Tag Archive for: pain

Could your Hamstring Strain Actually be a Back Problem?

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Have you ever strained your hamstring but the pain just doesn’t go away?

It’s been months since you first started hurting, you can’t actually remember how you injured it (it just started aching one day), you’ve been stretching and massaging it diligently, yet your hamstring still hurts.

This happened to a recent client of ours (“Sandy”).

Sandy was a runner and regular gym goer, who one day noticed an ache in her hamstring. She assumed she had just overdone it working out. She rested it a few days and the pain went away, but when she tried to get back to running she couldn’t. Her hamstring pain came right back. Thinking she hadn’t let it heal enough, she went back to resting it, but this time, decided to add some massage and stretching to her routine. 

A few weeks later… you guessed it… Sandy still couldn’t run.

She also noticed the pain in her hamstring started to feel “different.” It was becoming more deep and achy and started to hurt all the time instead of only when she tried to exert it. It even hurt when she sat for too long. She still couldn’t run and was starting to get worried. Her doctor told her it was just a “strain” and that she had to let it heal. The problem was that it wasn’t healing. Several months had now gone by and she was running out of exercises and stretches to try that would “let it heal.”

Luckily, Sandy attended our recent back pain and sciatica class and realized that the pain in her hamstring might not be a strain at all. 

And her instincts were right! Let me explain.

When you truly strain a muscle, it means you have done damage to your muscle tissue. Although it’s possible to have chronic problems from a strain that isn’t rehabilitated properly, strains typically do in fact heal. Once the inflammation from the tissue damage goes away, and you start doing the proper stretching and strengthening, your muscle eventually gets back to normal. Until a muscle strain is fully healed, it will typically be aggravated if you accidentally over-stretch it or exert it. But you usually don’t feel anything when you’re resting the muscle. In Sandy’s case, her hamstring was starting to feel worse when she was resting — the longer she sat, the worse she felt. Your hamstring is completely relaxed when you are sitting, so something wasn’t adding up.

This was the first sign we were likely dealing with something other than a “hamstring strain.” The second sign was that we could take her pain away by moving her back! Yes, you heard that right.

By moving and stretching her back in a specific way, we were able to significantly relieve the pain in her hamstring.

The reason her hamstring was actually hurting was because a nerve had been aggravated in her back. The nerve was causing pain to radiate into her thigh. That’s why it hurt when she sat for too long and it’s why she couldn’t tolerate any running. Sitting puts more stretch and pressure on the nerves in your back, and running puts a lot of compression through your back. Generally speaking, nerves don’t like to be stretched, especially aggravated nerves, and they don’t like to be compressed if they are aggravated either. By stretching her back in a very specific way, we were able to relieve the pressure from the nerve that was giving Sandy her “hamstring strain.” This confirmed that she was indeed having a back problem.

Has anything like this ever happened to you?

If you’ve got pain anywhere in your buttocks, hip, thigh, or leg that isn’t going away — especially if you’ve done your due diligence and tried all the “right things” — it’s possible you could have a back problem causing this pain instead. These types of back problems are easily missed if you don’t know how to accurately assess them and it won’t be picked up by an MRI or X-ray. The best way to figure this out is through specialized movement testing, like we did with Sandy. 

We talked all about this in our recent back pain and sciatica class. If you want access to the recording, just call our office: 603-380-7902. If you want to take the next step and meet us in person — you can schedule a FREE Discovery Session with one of our specialists right here! 

PhysicalTherapy Porstmouth NH

Five Reasons to Include Pilates in Your Life

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Pilates has been around for about 100 years, yet so many people have NOT heard of this incredible exercise method. It was first created by Joseph Pilates and initially gained popularity among the dance community as a way to recover from and prevent injuries.

But you don’t have to be a dancer to practice Pilates or enjoy the benefits. It’s become very mainstream over the years and for good reason.

I’ve been incorporating Pilates into my physical therapy practice for the last 11 years and it’s been transformational.

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength. It helps our clients connect to their bodies in a way they haven’t been able to achieve with traditional strengthening methods. Most of my clients are well into their 50’s and 60’s, and they love Pilates because it helps them have more energy, better balance, and improved strength and mobility. It allows them to participate in all the activities they love with more ease – and most importantly – significantly decreases the likelihood of injury.

But not all Pilates classes are created equal. And it’s important you choose your Pilates studio based on what your most important needs are.

Here are five reasons to consider adding Pilates to your life – and things to watch out for when choosing a program:

1. Pilates helps prevent back pain.

Once you hit 40, your risk of back injury starts to climb. We see a lot of folks in our office who’ve tried traditional physical therapists or chiropractors, and so many different kinds of core strengthening programs, but still have recurring back pain. They’ve been successful in getting rid of their pain in the short term, but they aren’t able to keep it gone for the long term.

Keeping pain GONE is what we specialize in – and one of the ways we do that is with Pilates. But “general/cookie-cutter” Pilates isn’t always enough.

For example, our Pilates instructors work closely with our PT team and get enhanced training on how to navigate back pain, and we keep our classes small so that we can pay close attention to everyone. If you’re recovering from an injury, or vulnerable to back pain, you’ll want to beware of classes that are overcrowded and not individualized. More than 5-6 people in a class when you’re trying to recover from back pain could be dangerous and increase your likelihood of re-injuring yourself. It’s impossible for your instructor to keep a close eye on you or give you individualized modifications when there are too many people in class.

2. Pilates strengthens your whole body, not just your core.

One of the keys to lifelong fitness is what I call “balanced strength.” In other words, each part of your body works together to produce the right amount of force, at the right time. I see lots of “strong” people in my office, but they can’t do the activities they love, because their muscles aren’t working together in the right way at the right time. This can result in compensatory patterns over time – that may predispose you to injury.

