Tag Archive for: physical therapist

Physical therapy specialist treating frozen shoulder with non-invasive therapy in Portsmouth NH

Frozen Shoulder: Could Your Metabolism Be the Real Culprit?

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Frozen Shoulder: Could Your Metabolism Be the Real Culprit? (Portsmouth, NH Expert Explains)

If you’re dealing with a frozen shoulder, daily life can become difficult fast. Simple activities like putting on a jacket, reaching for a coffee mug, or sleeping comfortably can feel stiff, limited, or nearly impossible.

Traditionally, frozen shoulder has been viewed as a musculoskeletal issue caused by a tight shoulder capsule. Because of this, treatments often focused on aggressive stretching, cortisone injections, or even manipulation under anesthesia.

However, new research suggests frozen shoulder may actually be rooted in metabolic and immune system dysfunction— not just the shoulder itself.

New Research Shows Frozen Shoulder Is More Than a Shoulder Problem

A 2025 review published in the Journal of Clinical Medicine (Navarro-Ledesma et al.) proposes that frozen shoulder is influenced by:

  • chronic inflammation
  • metabolic dysregulation
  • hormonal changes
  • immune system imbalance

This supports something clinicians have observed for years:
frozen shoulder is a whole-body condition that shows up in the shoulder.

This also explains why standard treatments often don’t work long-term — because they fail to address the deeper biological factors influencing healing.

Why Frozen Shoulder Happens More in People Over 40

Frozen shoulder affects 2–5% of the population, especially women ages 40–60. What’s striking is how strongly it’s linked to metabolic issues:

  • Diabetes (10x higher risk)
  • Thyroid dysfunction
  • Obesity
  • Elevated inflammatory markers

These are no longer considered coincidences.

Another 2024 study (Healthcare, Hamed-Hamed et al.) found that individuals with elevated GGT (a liver enzyme linked to metabolic stress) or higher TSH (thyroid dysfunction) had worse stiffness and poorer outcomes.

This means your shoulder’s ability to heal is directly influenced by your whole-body biology, not just the joint itself.

Why Traditional Frozen Shoulder Treatments Often Fail

If frozen shoulder is driven by metabolic and immune changes, then forcing the shoulder to move aggressively can make symptoms worse.

Common treatments that fall short:

Cortisone injections
– Provide short-term relief
– Do not address systemic inflammation
– May weaken tissue with repeated use

Manipulation under anesthesia
– Can cause tearing or trauma
– May worsen inflammation
– Stiffness often returns

Aggressive stretching
– Overloads irritated tissue
– Increases inflammation
– Rarely works without addressing metabolic drivers

This is why many people go months or years without meaningful improvement.

A Smarter, More Effective Approach to Frozen Shoulder Treatment

At CJ Physical Therapy & Pilates in Portsmouth, NH, we use a whole-body, research-supported approach that calms inflammation, supports natural healing, and restores shoulder mobility safely.

Two of the most effective regenerative therapies include:

Shockwave Therapy (ESWT)

  • Stimulates blood flow
  • Softens tight, fibrotic tissue
  • Reduces chronic inflammation
  • Encourages natural mobility

EMTT (Electromagnetic Transduction Therapy)

  • Supports healthy cellular activity
  • Improves circulation
  • Reduces inflammatory signaling
  • Enhances tissue regeneration

These non-invasive therapies help your shoulder transition from the painful freezing phase into the healing thawing phase more effectively — without causing trauma.

Once inflammation calms, mobility exercises finally start to work as intended, allowing for faster and longer-lasting improvements.

Why This Matters for Seacoast Residents Over 40

Frozen shoulder rarely develops randomly. In your 40s, 50s, and 60s:

  • hormones shift
  • blood sugar regulation becomes more difficult
  • inflammation increases
  • connective tissue becomes more reactive

The right environment — not aggressive force — helps the shoulder heal.
Shockwave therapy, EMTT, and guided mobility exercises create the conditions your body needs to restore function naturally.

