stress this puts on your spine makes it easy to “throw your back out.” Now let’s be clear – that doesn’t mean you should never bend or twist – your spine is designed to safely perform these motions. The problem occurs when you add load to this motion (like heavy snow) or do it repeatedly.

To protect your back – lead with your pelvis and hips instead of your torso. When turning to throw or push snow, keep your shovel and hips (use your belly button as a guide) pointing in the same direction. If they’re out of sync, it means you’re twisting from your torso instead of pivoting – and that’s a surefire way to hurt your back when shoveling.

4. Breathe to Engage Your Core

Holding your breath during exertion is common, but it can be a big problem – especially when it comes to core activation. When you hold your breath, your diaphragm can’t expand and contract properly, which is essential for engaging your deep core muscles. If your deep core isn’t firing, your larger abdominal and back muscles will struggle too.

Strengthening your core is beneficial for all activities – not just shoveling—but none of it matters if you forget to breathe. Without proper breathing, even the strongest core won’t do its job effectively, and this can set you up for a back injury over time.

5. Stay Hydrated

Even in cold weather, physical exertion can lead to dehydration. Just because you’re not sweating or feeling thirsty doesn’t mean you don’t need water. In colder temperatures, your thirst signals aren’t as strong, making it easy to overlook hydration. And even if you’re not sweating, you’re still losing fluids. Dehydration can lead to muscle fatigue, cramping, and stiffness – all of which increase your risk of a back injury while shoveling. Plus, when your muscles aren’t properly hydrated, they become less flexible and more prone to strains, making bending and lifting feel even harder.

To stay ahead of dehydration, drink water before, during, and after shoveling – even if you don’t feel thirsty. Sip small amounts frequently rather than chugging large amounts at once. Warm fluids like herbal tea or broth can help keep you hydrated while maintaining body temperature. Be mindful of caffeine and alcohol, as they contribute to dehydration. Staying hydrated keeps your muscles and joints working efficiently, making shoveling safer and easier for your whole body, not just your back.

6. Use Ergonomic Tools

Investing in an ergonomic shovel can reduce strain on your back and joints. These shovels promote better posture by minimizing bending. Many have curved handles or adjustable lengths, allowing you to maintain a more upright position. This distributes the workload more evenly, reducing stress on your back.

Now, you might be thinking, “I have a snow blower – my back will be fine.” Think again. It’s easy to push with your upper body instead of your legs, which puts strain on your spine. Poor technique makes your back more vulnerable to injury – even if you don’t feel pain in the moment. The real trouble comes later when you grab a shovel for a quick cleanup or simply sit down to relax. You may be in for a rude awakening when you stand up and realize your back is stiff and locked up. Ergonomic shovels and equipment like snow blowers go a long way in protecting you back – but they don’t replace the need for good posture and proper body mechanics.

Bonus tip: See a Specialist

If you’re already prone to back injuries and dread the thought of shoveling another snowstorm – it’s time to seek help. These tips are great for protecting a healthy back and preventing future injuries, but they won’t solve an ongoing back problem. You need expert care for that. Look for a back pain specialist who prioritizes natural solutions over pills and injections (such as a mechanical back pain specialist) so you can get back to doing all the activities you love. Oh—and shoveling too.

Are you local to Portsmouth, NH?

If so, consider speaking to one of my back pain specialists by clicking HERE.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

pain

Your Pains Location May Not be it’s Source

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Pain is both a confusing and scary topic.

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

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

Let me explain.

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

Confused? I don’t blame you.

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

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

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

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

How can you figure this out?

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

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

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

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

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

tendinosis

Why the Difference between Tendinitis and Tendinosis Matters

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Tendinitis and Tendinosis: Why the Difference between them Matters.

Many patients at our specialized physical therapy practice in Portsmouth, NH, suffer from either Tendinitis or Tendinosis. Tendinitis and Tendinosis sound very similar, and are often used interchangeably but they couldn’t be more different. And neither should their treatment regimen.

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon.

Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

Tendons are tight, yet flexible bands of fibrous tissue that connect your muscle to bone. Without tendons, your muscles would be useless. Tendons are extremely organized, and the fibers are designed in a way to withstand and transmit high forces of tension so your muscle can function properly.