Pilates emphasizes full body strength that is coordinated. Coordinated strength is essential if you want balanced strength – which will give you the best shot at avoiding injury.

3. Pilates improves your flexibility.

Do you stretch your hamstrings every day but they never seem to improve?

It could be because you’re not stretching the right way – OR – it could be that you shouldn’t be stretching them at all! (Conversation for another day…)

Either way, the great thing about Pilates is that it improves your flexibility in a way that strengthens at the same time. The “old school” way of stretching was to find the most uncomfortable position for your muscle and just hold it for 30 seconds. Research has shown this is not effective in most cases. The best way to stretch is to do it dynamically with movement. In Pilates, you never stop moving, and one of the central concepts to the practice is “lengthening”. Basically, you use the concept of self-induced opposition to strengthen and stretch at the same time – this is how you end up with flexibility that lasts.

4. Pilates minimizes stress on your joints.

Aging is a real thing and along with it comes arthritis. But it’s not a death sentence like most people are led to believe. The key to combating arthritis is maintaining a mobile and well balanced joint. When you optimize everything that surrounds your arthritic joints, your symptoms decrease.

Pilates helps with all this – without causing any additional stress.

Since Pilates is based on the idea of constant opposition – lengthening while strengthening – you end up with a joint that is happy and balanced when you incorporate a regular practice of Pilates into your life. It helps to minimize the impacts of arthritis and even prevent the rate of degeneration.

5. Pilates trains your nervous system.

Say what? Is this even something I should care about?

Yes it is — and it’s almost ALWAYS a missing link I find for people who’ve been at a certain activity for a really long time, and then suddenly start having pain.

If you don’t train your nervous system, it gets lazy, and compensation patterns develop. When one part of your body is compensating for another, it ultimately leads to imbalance. The right type of Pilates will help with this.

Notice I said “right type.”

If you’re looking to just work out and have fun, then almost any Pilates will do. But if you’re wanting to truly correct your body’s imbalances and train your nervous system, Pilates is still your ticket but it needs to be with a qualified instructor.

If you’re not yet incorporating Pilates into your everyday routine… what are you waiting for!?

It’s my go-to exercise system for folks over the age of 40 and it’s my favorite way to help people keep their back pain gone.

 

back pain

Tight knots in your muscles? Do’s and Don’ts

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At one point or another, or perhaps even this very second, you’ve experienced tight knots in your muscles.

They are annoying, nagging, uncomfortable, and quite often painful.

The most common area to feel these knots is in your upper traps (the triangle shaped area between your shoulder blades and base of your neck). But other areas of your body that love to get knotted up include your mid and lower back, your hips and butt, the front and sides of your thighs, and the back of your lower legs.

The first thing people think to do when experiencing these tight knots or muscle spasms is to get a massage or try rolling them out with a foam roller. Lately, theraguns seem to be the craze. These devices look like power drills and use percussive therapy to reduce pain and relieve tightness in the affected area. In our office, for really stubborn and painful knots, we use something called dry needling, which is where you take a tiny acupuncture needle and insert it into the tight knot to bring blood flow to the area and release tension.

These are all great options, and for the most part, I put them in the category of “Do’s” when it comes to getting rid of tight knots in your muscles.

Sounds pretty simple, right? Well, not so fast. Not all muscle knots are meant to be released.

Spil for 10 Kr.: Casizoid’s Bedste Danske Casinoer i 2025

I en verden, hvor online casinoer blomstrer som aldrig før, kan det være en udfordring at finde de bedste og mest pålidelige udbydere. Men frygter ikke, for vi har gjort det hårde arbejde for dig. I denne artikel vil vi dykke ned i de førende danske casinoer i 2025 og afsløre, hvad der gør dem så unikke og attraktive for spilleglade entusiaster som dig.

Uanset om du er en erfaren gambler eller en nybegynder på jagt efter spænding, vil vores dybdegående analyse give dig et solidt fundament for at træffe de bedste valg. Vi vil dissekere alt fra spilleudvalg og bonusser til brugeroplevelse og sikkerhed, så du kan maksimere dine chancer for succes og undgå faldgruber. Vær parat til at blive overrasket, for de casinoer, vi har udvalgt, vil ikke kun underholde dig, men også sikre, at du får mest muligt ud af dine penge.

Sikkerhed og regulering af danske casinoer

I 2025 vil de bedste danske casinoer være dem, der tilbyder en uovertruffen spilleoplevelse med en bred vifte af spændende spil og generøse bonusser. Casizoid, en af de førende anmeldelsessider for online casinoer, har udpeget de mest lovende casinoer, der vil dominere markedet i de kommende år. Disse casinoer vil sætte nye standarder for brugeroplevelse, sikkerhed og ansvarligt spil.

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Populære spil og jackpotter

I 2025 vil online casinoer i Danmark have taget et enormt spring fremad i forhold til i dag. Spil for 10 Kr.: Casizoid’s Bedste Danske Casinoer i 2025 vil byde på en helt ny oplevelse med utroligt realistiske og immersive spil. Takket være den hastige teknologiske udvikling vil grafikken være så levende, at man næsten kan føle sig som om man sidder ved et rigtigt casinobord. Desuden vil udvalget af spil være enormt, og der vil være noget for enhver smag, uanset om man foretrækker klassiske casinospil eller de nyeste og mest innovative titler.

Et af de vigtigste aspekter ved casinoer med 10 kr. i 2025 vil være den forbedrede brugervenlighed. Hjemmesiderne vil være intuitive og nemme at navigere, og der vil være masser af nyttige funktioner som live chat-support og detaljerede vejledninger til spillene. Derudover vil sikkerheden være i top, og man kan føle sig tryg ved at spille på disse casinoer. Alt i alt lover Casizoid’s Bedste Danske Casinoer i 2025 at være en sand oplevelse for alle casinoentusiaster.