Final Thoughts

If you’ve been told to simply:

  • “wait it out,”
  • get another cortisone shot,
  • or undergo manipulation under anesthesia…

…it may be time to consider a more effective, biologically aligned solution.

Frozen shoulder may start in the shoulder, but the real drivers are systemic. Addressing these factors leads to quicker, safer, and more complete recovery.

Looking for Frozen Shoulder Treatment in Portsmouth, NH or the Seacoast?

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 you want natural, research-backed solutions for frozen shoulder — without medication, injections, or aggressive procedures — we can help.

CJ Physical Therapy & Pilates — Portsmouth, NH –  cjphysicaltherapy.com –  603-380-7902

Physical therapist helping patient with natural knee pain relief in Portsmouth NH

Six Tips for Managing Knee Pain without Medication

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6 Natural Ways to Manage Knee Pain Without Medication or Surgery

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

Introduction

When you’re suffering from lingering knee pain that just won’t go away, it can deeply affect your day-to-day life. And when this happens, it’s easy to become desperate and resort to daily medication or “quick fix” procedures or surgery.

But there’s good news — there are plenty of natural, non-medicated ways to manage knee pain successfully and improve how you feel, even if you’ve been dealing with knee pain for years. You don’t always need medication or invasive treatments to find relief — despite what the medical community tells you.

Understanding the Problem: Why Knee Pain Lingers

Knee pain often develops gradually due to muscle imbalances, stiffness, or overuse. It can also stem from poor movement patterns that put excess strain on your knees. Many people turn to medication for temporary relief, but this doesn’t fix the underlying cause.

By addressing the true source of your discomfort — how your body moves, supports, and aligns itself — you can find lasting relief naturally.

Common Causes of Ongoing Knee Pain

  • Weak hips or core muscles that lead to poor alignment

  • Stiffness in the hips, hamstrings, or quadriceps

  • Prolonged sitting or sedentary habits

  • High-impact or improper exercise routines

  • Unsupportive footwear

  • Poor balance or coordination

Understanding these root causes allows you to take meaningful, proactive steps toward recovery — without medications or procedures.

Natural Solutions: 6 Proven Tips to Relieve Knee Pain

1. Strengthen Your Hips and Core

Your hips and core play a crucial role in providing stability and support for your knees. When these muscles are weak or unbalanced, your knees bear the brunt of poor mechanics during movements like walking, running, and squatting.

Strengthening your hips and core improves body alignment, reduces strain on your knees, and promotes long-term joint health. Try exercises such as glute bridges, side leg lifts, and planks for better stability and reduced pain over time.

2. Improve Your Flexibility

Mobility comes before stability when it comes to joint health. Stiff joints force surrounding muscles to overcompensate, leading to more discomfort and inefficiency in movement.

Improving flexibility—especially in your hips, hamstrings, and quadriceps—helps distribute forces evenly through your body and reduces strain on your knees. Regular stretching, yoga, or mobility exercises can enhance your joint motion and reduce chronic knee discomfort.

3. Don’t Sit Too Long

Sitting for extended periods can cause stiffness in your knees and reduce circulation. It may also create or worsen imbalances in your hips and back that contribute to knee pain.

Make it a habit to stand up and move every 30 minutes. Light stretching, short walks, or even standing for a few minutes can help keep your knees flexible and pain-free.

4. Stay Active

Regular, low-impact exercise is one of the best ways to manage knee pain naturally. Activities like swimming, cycling, and walking increase blood flow, reduce inflammation, and lubricate the joints.

If arthritis is a concern, consider Pilates or resistance band exercises to build strength without overloading your knees. Avoid high-impact movements that cause pain and focus on maintaining flexibility, balance, and muscle endurance.

5. Wear Supportive Footwear

Footwear plays a big role in knee health. Shoes that don’t support your feet properly can cause poor alignment and extra stress on your knees.

Choose shoes with good arch support, cushioning, and proper alignment. Replace worn-out footwear regularly, and consider custom orthotics if needed to optimize foot and knee mechanics.

6. Optimize Your Balance

Good balance isn’t just about preventing falls—it also helps your knees function efficiently. When your body is well-balanced, the load is distributed evenly across muscles and joints.