With tendinitis, your tendon becomes inflamed and irritated, typically due to repetitive overuse, and it will hurt when you try to move. The most common areas for tendinitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

Tendonitis is an acute condition, and the best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. But this should only be for a short period of time. From there, you want to figure out what caused the tendinitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendinitis.

When you don’t manage tendinitis properly, and it goes on longer than a few months, it can result in tendinosis.

Tendinosis is a very different condition where the fibers in your tendon actually start to break down. An important thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you, and could even worsen the condition.

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers and get blood flowing to the tissue (actually create some inflammation). Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to get blood flow to the area and re-organize those fibers so your tendon can work properly again. Passive treatments like ice, rest, and medicine will not help tendinosis.

The only exception is shockwave therapy (also known as Extracorporeal Pulse Activation Technology).

With shockwave therapy, high-energy sound waves stimulate the body’s natural healing mechanisms by increasing blood flow to the injured, affected area. The increased blood flow delivers oxygen and nutrients to the damaged tissue to help accelerate healing and reduce inflammation.

With pain reduced and the healing process promoted, your tendon is now primed for physical rehabilitation and re-organization of the tendons, the next most essential part of getting rid of your tendinosis.

The only way to truly re-organize tendons is to put stress on them so they can “remodel”. To do this, you have to put just the right amount of stress to cause a little bit of pain (inflammation) – but not so much that your tendon gets inflamed again.

This is literally one of the few times where “no pain no gain” actually holds true. A properly trained physical therapist who is well-versed in tendinosis rehabilitation will know how to do this and can guide you through it.

You have to retrain the fibers in your tendon to withstand normal forces again – and this process takes both time and careful loading strategies.

The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love again as if nothing ever happened. You don’t have to accept this as a chronic condition.

If you’re confused on tendinosis and tendinitis after reading this don’t worry – so is half the medical community.

The take home points to remember are that tendinitis involves pain and inflammation. There is no damage to your tendon, and it only lasts about 4-6 weeks.

Treatment for tendinits should involve passive modalities like ice and rest. The focus should be on what caused your tendon to get irritated in the first place. Then, you can get rid of it before it turns into tendinosis.

If the problem in your tendon has gone on longer than 3 months, you must suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon. Passive treatments (with the exception of shockwave therapy) will not work. They could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies, aka strengthening. That will properly re-organize your tendon so that it can be strong and functional again. This is extremely challenging to do on your own.

So it’s a good idea to talk to an expert about this. If you are local to and looking for physical therapy in Portsmouth, NH, reach out to schedule a FREE 30 minute discovery session.

Tendonisis

Tendonitis vs. Tendinosis – The BIG difference and why it matters

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If you’ve ever suffered from tendonitis or tendinosis – then you know that it can last anywhere from a few weeks to several months!

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon. Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably, they couldn’t be more different. When tendonitis isn’t caught early enough or treated properly it can turn into tendinosis. The treatment for acute tendonitis is very different from chronic tendinosis.

Let me explain…

Tendonitis is an acute condition. The best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

When you don’t manage tendonitis properly, and it goes on longer than a few months, it can result in tendinosis. Tendinosis is a very different condition where the fibers in your tendon actually start to break down. The first thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you. I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again.

Passive treatments like ice, rest, and medicine will not help tendinosis. They might help to relieve any pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area. In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis. Making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right? Well technically it is, but the biggest problem is that this process takes time – up to 9 months in many cases. And most patients I come across simply don’t have the patience for this. Or they simply aren’t told about it.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time. You have to put just the right amount of stress to cause a little bit of pain. However, not so much stress that your tendon gets inflamed again. A properly trained physical therapist that is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time. The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry. So is half the medical community.

The take home points to remember are these:

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks. Treatment for this should involve passive modalities like ice and rest. The focus should be on what causes the tendon to get irritated innitially.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies. These will properly re-organize the tendon so that it can be strong again! This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

Luckily – we’ve introduced a brand new treatment modality in our office. It accelerates the healing of soft tissue and tendon injuries.