Mobilvenlige casinoer og apps

I 2025 vil online casinoer i Danmark være mere spændende end nogensinde før. Casizoid, den førende autoritet inden for anmeldelser af online casinoer, har allerede udpeget de bedste danske casinoer for det kommende år. Disse casinoer lover at tilbyde en uovertruffen spilleoplevelse med et bredt udvalg af spil, generøse bonusser og fremragende kundeservice.

Blandt de højst rangerede casinoer finder du velkendte navne som CasinoMagic, SpilenDanmark og CasinoSikker. Disse casinoer har bevist deres værdi gennem årene og fortsætter med at imponere spillere med deres innovative tilgang til online gambling. Uanset om du foretrækker klassiske casinospil som roulette og blackjack, eller du er mere til de nyeste slotmaskiner og live dealer-spil, vil du finde noget, der passer til din smag på Casizoid’s liste over de bedste danske casinoer i 2025.

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I 2025 vil Casizoid’s liste over de bedste danske casinoer være fyldt med spændende og innovative tilbud. Online casinobranchen udvikler sig konstant, og spillerne kan forvente endnu flere underholdende og belønningsrige oplevelser. De førende casinoer vil tilbyde en bred vifte af spil fra anerkendte udviklere, herunder de seneste slotmaskiner, bordspil og live casino-titler.

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“Don’t” aggressively release a tight knot in your muscle until you know why it’s there. 

Sometimes, muscle knots form as a critical compensatory strategy. If released too quickly, they can set off an array of problems. I was just talking to my massage therapist about this, because she’s seen it happen to her own clients. Occasionally, she’ll work her magic to get rid of tight muscle knots only to find the client feels worse after the session. This can happen when the tight knot was there to compensate for a weak muscle elsewhere. 

Let me explain. 

Muscles are connected via highly innervated tissue called fascia. It looks like a spider web and one of its main functions is to connect organs and muscles together. Fascia is still being studied, but one of the theories is that if one muscle group in that fascial line is not doing its job, a different muscle will work extra hard in its place to take up the slack. Eventually, that muscle will get exhausted and tighten up into a knot, because it’s doing more work than it was designed to.

If you release a knot that is “holding the line” together, you’re asking for trouble.

In this example, what I’ve found is that the passive methods of releasing muscles (those I mentioned earlier) aren’t very effective at helping you get rid of the problem. You might actually end up feeling worse or having pain elsewhere. If your tight muscle knot is there to act as a survival mechanism, it’s going to take a more comprehensive and total body approach to resolve it. You’ll need to figure out which muscle or muscles the tight knot is compensating for and address them at the same time you work to release the tight knot. You can keep getting your weekly massage, but you’ve got to pair it up with correctly prescribed exercises.

To summarize, DO figure out WHY you have a tight knot in your muscle first.

Is it there because you overworked it in the gym? Maybe you’ve taken on a new project at home that is repetitive in nature?

If these are the reasons you’ve got tight knots in your muscles, then DO release them. You’ll likely feel better. And then correct the movement patterns, so the knot doesn’t come back.

If you feel worse after releasing the tight knots in your muscles, or the knot keeps coming back, then the problem likely involves more than just that muscle and you need a more comprehensive approach to get rid of it.

DON’T continue to release it over and over.

If you’re suffering from stubborn knots that won’t go away, get assessed by movement experts like us who can diagnose your problem accurately and help you get rid of the tight knots in your muscles for good.

 

Dr. Carrie Jose – back pain specialist and Pilates expert – owns CJ Physical Therapy & Pilates in Portsmouth, NH

The Location of Your Pain may NOT be its Source…

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One of the most confusing topics we deal with in our practice is pain. And there’s lots of advice out there on what to do about it…

Should you rest or move? Apply heat or ice? See a doctor or let it go away on its own?

Before you can even think about a solution to your pain, you must first accurately determine where it’s coming from. If you have pain in your knee, but it’s actually coming from your back, the best knee treatment in the world is not going to fix it.

Inaccurate diagnosis of pain is a BIG reason why so many people suffer longer than they need to, and undergo unnecessary surgeries.

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 do that.

For example, I’ve seen people in my office with what they think is unrelenting tennis elbow, only to find out it was actually a problem in their neck causing it. I’ve seen people disappointed after a failed knee surgery, because the problem was never in their knee and actually coming from their back.

Isolated extremity pain (knees, elbows, shoulders) is one of the most misdiagnosed problems we see in our office.

A recent study by Richard Rosedale, et al. in the Journal of Manipulative Therapy investigated this – and it was found that over 40% of people suffering from isolated extremity pain actually had a spinal source of symptoms.

In other words, their extremity pain was actually coming from their neck or back.

I can’t tell you how many times we’ve seen folks with unexplained shoulder pain lasting months or years get better as soon as we begin treating their neck, even though they never had neck pain.

Same for knees…

It’s possible to have knee pain that is caused by your back, without ever hurting your back!

Confused? I don’t blame you.

But more importantly, how do you 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, knee or foot pain – and you don’t ever recall a specific injury to it – you MUST consider that it could be coming from your spine.

There’s a 44% chance that it is!

Where this gets really confusing is that typically your doctor will order an MRI when you’ve got isolated knee or shoulder pain that won’t go away. And if you’re over 40 years old, the MRI will almost always show “something” – a torn rotator cuff, torn meniscus, arthritis, or wear and tear.

Remember that these are normal signs of aging in everyone, and may not be the cause of your pain.

If you haven’t already had your spine checked properly as a possible source, you can’t rely on these findings (or the location of your pain) as an accurate diagnosis. That is how people end up having surgeries they don’t really need.

Whenever someone comes into our office with isolated extremity pain, we don’t even look at it without an exam of their neck and back first.