Practice simple balance exercises such as standing on one leg, using a balance board, or doing yoga. Improving your balance helps reduce knee strain, enhances coordination, and promotes overall stability.

Next Steps: Find Natural Relief in Portsmouth, NH

If you’ve been dealing with knee pain for a while and haven’t incorporated these tips yet, now is a great time to start. Try these strategies first before resorting to something invasive—or accepting a life on daily pain medication.

And if you need guidance, it’s a good idea to consult with a physical therapy specialist who focuses on natural treatments for knee pain.

Are you local to Portsmouth, NH?

 CLICK HERE to speak with one of our specialists at CJ Physical Therapy & Pilates. We’ll help you figure out which strategies will get you back to doing all the activities you love—while avoiding medications and procedures.

About Dr. Carrie Jose

Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Pain Expert, and owner of CJ Physical Therapy & Pilates in Portsmouth, NH. She also writes for Seacoast Media Group.

To get in touch—or to request a free copy of her guide, “7 Easy Ways to Get Rid of Knee Pain”— CLICK HERE.

A Physical Therapy Expert’s Guide to Enjoying Fall Activities Pain-Free

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A Physical Therapy Expert’s Guide to Enjoying Fall Activities Pain-Free

Fall is my favorite season-and I know it is for many of you too. Crisp air, colorful leaves, pumpkin patches, and cozy outdoor gatherings are some things that come to mind. But there’s also raking leaves, picking apples, chopping wood, and moving heavy things like hay bales or pumpkins. Any of these activities can produce unwelcome strain on your body if you’re not careful. 

Here’s a guide to enjoying all that fall has to offer-from a back pain and mechanical pain expert-so you can do as much as you want this fall season while keeping your back and joints pain-free.

  1. Rake Leaves with Care

Raking is a quintessential fall activity, but it’s also repetitive and strenuous, which can lead to back pain if done improperly. To protect yourself, begin by warming up. Just as athletes warm up before a game, you should warm up before raking. Try a brisk 5-10 minute walk around your yard or neighborhood to get your blood flowing, followed by gentle stretches for your back, shoulders, and legs. A few torso twists and arm circles will help loosen up your muscles and prepare them for the repetitive motions of raking. Next, choose a lightweight rake with a long handle that allows you to stand upright. Avoid bending forward too much, and alternate sides regularly to avoid overusing one side of your body. When bending to gather or bag leaves, squat using your legs and keep your core engaged. Avoid twisting from your waist, as this puts your spine in a vulnerable position. Instead, pivot your entire body to avoid strain. Raking for extended periods can tire out your muscles, making you more susceptible to injury, so set a timer for every 20-30 minutes and take a short break to stretch your back and shoulders.

  1. Safely Pick Up and Carry Pumpkins

Pumpkin picking is a fall favorite, but carrying heavy or awkwardly shaped pumpkins can strain your back and shoulders if you’re not careful. Here’s how to keep things safe and pain-free. First, when lifting a pumpkin, bend at your knees and use your leg muscles to power the lift. Keep the pumpkin close to your body and avoid twisting as you lift. If possible, use a cart or wagon to transport heavier pumpkins and prevent carrying strain. Many farms and pumpkin patches provide carts-take advantage of them! If you’re decorating with multiple pumpkins or other fall items, consider limiting the number of trips you make to and from your car or home to avoid repetitive strain. This advice applies to picking up and carrying anything-whether it’s hay bales, fall decorations, or putting away summer furniture.

  1. Use Good Posture When Apple and Pumpkin Picking

Apple orchards and pumpkin patches can be so much fun, but both activities involve a lot of bending, reaching, and lifting. Use these tips to protect your body. Instead of overstretching to reach that perfect apple, use a ladder or stool. Overreaching can lead to shoulder and back strains, so play it safe and keep a good base of support as you reach up. When standing or walking for extended periods in the orchard or patch, practice standing tall, with your weight evenly distributed between both feet. This not only helps reduce fatigue but also protects your lower back. Additionally, if you know you’ll be walking and standing for prolonged periods, wear good, supportive shoes. This will go a long way in helping your spine and the rest of your joints absorb the load of your body as well as those pumpkins and apples.