It’s called Shockwave Therapy and we are currently accepting new patients for this service. If you’re already a client – you will get this service at no charge. Just ask your specialist next time you’re in and see if you’d be a good fit for this treatment.

But if you’re not a current client – and are currently suffering from something like plantar fasciitis, tendonitis, or some other soft tissue strain or injury – you could be perfect for this treatment! Studies have shown about 70% reduction in symptoms in as little as 6 sessions.

While this won’t completely “fix” your tendon or soft tissue problem – it can have a significant reduction on your pain which will allow you to more easily do the work that WILL fix your problem.

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

physical therapy

How to Know if You’re Getting Quality Physical Therapy

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How to Know if You’re Getting Quality Physical Therapy

I’ve been a Physical Therapist for just over 20 years and I’ve seen a lot of changes in my field over the course of my career. One of the biggest (and saddest) changes I’ve seen is the overcrowding of physical therapy clinics. This has ultimately impacted the quality of care you receive. Reimbursements from insurance companies have gone down. In turn, traditional physical therapy clinics have been forced to increase their volume of patients.

That means you rarely get to spend time with your therapist anymore. And your treatment sessions may consist of repetitive exercise sets that you typically can do at the gym or on your own, and that aren’t all that prescriptive or effective. If you do manage to get some one-on-one time with your therapist – whether it be for hands-on-care or actual consultation about what’s going on with you – it’s often just a quick 20 min.

The rest of the time, your well-meaning therapist is often held hostage to a computer because of all the documentation requirements placed on them (just to get paid and keep their jobs).

The end result… you spend an hour or two at the clinic each week doing “supervised” exercises that may or may not be addressing your problem. As this model of care is becoming more and more standard, it’s impossible for the quality of your treatment not to suffer. Many folks I speak with say that traditional physical therapy is a “waste of time”.

Why bother going when they can do everything on their own at home?

Worse – when traditional PT does fail – what next? Most people go back to their doctors hoping for a different solution. But in most cases – after the perceived “failure” of PT – the logical next step involves unwanted procedures or surgery.

But what if you don’t need that? What if quality physical therapy could have fixed your problem – but you just didn’t know what that looked like?

Herein lies a major problem in the current management of musculoskeletal conditions such as back, neck, knee and ankle pain. It’s important that you understand what quality physical therapy is and isn’t – so that ultimately you can advocate for the best treatment – and not settle for anything less.

Let’s start with what quality physical therapy is not…

It’s not a bunch of general exercises and ultrasound treatments. It shouldn’t consist of you riding a bike for 10 min, lying on a hot pack with e-stim for 15 min, and then getting some generalized massage before they send you off on your way. And most certainly, quality physical therapy does not feel cookie cutter or like a waste of time.

Quality physical therapy treatment – on the other hand – is customized, specific, and obvious.

When you receive quality physical therapy – it’s about so much more than making you feel good and reducing your present symptoms. Of course that’s a happy byproduct. But quality physical therapy treatment should consist of a proper musculoskeletal diagnosis. This will explain to you exactly why you’re having symptoms.

No more guessing games. And spoiler alert – your physical therapist’s diagnosis – when done properly – is often different and far more specific than your doctor’s. From there – you should have a clear plan to eliminate and/or get your pain back to something manageable. In other words, you should feel so good that you never even would have called your doctor or PT in the first place.

But what’s the most important aspect of your treatment?  What distinguishes quality physical therapy from the regular kind? It’s how things work and function when you’re not at physical therapy.

In other words – do you always feel good when you leave only for the pain to come back the next day?

You should leave every visit with a crystal clear path forward.

It’s critical that you know how to keep your pain gone after your physical therapy is finished as well as prevent it from coming back. Generalized, non-prescriptive exercises won’t be enough to accomplish this. You need very specific and purposeful treatment – and in a nutshell – that’s what quality physical therapy looks like. And you know what – it works.

When done correctly – 80% of all musculoskeletal problems can be resolved naturally and without procedures or surgery – even without pain pills for that matter. I love my chosen field and I continue to have faith in my colleagues. Quality physical therapy does still exist – you just may have to go hunting for it.