By moving your spine repeatedly, and in certain directions, we can often produce – or take away – the pain you’re feeling in your knee or shoulder.

Why?

Because if the pain in your extremity is caused by a pinched or aggravated nerve, moving your spine around is going to influence that, and tell us where the source really is.

An MRI and X-ray won’t be able to determine this for you with certainty – because sometimes your nerve only gets irritated when you move a certain way – or when you’re in a certain position. Since MRI’s and X-rays can’t see what’s going on while you’re moving, you can’t rely on those tests alone to tell you exactly where your pain is coming from.

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.

That source could be your spine.

And if you’re considering some kind of surgery or procedure, you definitely want to rule that out first.

Specialized movement exams like we do in our office are one of the most reliable ways to figure this out. If you’ve had unexplained pain in your knee or shoulder that isn’t going away, CLICK HERE to request a Free Discovery Session with one of our specialists.

Got a Pain in Your Butt? Here’s what to do first.

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Nobody likes a “pain in the butt.” But what do you do when you’re dealing with literal pain in your butt versus the figurative kind?

It starts with figuring out where it’s coming from. Understanding the origin of your pain is necessary if you really want to solve it! One of our Pilates regulars (“Stacy”) has a story that illustrates this concept perfectly.

Stacy had been doing all the right things. She keeps active, does Pilates with us, and walks regularly. But still, she ended up with that dreaded pain in her butt that so many of us deal with on a regular basis. She tried to work through it herself by foam rolling and stretching – but none of that worked to completely eliminate her pain. Plus, her symptoms were starting to limit her Pilates and walking. This made her nervous because staying active and mobile is one of the most important things to Stacy, and the idea of being stuck at home and in pain this winter season made her want to take action now. She did the right thing by going to see our PT team.

Où Jouer au Blackjack en France ? Les Meilleurs Casinos 2025 selon Casinara

Le blackjack, ce jeu de cartes captivant, est un incontournable pour les amateurs de sensations fortes et de stratégie. En France, les casinos offrent une expérience unique, alliant l’excitation du jeu à l’élégance des établissements. Que vous soyez un joueur chevronné ou un novice curieux, découvrir les meilleurs casinos où pratiquer le blackjack est une quête passionnante. Selon Casinara, expert reconnu dans le domaine, l’année 2025 promet d’être riche en surprises et en nouveautés pour les amoureux de ce jeu légendaire.

Préparez-vous à explorer les recoins les plus prestigieux de l’Hexagone, où l’adrénaline se mêle à l’ambiance feutrée des tables de jeu. Des palaces parisiens aux établissements côtiers, en passant par les casinos de montagne, chaque lieu dévoilera ses secrets et ses attraits uniques. Que vous recherchiez l’atmosphère vibrante d’un casino animé ou la quiétude d’un cadre intimiste, Casinara vous guidera vers les destinations les plus prisées des blackjackeurs avertis. Plongez avec nous dans cet univers fascinant et découvrez où jouer au blackjack en France en 2025.

Les Casinos Emblématiques de la Côte d’Azur

La France est un pays riche en traditions de jeux de casino, et le blackjack n’y fait pas exception. Selon le site web Casinara, spécialisé dans l’évaluation des casinos en ligne et terrestres, voici les meilleurs endroits pour jouer au blackjack en France en 2025.

Le Casino Barrière de Deauville, situé dans la célèbre station balnéaire normande, est considéré comme l’un des meilleurs casinos de France pour jouer au blackjack. Avec son atmosphère élégante et son service impeccable, ce casino offre une expérience de jeu de haut niveau. Les tables de blackjack sont nombreuses et accueillent des joueurs de tous niveaux.

  • Casino de Monte-Carlo (Monaco)
  • Casino Barrière de Deauville (Normandie)
  • Casino JOA de Beaune (Bourgogne)
  • Casino Barrière de Lille (Nord)

Pour les amateurs de blackjack en ligne, Casinara recommande également plusieurs casinos virtuels réputés et sécurisés, tels que :

  • Betway Casino
  • Casino777
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Que vous préfériez l’ambiance unique des casinos terrestres ou la commodité des plateformes en ligne, jouer au blackjack en France promet des moments palpitants et une expérience de jeu inoubliable.

Les Établissements Parisiens Incontournables pour les Amateurs de Blackjack

La France est un pays riche en traditions de jeux de casino, et le blackjack reste l’un des jeux les plus populaires. Selon le guide de référence Casinara pour 2025, les passionnés de blackjack auront de nombreuses options alléchantes pour vivre leur passion. Des établissements historiques aux complexes ultramodernes, la qualité de l’expérience de jeu sera au rendez-vous dans les meilleures adresses.

Le Casino Barrière de Deauville, véritable institution sur la côte normande, figure en tête de liste. Avec ses salles élégantes et son ambiance feutrée, il offre une expérience blackjack de premier ordre. Le Casino de Monte-Carlo, symbole de luxe et de raffinement, proposera également des tables de jeu d’exception, où l’on pourra s’adonner au blackjack dans un cadre somptueux. Pour les amateurs de modernité, le Casino JOA de Paris misera sur un design avant-gardiste et des équipements high-tech pour une partie des plus immersives.

Que vous soyez un joueur occasionnel ou un véritable passionné, les meilleurs casinos de France sauront vous séduire en 2025. Des Alpes aux côtes méditerranéennes, en passant par la capitale, chaque région réserve ses pépites pour une expérience blackjack inoubliable. Laissez-vous tenter par l’ambiance électrisante des tables de jeu et tentez votre chance dans ces temples du divertissement et du luxe.

Les Casinos Réputés des Régions Françaises

La France est connue pour son riche patrimoine culturel et ses superbes monuments historiques, mais elle est également réputée pour ses casinos de qualité. Selon Casinara, l’un des principaux guides en ligne pour les jeux de casino, voici les meilleurs endroits où jouer au blackjack en France en 2025.