  1. Move Often and Stay Hydrated

All-day outdoor fall activities can wear you out, especially if you’re standing, bending, or lifting frequently. Staying mindful of your body can make a big difference. Make a point to take a stretch break every hour or so. Focus on simple movements that lengthen your spine and open up your chest and shoulders, such as reaching your arms overhead and gently twisting your torso side-to-side. Cooler weather can make you feel less thirsty, but it’s still essential to stay hydrated. Dehydration can lead to muscle stiffness, fatigue, and even unwanted spasms and cramps, increasing the risk of strains.

  1. Cool Down After Activities

Once you’ve wrapped up your fall fun, give your body a few minutes to cool down and recover properly. A little bit of post-activity care can go a long way in keeping pain at bay. After raking, decorating, or any heavy lifting, spend five minutes stretching your back, legs, and shoulders. Simple stretches like extending your spine backward or pulling your knees to your chest can help relieve tension. After a full day of physical activity, it’s tempting to sink into a couch or recliner, but try to avoid slumping immediately afterward. Instead, sit with a straight back, or go for a light walk. This can help prevent stiffness and reduce the likelihood of soreness.

Enjoy Fall the Pain-Free Way

Fall activities are a great way to enjoy the season and embrace the outdoors, but they don’t have to come with pain and strain. Taking a few preventive measures, such as warming up, being aware of your body, and using proper lifting techniques, can make a significant difference in how you feel afterward. With these tips, you’ll be ready to fully enjoy apple-picking, pumpkin patches, and all the beauty that fall has to offer-with a lot less ache. That being said, if you try every tip I’ve mentioned and don’t notice any difference in how you feel or tolerate these activities, your problem might need expert help. Reach out so we can help you find a mechanical pain expert in your area who can work with you.

Are you local to Portsmouth, NH? If so, consider speaking to one of my specialists in a Free Discovery Session. This 30-min session is a designed to: 1. Make sure we can help you 2. Make sure you’re a good fit for what we do 3. Make sure we’re a good fit for you. 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, call 603-380-7902, or CLICK HERE to get a free guide for preventing back pain.

Frozen Shoulder: Why the “Quick Fix” May Set You Back

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If you’ve ever suffered from a “frozen shoulder,” you know firsthand how debilitating it can be.

The shoulder pain and stiffness make it hard to reach into cabinets, fasten a seatbelt, or even sleep comfortably – and this condition can hijack your life for months, sometimes even years. The bigger problem is that the usual advice – to just “wait it out,” get a cortisone shot, or let a surgeon force the shoulder to move under anesthesia – can often do more harm than good. But there is a better way forward, and it involves working with your body instead of against it.

What exactly is frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, occurs when the capsule around your shoulder joint becomes inflamed and tightens. It affects more women than men, most often between the ages of 40 and 60. Metabolic health plays a major role as well. Conditions like diabetes, obesity, high blood sugar, and elevated lipids significantly increase the risk, likely because they contribute to inflammation and tissue changes in the shoulder capsule. As the capsule thickens and stiffens, motion becomes restricted and pain increases. Frozen shoulder usually progresses through three stages: the painful phase, the frozen (or stiff) phase, and finally, the thawing phase. The good news is that most cases resolve on their own. The bad news is that “on their own” can mean two to three years without the right care – and that’s a long time to put your life on hold.

Why “quick fixes” don’t work

One of the most common interventions people get pushed toward is manipulation under anesthesia. On paper, it sounds appealing: you go under anesthesia with a stiff shoulder and wake up with more motion. But the reality is more complicated. A large review reported that about 14 percent of people needed a second procedure, and the overall evidence base was weak, with most studies lacking proper control groups.

Complications, though not frequent, can be serious. Tears of the capsule, labrum injuries, rotator cuff damage, bone bruising, fractures, and even nerve injury have all been reported. For a problem that often improves with proper conservative management, exposing yourself to those risks doesn’t make sense. Manipulation might have a place for rare cases that fail everything else, but it should never be your first option.