Sadly, the insurance-based model of physical therapy reimbursement has made it harder to deliver quality physical therapy for clinics. You may need to be prepared to pay out of pocket for some or all of your treatment in order to receive the quality physical therapy you deserve.

It’s worth the extra cost. Especially when you consider the alternative and risk of a failed procedure or surgery. That can have a much bigger “cost” at the end of the day.

Trust me – I’ve seen it.

Are you local to Portsmouth, NH?

If you’re dealing with pain – book a Free Discovery Visit with one of my Specialists. We will ask you what’s been going on -and determine if we would be the right fit to work with you.

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

How Stress Leads to Pain

How Stress Leads to Pain

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How Stress Leads to Pain

People are dealing with more stress than ever right now and it’s impacting people in different ways. Many folks I speak with have been experiencing a rollercoaster of emotions — and their bodies are reflecting that. Keep reading to learn how stress leads to pain.

Stress impacts everything from your gut, to your immune system, to your mental health, to your musculoskeletal system.

When it comes to musculoskeletal pain – common areas in your body that easily get impacted include your shoulders, jaw, head, and lower back.

Stress is your human response to physical, emotional, or mental changes in your body or living environment.

According to internal medicine physician Richard Lang, MD, PhD from the Cleveland Clinic: “Stress doesn’t necessarily cause certain conditions, but it can make the symptoms of those conditions worse.” It’s easy to fall into a vicious cycle. Your physical symptoms worsen. Your stress increases – and so on and so on. 

We know without a doubt that stress impacts our bodies – but exactly how or why this happens is an interesting phenomenon that is still being researched.

But for now – here are some of the working theories on how stress leads to physical pain.

Social conditioning 

Many of us are taught from a young age that expressing emotions, particularly negative emotions, is “bad” or “unacceptable.” The result is that you may have learned to hold stress inside your body when faced with a stressful situation. Researchers who study this believe that the muscle tension we develop is the result of “unspoken social beliefs” that we adopted as children in order to feel accepted or liked. This pattern carries into adulthood and becomes embedded into our subconscious systems, i.e. our nervous system. Later on, when faced with any type of stress, our muscles react based on how we’ve taught them. If you grew up learning to bury emotions and tension somewhere in your body as a response to stress, it’s easy to continue that pattern into adulthood.

Trauma

When we think of trauma – we often associate it with one big event or injury. Like an accident, major fall, or perhaps a violent crime or incident. This type of trauma typically results in obvious physical damage such as broken bones, bruises, or soft tissue and organ injuries. But trauma can also be more emotional in nature and less obvious. Emotional “micro-traumas” typically occur over the course of a lifetime and go unrealized for years. And regardless of the type of trauma or its perceived severity, your body reacts and “remembers” the emotional impact. But these memories are rarely conscious. Similar to what happens with social conditioning, if you’re faced with a stressful situation later in life that reminds your brain of a previous trauma, your body may still react like it did when the actual trauma occurred, except you won’t consciously know it.

For some folks, until they’re able to associate their physical symptoms with the deep, often emotional trauma that happened much earlier in life. They may continue to suffer or worse, resort to lifelong medications to manage their pain. Have you suffered from chronic pain and been told there is no “logical” evidence or reason for it? It’s possible it could be related to undiagnosed trauma. Find a therapist (psychology today is a great resource) who’s been specifically trained in this to help you.

Environmental Stressors and Habits 

Your environment and daily habits can have a huge impact on how your body feels from day to day. They can also influence both physical and emotional stress. For example, if you’ve been reading my articles for awhile, you know that sitting too much is a number one cause of back and neck pain. Sitting too much could be the result of your job – or stress.

When you’re stressed, you tend to be less motivated and you may opt for unhealthy coping mechanisms, such as more TV and more couch time. You’ll be less reluctant to exercise or go for a walk. How you set up your environment can play a big role in combating stress at home. If you’re working from home – choose a set up where you can stand at your computer for part of the day. Reduce the physical stress that sitting has on your body. Get the TV out of your bedroom. You’re more likely to get a good night’s sleep and less likely to turn the news on first thing in the morning.  This can be a source of stress in and of itself. The take home point is that life is hard enough. So set yourself up for success by creating an environment that encourages good daily habits.