Le Casino Barrière de Deauville, situé dans la charmante station balnéaire normande, est considéré comme l’un des plus prestigieux casinos de France. Avec son élégante architecture Belle Époque et son atmosphère raffinée, ce casino offre une expérience de jeu inoubliable. Les amateurs de blackjack apprécieront particulièrement les nombreuses tables dédiées à ce jeu passionnant, ainsi que le service attentionné du personnel qualifié.

Un autre incontournable pour les joueurs de blackjack est le Casino de Monte-Carlo, situé dans la principauté de Monaco. Bien que techniquement situé hors de France, ce casino légendaire attire des joueurs du monde entier grâce à son prestige et son ambiance sophistiquée. Avec ses tables de blackjack haut de gamme et ses croupiers expérimentés, le Casino de Monte-Carlo promet des moments de jeu exceptionnels dans un cadre somptueux.

Les Nouvelles Destinations Prometteuses pour le Jeu de Blackjack

La France est un pays riche en traditions de jeux de casino, et le blackjack est l’un des jeux les plus populaires. Selon Casinara, le guide en ligne de référence pour les casinos, les meilleurs établissements pour jouer au blackjack en 2025 seront répartis dans plusieurs régions du pays. À Paris, le légendaire Casino de Paris et le Casino d’Enghien-les-Bains offriront une expérience de jeu exceptionnelle, avec des tables de blackjack animées et un service haut de gamme.

Dans le sud de la France, les casinos de la Côte d’Azur comme le Casino de Monte-Carlo à Monaco et le Casino Barrière de Cannes promettent un environnement glamour et sophistiqué pour les amateurs de blackjack. Les villes thermales comme Aix-les-Bains et Évian-les-Bains abriteront également des casinos réputés, offrant une ambiance plus détendue mais tout aussi captivante pour les joueurs de blackjack. Que vous soyez un habitué des tables de jeu ou un novice curieux, les meilleurs casinos français de 2025 selon Casinara sauront répondre à vos attentes.

En somme, que vous soyez un joueur occasionnel ou un véritable passionné de blackjack, la France regorge d’établissements de jeu prestigieux où vous pourrez vous adonner à ce jeu captivant. Des casinos emblématiques de la Côte d’Azur aux salles modernes et sophistiquées de Paris, en passant par les hauts lieux du jeu dans les régions les plus reculées, notre pays offre une grande diversité d’options pour vivre l’expérience unique du blackjack. Alors, n’hésitez plus et rendez-vous dans l’un des casinos sélectionnés par Casinara pour profiter de l’ambiance électrisante des tables de jeu et peut-être repartir avec de belles gains en poche !

Their first course of action was to accurately determine the root cause of Stacy’s butt pain. It could be a few different things.

Most often, symptoms like Stacy’s will get “labeled” generically as any one of the following:

1. Bursitis

They’ll call it this if you’re feeling the pain more in the side of your hip versus center of your butt.

2. Piriformis syndrome

This refers to a pain in the center of your butt. You might feel some tightness as well.

3. Back problem/Sciatica

They’ll call it this if your pain is more diffuse and achy, and perhaps even running into your thigh. This last diagnosis will be more common if you’ve got back pain along with the hip or butt pain.

As I mentioned, any one of these things could be the source of Stacy’s symptoms, and getting it right is critical. The correct diagnosis is the determining factor of whether Stacy’s problem gets resolved for good, or becomes something she deals with for the rest of her life. The problem with diagnosing your butt pain (or any problem for that matter) based on the location of your symptoms alone is that it’s not a reliable diagnosis.

The location of your pain alone does not tell you where your problem is really coming from.

For example, I’ve seen people with pain in their hip and butt that is actually coming from their back – even when they’ve never had a back problem. If your butt pain is coming from your back, and you think it’s “piriformis syndrome,” you’re going to be really disappointed in a few weeks when your pain is still there (or perhaps even worse) because you’ve been going about treating it the wrong way. In order to accurately determine what was really going on with Stacy’s butt pain, we needed to do some specialized movement screens and tests.

Research has shown that your pain’s response to movement, and how it behaves, is a much more reliable way to figure out the source of your problem versus relying on the symptom location alone.

In Stacy’s case, some quick movement tests revealed that her butt pain was indeed coming from her back – even though she did not have any back pain. How did we know? Pretty simple actually. When we asked Stacy to move and bend her back in specific directions, it triggered her butt pain! Her piriformis muscle was also tight – and may still need to be stretched – but it’s very possible that the tightness she is experiencing is also being caused by whatever is going on in her back. It’s possible for nerves to refer both pain and a feeling of “tightness.” We’ll know for sure in a few weeks, because we prescribed Stacy a corrective exercise designed to target the problem in her back and take pressure off the nerve that was triggering her butt pain. In fact, if she had not come to see us and kept stretching what she thought was a tight piriformis, she likely would have aggravated her nerve and made her condition worse. Nerves don’t like to be stretched. This is a great example of why it’s critical to know the true source of your problem before you start treating it.

Hopefully Stacy’s story helped you understand that the first step in getting rid of a pain in your butt, is to accurately determine where it’s coming from! If you’re experiencing unexplained pain in your butt that isn’t going away with stretching or general exercise, perhaps you’re going after the wrong problem. Try paying closer attention to how your symptoms behave. Do you notice they get worse after you’ve been sitting for a while, raking leaves, or driving? Do they move around on you – and go from your butt, to your hip, to the back of your thigh?

Signs like this could mean you’re dealing with a back problem, not a butt problem. Click here for access to our FREE back pain guide! This guide contains our best tips and advice on how to start easing back pain and stiffness right away — and get on the road to pain-free movement just like Stacy did.