Cortisone injections are another common recommendation. While these can provide short-term pain relief, they come with a big catch. Cortisone is not a healing agent – it simply suppresses inflammation. Multiple studies have shown that repeated cortisone injections can weaken tendons and joint tissue, which may actually slow long-term healing and set you back. Frozen shoulder already has a natural life cycle, and while cortisone can blunt pain temporarily, it does not change the overall course of the disease. Worse, relying on injections can delay the real solution: restoring mobility through movement and proper rehab.

Do you have the correct diagnosis?

Another important point often overlooked is that a doctor’s diagnosis of “frozen shoulder” may not always tell the whole story. Adhesive capsulitis is commonly misdiagnosed, because many shoulder problems can look and feel like frozen shoulder in the early stages. Stiffness and pain are not unique to adhesive capsulitis – rotator cuff injuries, labral issues, arthritis, and even postural or mechanical problems can mimic it.

A 2016 case study published in the International Journal of Sports Physical Therapy highlights this problem. A patient was referred with a diagnosis of adhesive capsulitis. But when evaluated using Mechanical Diagnosis and Therapy (a form of specialized mechanical therapy), the presentation was actually consistent with what’s known as a “shoulder derangement.” Instead of requiring the long and difficult course typically associated with frozen shoulder, the patient responded quickly to specific corrective movements – achieving full pain relief and restoration of motion within just a few visits. This underscores why it’s so important not to take a frozen shoulder diagnosis at face value. The right examination makes all the difference, and sometimes what looks like frozen shoulder is actually a mechanical problem that can be resolved much faster.

What should you do?

But let’s say you do, indeed, have frozen shoulder. While it’s true that in most cases you have to let it “thaw out” and get through the freezing stage, there are natural treatments that can speed this up. Non-invasive technologies like Extracorporeal Shock Wave Therapy (ESWT) and Extracorporeal Magnetotransduction Therapy (EMTT) give your body’s natural healing mechanisms a boost to aid in both pain relief and mobility.

Shockwave therapy uses acoustic waves to stimulate healing, increase blood flow, and help tissues remodel, while EMTT uses high-energy pulsed electromagnetic fields to influence cells at the microscopic level and calm inflammation. On their own, each has been shown in recent studies to reduce pain, restore motion, and improve function. But when used together, the results are even more powerful. Shockwave helps loosen the capsule and ease pain so movement becomes possible, while EMTT supports the healing process at the cellular level. This combination accelerates recovery, making it easier to progress with the stretching and strengthening that ultimately restore long-term shoulder health.

The real power of these therapies is how they fit into a bigger plan. Specific stretching techniques, corrective mobility drills, and later, strengthening exercises are still the foundation of recovery. But when you can reduce pain and inflammation more quickly with shockwave and EMTT, you unlock the ability to move sooner and with less fear. That means you don’t just get better – you get better faster.

Final thoughts

Frozen shoulder does not require surgery, force, or repeated cortisone injections. In fact, those approaches can cause setbacks or complications that make recovery even harder. A smarter path is to combine natural, non-invasive therapies like shockwave and EMTT with guided, progressive movement from a specialist. Research is showing us that these tools can help people reduce pain, improve range of motion, and shorten recovery time – all without exposing you to unnecessary risk.

If you’ve been told to “wait it out” or to sign up for an aggressive procedure, it may be time to get a second opinion. Frozen shoulder is tough, but it is not unbeatable. With the right plan, the right tools, and the right guidance, you can move past the pain and stiffness – and get your life back.

Sound like you?

Consider speaking to one of our specialists in Downtown Portsmouth, NH. Click here to request a free discovery visit.

Back MRI

Are your Back MRI results reliable? Research says otherwise.

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Whenever pain flares up – one of the most popular questions and concerns I get from clients is whether or not they need an MRI. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI, right?

Not necessarily.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. But what we now know from research is that all those findings on an MRI don’t always correlate with what’s actually causing your pain.