Regardless of how or why stress impacts your body, there is one thing I know for certain, movement helps.

Start there and see what happens. Regular, every day movement helps you both physically and mentally and I have yet to see any negative consequences from a daily movement or exercise habit. If musculoskeletal pain is currently keeping you from daily movement – then talk to an expert who can help. 

Request to talk 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 visit with one of my specialists.

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

When You Can’t Feel Your Abs

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I’ve been a physical therapist for 20 years, a Pilates instructor for 11, and have been specializing in back pain for the past 10 years of my career. When it comes to core strength and preventing back pain, I am an expert in my field. Yet for some reason this morning, during my Pilates workout, I just couldn’t feel my abs. I teach people how to do this every single day yet this morning, I couldn’t seem to access my own.

What was happening?

And more importantly – if it can happen to someone like me – it can certainly happen to someone with less training than I have. I started to think about all the reasons this could be happening to me. Had I gotten enough sleep? What had I eaten the day before? Could it be stress?

And then it hit me.

I had just come back from a 2-day course where I’d been sitting far more than usual. I sat for 8 hours straight. Two days in a row. Not to mention all the very cramped sitting I did on the plane to and from this course. When one of my clients is about to have a few days like this, this is what I recommend. Get up from your chair and stretch backwards as frequently as possible every few hours.

But guess what – I didn’t follow any of my own advice. The result? A stiff back and sleepy abs upon my return.

Our bodies are highly intelligent and have every capacity to heal themselves when given the right environment. Conversely, when in the wrong environment, our bodies will also do what it takes to naturally protect from harm and injury. In my case, I came home from this course with a stiff lower back.

Back stiffness is the first sign that your back is not happy. This means your chances of tweaking it or exacerbating an old back injury are higher. When any joint is stiff and not moving well the muscles surrounding that joint will become naturally inhibited or weakened. This occurs on purpose as a protection mechanism. Your body doesn’t want a fully contracted muscle compressing an unhappy joint. In the case of your lower back, the muscles that can get inhibited when your back is not happy include your abdominals as well as back muscles.

So what can you do when you feel less core strength?

The good news is I’ve already helped you with step one: awareness. Inhibited muscles are not the same as weak muscles. In my case, I do have strong abdominals. My weekly routine consists of a regular Pilates practice, lifting weights, and I perform activities like hiking and running that engage my core. Yet despite all this, my abs were simply not having it this particular morning. They were not set up for a successful workout.

The combination of my stiff back and having sat for several days just meant that I needed to do something different to prepare my lower back and abdominals for this workout – so that I wouldn’t injure myself. My sleepy abs and stiff back were, in effect, trying to tell me just that.

All I needed to do was have the awareness this was happening so I could take appropriate action.

It’s no different than when you go on vacation and you get off your routine by eating more than usual. You might return a bit bloated and not feeling your best self. This kind of feeling we are accustomed to. And might respond by getting a bit strict with our diets until feeling back on track. Our joints can react similarly to a change in routine – we’re just not as accustomed to the signs and symptoms that let us know. But once you are – you can easily manage this and avoid injury. Had I pushed through my Pilates routine as normal this morning despite sensing that my back and abdominal function was off – there’s a good chance I’d be sitting here writing to you with full on back pain instead of just some lingering stiffness.

If you’re reading this, and you’re over the age of 40, odds are pretty good that you’ve experienced back pain at some point in your life. The odds are also pretty good that you’ve experienced back pain more than once.

If this is a recurring pattern for you, your abdominals and deep core may not be functioning at their best.

You could be caught in a vicious cycle of trying to improve your core strength only to keep hurting your back.

The missing solution for you might be that nobody has fully examined your back in a way to ensure that it’s moving fully and freely like it should. Once your back moves well, you can usually start to strengthen your abdominals without a problem.

If you’re confused right now – I don’t blame you.

The take home point here is that if you keep experiencing weakness in a particular area despite trying to strengthen it consistently, it’s possible you could have a problem in your joints that is keeping your muscles from fully activating like they should.

Talk to one of my specialists about it.

Someone from my client success team will call you right away and see if you are a good fit for what we do. At the end of the day – we’re here to help.

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].