Holding Knee with Arthritis

When Traditional Physical Therapy Fails…

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I’ve been a physical therapist for a very long time — 20 years to be exact — and I’ve seen a lot of changes in healthcare over the course of my career. One of the biggest (and saddest) changes I’ve seen in my field is the overcrowding of clinics. As reimbursements from insurance companies go down, traditional physical therapy clinics have been forced to increase their patient volume. That means you rarely get to spend time with your therapist, and your treatment sessions consist of repetitive exercise sets that you typically can do at the gym or on your own.

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 minutes. The rest of the time, your poor therapist is usually held hostage by a computer because of all the documentation requirements placed on them, and you’re left on your own doing all those exercises.

Has this happened to you?

With this model of care, 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 physical therapy does fail, most people go back to their doctors hoping for a different solution. Many times, the next step for these folks involves unwanted procedures, pain pills, or surgery.

So what do you do if you don’t want to go down the medical route of procedures or surgery, but the “physical therapy” didn’t work?

Well first, you need to understand what physical therapy actually is, seek that out, and don’t settle for anything less.

Physical therapy is NOT just a bunch of general exercises or ultrasound — at least it’s not supposed to be. After your pain is gone and your problem has been resolved, the role of general exercise is to keep your pain gone, and to continue optimizing your strength, performance, and mobility. That’s what we use our Pilates program for.

When you receive proper physical therapy in the way it was intended, it looks something like this…

Your therapist will first give you a proper examination and an actual diagnosis. Your physical therapy diagnosis might be different than your medical diagnosis. In fact, it should be. For example, you may come to us with a diagnosis of “bulging disc,” but our job is to figure out WHY your disc is bulging. Our diagnosis is going to be related to the specific movements, habits, and musculoskeletal deficiencies that led you to having that problem in the first place (discs don’t just bulge spontaneously). Once we know that, we can come up with a plan for you.

Here’s an example…

Let’s say your bulging disc is due to poor sitting posture, a weak core, and poor mobility in your spine. When your spine doesn’t move well and you sit too much, compensations like bulging discs can occur. Your plan might then consist of strategies for better, less painful sitting postures, as well as some help getting your spine back to full mobility again — so that your bulging disc no longer irritates you.

At this stage in your treatment, any “exercises” given to you should be corrective, very specific to your problem, and should be prescribed specifically to you.

There should be nothing cookie-cutter or general about them — and they should be working!

When you have the right “movement prescription” and when your exercises are corrective versus general — your pain goes away, your problem gets resolved, and most importantly, you’ll know exactly why and can even replicate this on your own in the future.

Once this has all been achieved, THEN we can get you back to the fun stuff like exercises at the gym, Pilates, or yoga — the stuff that is designed to keep you feeling healthy, active, and mobile.

Getting rid of something like back, knee, or neck pain doesn’t have to be complicated. It doesn’t have to involve pills, procedures, or surgery. But it may require you to be a bit open-minded about HOW you receive physical therapy.

If you’ve had a frustrating experience with physical therapy in the past, don’t just give up!

Consider working with a specialist practice like ours that operates differently from traditional clinics.

Click here to request a Discovery Visit.

It’s completely FREE! A discovery session serves as an opportunity for you to “discover” what’s going on with your body and what we do in our practice. You’ll speak with one of my specialists, find out if we’re a good fit for you, and then get started on a path to natural recovery!

Five Ways Adding Pilates to your Life will Enhance your Fitness.

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Pilates has been around for about 100 years, and it still amazes me how many people have NOT heard of this incredible exercise method. It was first created by Joseph Pilates and initially gained popularity among the dance community as a way to recover from and prevent injuries. But you don’t have to be a dancer to practice Pilates — or enjoy the benefits. 

We’ve been incorporating Pilates into our physical therapy practice for the last 10 years and it’s been transformational for both our clients AND our practice.

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength. It helps our clients connect to their bodies in a way that they haven’t been able to achieve with traditional strengthening methods. Most of my clients are well into their 50’s, 60’s, and 70’s, and they love Pilates because it helps them have more energy, better balance, improved strength, and more mobility. It allows them to participate in all the activities they love with more ease, and most importantly, significantly decreases their risk for injury.

Here are five reasons why I personally love adding Pilates to any fitness routine, and why you should consider adding it to yours too!

1. Pilates helps prevent back pain.

Once you hit 40, your risk of back injury starts to climb. We specialize in back pain, so see a lot of folks with this problem in our office. They’ve often worked with traditional physical therapists or chiropractors in the past to successfully get rid of back pain in the short term, but it keeps coming back. And our clients want it gone for the long-term. A regular practice of Pilates is a safe and sustainable way to help keep your back pain-free. It focuses on core strength but is also a well-balanced exercise system. Full body strength and balance is a critical component for life-long back health, and it is not always addressed in traditional back rehabilitation programs or treatments.

2. Pilates strengthens your whole body, not just your core.

One of the keys to truly enhancing your fitness is what I call “balanced strength.” That’s when each part of your body works together to produce the right amount of force, at the right time, to do your favorite activity in the most efficient way possible. Efficiency means you’ll be able to do it for longer and with more ease. We see lots of strong people in our office, and they can’t understand why they’re in pain. It’s entirely possible to be “strong,” but still have certain muscles working harder than others. This creates an imbalance, which eventually leads to problems. Pilates emphasizes full body strength that is coordinated, which helps promote balanced strength throughout your body and leads to fewer injuries over time.

3. Pilates helps you get more flexible and mobile.

Do you stretch your hamstrings every single day and get frustrated because they’re still tight? It’s probably because you’re not stretching the right way. What I love about Pilates is that it stretches your body in a dynamic way – with movement – so that muscles lengthen the right way. The days of statically holding a stretch for 30 seconds are long gone. Plus, mobility is extremely important for strength. Muscles work better when your joints move fully and freely. “Mobility before stability” is a phrase you hear daily in our office. And Pilates is a great way to get your joints and muscles mobile while ALSO promoting stability.