One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Let me explain.

When it comes to back problems – or joint problems in general – what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature. That means your pain has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration and other age-related changes show up on an MRI.

What it’s important to understand is that disc degeneration, arthritis, and bulging discs are ALL a normal part of aging, but they often get blamed for problems they don’t actually cause. In other words, the source of your pain is often a movement dysfunction learned and repeated over time that is irritating you – not the age-related changes themselves. The best way to figure out if your problem is movement-related vs structure-related is… well… with a movement assessment… NOT an MRI.

So how does movement testing work and why is it more reliable than an MRI? 

This is a great question and not one that is easily explained… but I’m going to try!

When your back, neck or joint pain is mechanical in nature – one of the most important things to look at and pay attention to is how your pain behaves. Not necessarily where it’s located. With pain – the most important thing to determine is how it reacts against certain triggers and with different activities.

Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain?

When your pain is variable, it’s the most reliable sign that your pain is “mechanical” in nature. It also means you don’t need surgery or any kind of procedure to fix it. In fact, a procedure or surgery could leave you feeling worse off than before. Let’s say you “cut out” the structure – or inject it to make it numb – your movement problem hasn’t gone away and it’s only a matter of time before it starts aggravating something else.

Take home point…

MRI’s are a super powerful and amazing diagnostic tool – but their results when it comes to diagnosing neck, back, or joint pain MUST be taken with a grain of salt – and should absolutely be coupled with an expert mechanical joint evaluation before you decide on a treatment plan.

Because if you are dealing with chronic, long-standing aches and pains that have come and gone over the years – or have recently gotten worse – there is a 70-80% chance that it is a mechanical problem finally catching up to you and not a structural problem.

Figure out the root source of your neck, back, or joint pain by seeing a movement expert who specializes in mechanical pain FIRST. Because when you automatically assume that you need an MRI first, and you base your whole treatment plan off of those results – you can end up down a rabbit hole of unnecessary medical procedures or surgery that ultimately won’t give you the long-term relief you’re looking for.

Are you local to Portsmouth, NH?

Consider speaking to one of our 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.

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.

Active and Mobile

Six Ways to Keep Your Thanksgiving Festive and Fit

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Six Ways to Keep Your Thanksgiving Festive and Fit (Portsmouth NH Healthy Holiday Tips)

Thanksgiving is one of my absolute favorite holidays here on the Seacoast. I love the food, the sweets, family time, the Macy’s Day Parade, afternoon naps, and football. Traditionally, Thanksgiving means slowing down and indulging—but more and more people in Portsmouth, NH and across the Seacoast are looking for ways to stay active and feel good throughout the holiday.

And the benefits are real: improved digestion, better energy, happier joints (hips, knees, back, neck, shoulders), and a healthier balance to the extra calories you may enjoy.

If you want a festive and more active Thanksgiving this year, here are six simple, healthy Thanksgiving tips to help you stay moving and feeling great.

1. Practice Mindful Eating

You can enjoy every part of your Thanksgiving meal—while still supporting your digestion and energy—with mindful eating.

Mindful eating involves slowing down, savoring each bite, and paying attention to hunger and fullness cues. Studies show this can reduce calorie intake by up to 25%, simply by giving your brain time to register fullness.

It also helps digestion by encouraging thorough chewing and reducing the bloating or discomfort that often comes with holiday meals. Instead of loading your plate immediately, take your time, taste every dish, and enjoy the experience.

2. Interrupt Your Sitting

Even if you don’t feel overly full after practicing mindful eating, long periods of sitting can make your hips, back, and knees stiff—especially on soft couches.

Aim to stand up at least once every 30 minutes. This can be a fun job for a younger family member—let them be responsible for making everyone stand!

Regular movement breaks are one of the easiest ways to keep your spine and joints happy throughout Thanksgiving Day.

3. Sign Up for a Turkey Trot (or Create Your Own)

Turkey Trots are popular across New Hampshire and the Seacoast, and they’re a fun activity for the whole family. Most are 5Ks (3.1 miles), but even creating your own neighborhood walk or jog counts.