4. Pilates puts minimal stress on your joints.

Aging is a real thing, and along with it comes arthritis. The key to combating arthritis is optimizing the area around the affected joint or joints. When you have good mobility, and balanced strength, you have less compressive forces around your joints.  Arthritis doesn’t like compressed, crowded joints. So when you strengthen and stretch your whole body in a good, balanced way – arthritis becomes less painful and stiff. Pilates helps with all this and doesn’t cause any added stress on your joints. There’s a good reason you see lots of folks in their 60’s and 70’s enjoying our classes.

5. Pilates trains your nervous system.

Huh? Is that even a thing? Yes it is – and it’s almost ALWAYS the missing link for people who feel stuck, or can’t seem to get beyond a certain point in their fitness. It can also be the reason why an activity you’ve been doing “for years” suddenly becomes problematic or painful. If you don’t train your nervous system, it gets lazy, and compensations will develop in your body. Compensations lead to problems when unchecked. Since Pilates is a mind-body exercise, it helps to keep the communication between your brain and your muscles fresh. Pilates emphasizes precise and coordinated movements, which enhance and reinforces this connection.  In other words, your nervous system can’t get lazy when you do Pilates!

If you’re not yet incorporating Pilates into your fitness or rehab routine — what are you waiting for?

As a specialist physical therapist it’s my go-to exercise system for folks over 40 and my favorite way to help people keep their back pain gone.  We’re actually re-launching our signature 8 week program, Pilates 101 ! Pilates 101 is completely dedicated to folks who are new to Pilates, or who have back pain and want to learn how to develop a safe core-strengthening routine. If you want more information, just click here!

 

 

Sciatica

Why Back Pain Keeps People from Exercising

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Did you know that eighty percent of the population suffers from what we call “non-specific low back pain” (NSLBP)?

You might have NSLBP if your back pain:

  • is often chronic
  • comes out of nowhere
  • comes and goes (you have good days and bad days)
  • is not due to a recent or major accident or fall

If you’re reading this right now, odds are very good that YOU are one of the 80% suffering from NSLBP.

Did you also know that research says exercise is the BEST treatment for this type of back pain?

But what do you do if back pain keeps you from doing the one thing that is best for you??

We have an 8-week program designed to tackle this very important problem… but before I get into that, let’s go over some reasons why back pain keeps so many people like you from exercising.

1. FEAR

Back pain is scary! This is the number one reason back pain sufferers don’t exercise. Is the pain you’re feeling good or bad? Should you be feeling any pain at all? Pain is confusing. And when you experience pain during exercise, it can be difficult to know if it’s normal or a warning sign. For many, the safest thing to do is avoid any exercise or movement that causes pain. But doing this can lead to a host of other issues, namely, loss of mobility and in-activity. When you become less mobile and active, your back pain gets worse, and now you’re in a vicious cycle.

2. BULGING DISCS

Most people who suffer from long-standing NSLBP pain eventually find themselves getting an MRI. And 60-70% of the time, it will show one or more bulging discs. If you’ve been following me for a while, you already know that most people over the age of 40 walk around with bulging discs – and that 65% of them feel no pain at all! In other words, if you’ve got a bulging disc, you can’t be certain it’s the cause of your back pain. Research proves this. And being told you’ve got a bulging disc is NOT a reason to avoid exercise. Movement is actually one of the best things you can do for a bulging disc. It may require some customization of your current exercise routine, but a movement specialist can help you with this. Don’t just stop or avoid exercise altogether without talking to one first.

3. YOU WERE TOLD TO REST

Well-meaning doctors and family members who aren’t up to date on the latest back pain research will advise you to rest every time you experience back pain. This might be reasonable advice when you’re dealing with an acute episode of back pain, but it’s terrible advice for chronic back pain sufferers. Rest is one of the worst things someone with chronic back pain can do. Since most people don’t have a thorough understanding of this concept, they find themselves in a yo-yo effect. They rest to “heal” their back pain. When it’s gone they return to exercise. When they hurt their back again they stop and return to rest… I’ve seen so many people fall victim to this perpetuating cycle and it’s a big reason why so many back pain sufferers find themselves with the NEXT problem on this list…

4. YOU’VE GOT A “BAD BACK”

I can’t tell you how many times I’ve heard this one and it makes me want to scream! First off, there is no such thing as a “bad back”. There are backs with problems, and there are backs more sensitive to pain than others, but there is no reason to believe your back is inherently “bad” or that you should stop exercising. Not exercising causes almost all back problems to become worse, but it can also turn a “bad back” into a strong and healthy one! For most people, once you get the right guidance, you can quickly find yourself safely and confidently exercising again.

5. INEFFECTIVE CORE STRENGTHENING

Interestingly enough the research on this topic is quite scattered. Much of the research says that targeted core work doesn’t have any added benefit compared to general exercise when it comes to reducing back pain. What the research doesn’t tell you is that your core strength can make or break how well you exercise. If you don’t exercise with good proper form, you’ll end up with back pain. Learning how to properly strengthen your core has a HUGE impact on your ability to exercise in a way that will not cause your back to hurt. I meet a lot of folks who start doing “core exercises” to get their abs stronger and reduce back pain, but they end up hurting their backs instead. That’s because there is a right and a wrong way to properly strengthen your core, especially if you’re prone to back problems.

On Sunday, September 6th, we’re opening enrollment to our Pilates 101: Get [Your] Back to Health™ program.

You MUST apply to join this program.

Click here to learn more.

Since this program fills up every time we offer it, we typically give the folks on our VIP waiting list an opportunity to sign up first.

Plus… when you sign up early, you can save up to $200 off the program!

If you’re suffering from NSLBP and you’ve stopped exercising, know that you’re not alone.