A morning walk or run boosts circulation, lubricates your joints, and elevates your metabolism for hours afterward. It’s one of the best ways to balance your Thanksgiving Day indulgence while giving your body a healthy start.

4. Be Active During Commercials

Whether you’re watching the Macy’s Day Parade or football, hours on the couch can wreak havoc on your back and neck.

A simple solution? Do something active during commercial breaks. It doesn’t have to be complicated:

  • Squats

  • Heel raises

  • Planks

  • Back or hip stretches

Turn it into a family challenge if you’ve got competitive relatives—you know who they are.

5. Walk Your Dessert Off

Skipping dessert is optional—but walking afterward is highly recommended. Even a short 10–20 minute walk supports digestion, stabilizes blood sugar, and offsets stiffness from sitting.

Walking is one of the most natural, joint-friendly exercises you can do, and it’s especially beneficial after a big Thanksgiving meal.

6. Stay Hydrated

Hydration matters every day—but especially on Thanksgiving. Drinking water helps with digestion, nutrient absorption, and energy levels.

We often confuse thirst with hunger, so staying hydrated before and during your meal can help you feel more in control of your portions. Hydration also keeps your mind clear and your body energized, making healthier choices easier throughout the day.

Final Thoughts

There you have it—six easy ways to keep your Thanksgiving festive, active, and healthy. If back, hip, knee, neck, or shoulder issues are getting in the way of enjoying the holiday—or even these simple tips—it may be time to talk with a mechanical pain expert.

They can help you find the root cause of what’s bothering you and keep it gone—so by next Thanksgiving, you can enjoy the day fully.

And—it’s the perfect time to take advantage of our Black Friday Sale!
We’re offering our lowest prices of the year on sessions with our Physical Therapy Specialists and our Regenerative Shockwave Therapy.

👉 CLICK HERE to get full access to the Black Friday deals — packages are limited and only available while deals last!

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch—or to request a copy of her free guide “5 Simple and Easy Ways to Get Rid of Back Pain”—CLICK HERE or call 603-380-7902.

Avoiding Movement

How Fear Can Worsen Your Injury: The Hidden Dangers of Avoiding Movement

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Fear is a natural, protective response to injury.

But sometimes it can do more harm than good if you’re not careful. Reason being… When we experience pain or injury of any kind – while the pain can range from mild to excruciating – the real “pain” comes from not knowing what you just did. 

Was it anything serious? Will it go away on its own? What should I do?

All these questions compound the unknown which tends to manifest itself as some version of fear and trepidation. And the degree at which this occurs is highly variable among individuals. On one end of the spectrum – the fear of making an injury worse can lead to behaviors that hinder recovery. But on the opposite end – the fear of not doing enough and being cavalier about “no pain no gain” could also impede your recovery.

The good news is that with the right knowledge, tools, and team of experts – you can “train your nervous system” to interpret pain appropriately and avoid the hidden dangers of not moving enough. If fear is caused by the unknown of what’s happening when you feel pain or have been injured – then a better understanding of pain (what it is, what it’s telling you, and how it behaves) and how your body naturally heals from injury is going to help lessen that. I always say: “Movement is medicine – but knowledge is power”

So… as I’ve alluded to… one of the most common misconceptions about injury recovery is the need for prolonged rest.

When we get injured, our instinct is to “protect” the affected area, which typically translates to avoiding movement altogether. While this may seem a prudent strategy, it can actually delay your body’s natural healing process. 

Let me explain…

Yes, an initial resting period makes sense in some cases, especially after an acute injury where you’ve experienced some form of trauma to your tissues. But as soon as that initial inflammatory period ends – you’ve got to start moving. This is crucial for the proper healing of tissues that have been damaged from an injury. Plus – a lot of injuries don’t occur traumatically. They happen slowly over time. This type of pain requires a totally different approach to healing.