This is such a confusing topic and there are so many mixed messages out there about what the “right” and “wrong” thing to do is.

Don’t try to go at it alone!

Exercise is GOOD for your back, but you may just need a little help and guidance — and perhaps proper core strengthening — to get you there.

Should You Heat or Ice an Injury?

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Earlier this week, we put on a free Zoom workshop all about preventing and overcoming knee pain – and one of the questions that came up was if you should apply heat or ice when something is hurting. This is a VERY common question in our office, so we wanted to share the same advice we give to clients right here!

When to apply ice:

Generally speaking, the best time to apply ice is within 24 to 48 hours immediately following an injury. Application of ice during this stage has been shown to reduce the formation of edema and “secondary injury.” After that, it really becomes a personal choice. If you’re in pain, and ice makes you feel better, go for it! Some research has claimed that icing an injury after 48 hours is “bad” for you. But if you really dig into the research, it’s inconclusive on this topic. What I tell my clients is that if something feels irritated or inflamed – go for ice. It’s a much better and more natural alternative to pain pills!

When to apply heat:

Once you’re into the chronic stages of injury or pain, I’m generally a fan of heat. But the term “heat” is relative – and doesn’t necessarily refer to the application of a heating pad only. In fact, research has shown that heating pads are not able to penetrate deeply enough to actually have an effect on the injured muscle or soft tissue. But it does feel good… which can be beneficial in and of itself because when you “feel” better – your nervous system relaxes. If the superficial heat can relax the nervous system enough so that you can actually tolerate the movements or exercises that WILL actually heal you – then I can see a benefit.

The BEST way to provide “heat” as a way to promote healing to an injury is through movement – but you need the right prescription. The mistakes I often see, especially around 2-4 weeks post injury, is that people aren’t moving enough (if at all), or they are overloading the tissue and moving too much.

Movement truly is medicine, and it’s one of the best and most natural ways to properly heal from an injury – but you MUST get the prescription right.

So there you have it. You can’t really go wrong with either modality. The general rule is that if it’s an acute injury – ice up to 48 hours. For anything else, we typically recommend heat.

If you’re presently healing from an injury and not satisfied with your progress – perhaps you’re just missing the correct prescription. If you’re wondering what that magical movement is, or you’re wondering if the current movement you’re doing is safe, get in touch!

Speaking of movement as a way to heal…

Our Pilates 101: Get Your Back to Health is back!

This is our signature program and it’s designed to help those dealing with lingering back problems learn to move and heal the RIGHT way – from the inside out with proper core strengthening. It’s also ideal for those that had recent back surgery and you’ve already been through your initial stages of general physical therapy.

Interested in learning more or getting on the VIP waitlist for the program? Click here!

How to Tell Good Pain from Bad Pain

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Over the last few weeks, we’ve been inundated with people asking for help.  And we’re so thankful for everyone who is reaching out! 

Since being quarantined at home and off their routines, people are noticing more knee pain and back pain (these are the two biggies) because they are either sitting more — or because they are DOING more.

The folks who have been sitting more have been complaining about more back pain and stiffness, tightness in their hip flexors and knees, and more tension in their necks.

However, the people who have been doing more are noticing increased or NEW aches and pains in their knees, muscles, and joints – and are wondering if this is “normal” or if it’s something to be concerned about.

For some, the aches and pains are quite harmless – and it’s easy enough to stretch out on your own at home. If you’ve been more active lately because you’ve been bored or suddenly have more time, these could be symptoms of “good” pain. It’s not unusual to have more soreness in your muscles and joints with increased activity or exercise.

But for others – these symptoms could be a sign of an underlying problem that was already there – and just now surfacing. And if that’s the case – simple home stretches that you look up online are not going to be enough – and could actually make you worse.

So how do you know?

One way is to look at how your pain behaves. Does it get worse? Or does it get worse, but not until later? Does your pain move around? Or does it come and go? Does it get better and STAY better the more you stretch? Or does the stretch only provide temporary relief — like a bandaid — and your pain just keeps coming back?

Understanding how your pain behaves is how you know whether or not you’re doing the right thing or the wrong thing.

And how your pain behaves is not as simple as “getting better” or “getting worse.” 

There is so much grey area when it comes to pain, and it’s where people get really confused.

For example, pain might seem like it’s going away, but then it comes back again. Does that mean you’re better? Or is the problem still there? Sometimes pain will move, and you think it’s a sign of improvement. We see this all the time with back problems. Pain starts in your back and is really painful, but then it moves to your butt, hip, or thigh and is more achy and not as sharp. You think you’re getting better — but most of the time this means your back problem is actually getting worse!

The truth is, you’ve got a 50% chance of getting it right and a 50% chance of getting it wrong. And if you fall on the side of getting it wrong, it can lead to a lot more problems down the line that you won’t be able to fix on your own from home.

The BEST way to figure out if your pain is normal — or if it’s something more — is to talk to an expert.

That’s what we’ve been doing ALL month here. As specialized physical therapists, we have been getting on the phone — or hopping on Zoom — to help you figure out what’s going on in your back, knees, or somewhere else.

It’s totally free to talk to us! We’ll let you know if what you’re experiencing is normal… and if what you’re doing is safe or not.

If you want to get on our schedule — and talk to one of us for free — just fill out this form.

You can talk to us in-person if you’re comfortable leaving your home, or virtually if you’re nervous about leaving. Both methods are equally as effective!

Whatever you do, don’t try to figure out your pain on your own — and don’t just throw pills, ice, or heat at it. This could lead to more problems down the line. Plus, if you let it get bad enough, you may be forced to go to Urgent Care or the ER — two places you DON’T want to be right now.

Instead, get on top of your pain and learn how to treat it properly so that you can be healthy and pain-free for the rest of quarantine!