In either case – resting for too long and not moving enough can lead to all sorts of problems such as muscle atrophy, joint stiffness, and reduced overall function. Plus – you’re teaching your nervous system that it’s “safer” to not move – which can cause problematic adaptations over time if you’re not careful. In other words, you need movement, and even a little bit of pain to occur for proper recovery from an injury. But you’ve got to balance this. Too much too soon could re-injury you – while not doing enough will put your body and nervous system into “protective mode” – making it harder to incorporate necessary and healthy movement later on.

So how do you balance this process? How do you know if the pain you’re feeling during movement is good or bad?

Understanding how pain behaves is key. Generally speaking, pain during movement that doesn’t last is considered “safe”. We call this hurting versus harming. It’s generally ok to hurt, but never ok to harm. As your mind and body experience this phenomena together – you’re effectively coaching your nervous system to not react to the sensation of “hurting” in such a sensitive way. The more you move, and the more your nervous system realizes the painful feeling is not resulting in harm or more injury, the more that hurt sensation fades. Your nervous system no longer interprets it as pain. This is a normal and healthy response to pain when dealing with any injury – but especially those that are chronic and didn’t come on so suddenly.

The danger you run into when you never allow hurt to happen and avoid any amount of pain altogether – is that you encourage fear to run the show. Your nervous system never “learns” what good pain is vs bad pain – and it starts to get confused. Before you know it, any kind of sensation is perceived as pain (danger) by your nervous system – which only serves to fuel the fear of movement even more. It becomes a vicious cycle that is hard to break.

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

This can be a nuanced and complicated concept to understand – and it’s why I don’t recommend going at it alone. Working with a movement expert who truly understands the process of healing and how your nervous system plays into all this will help take the guesswork out of all this and build confidence in this process.

Movement really is medicine and it’s a powerful one – when you’ve got the knowledge to use it properly.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To book a free discovery visit with one of our specialists CLICK HERE.

Man holding his head in pain from a headache in Portsmouth NH, neck-related headache concept

5 Signs your Headaches are coming from your Neck

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Headaches impact approximately 47% of the population and are one of the most common disorders of the nervous system. If you suffer from headaches regularly, then you already know how disruptive they can be on your work life, social life, daily activities, and just overall energy and well-being. 

But what makes headache management particularly challenging is how often they are misdiagnosed. The most common types of headache disorders are what’s known as primary headache disorders – and those include migraines, cluster headaches, and tension-type headaches. But you could also be suffering from a secondary headache disorder – which is caused by some other illness or physical issue. One of the most common forms of secondary headache is something called a “cervicogenic headache” – meaning it comes from your neck. They can be quite debilitating and are commonly confused with migraines – but there are some key signs to look for that make them different. 

Let’s look at 4 signs that might indicate your headache is coming from your neck:

1. Headaches worsen with certain neck movements

If you find that certain movements or positions of your neck exacerbate your headaches – it could be a sign that your headaches are coming from your neck. Sometimes it’s very specific movements that trigger a headache – such as tilting your head forward or backward – or turning it from side to side. But other times it’s less obvious and related to more prolonged postures. For example, I’ve had patients experience headaches from sitting at a bar for several hours and turning their head to a certain side to talk to their friend. Pay attention to whether certain neck movements or positions create discomfort in your neck that either precedes or worsens your headache. It could mean that your headache is coming from a source in your neck.

2. Your Neck is Stiff

Another telltale sign of neck-related headaches is limited mobility or range of motion of your cervical spine (neck). If you find yourself struggling to turn your head fully, or you experience pain and stiffness when attempting to do so, it could indicate an underlying issue in your neck that is causing your headache. A common saying in my office is “mobility before stability”. If the joints in your neck don’t move fully and freely, the structures around those joints (muscles and nerves) can become angry and irritated – and this could be the source of your headaches.

3. Tenderness in your neck muscles

If you routinely have sensitivity and tenderness in the muscles of your neck – it could indicate an underlying neck problem. If you notice that your headaches seem to get triggered whenever the tension or tenderness in your neck muscles worsens – then there’s a good chance your headaches are coming from your neck. The muscles of your neck can get tense and irritated for a number of reasons – most commonly because of poor posture or because they are being overused in some capacity. Since your neck muscles have direct and intricate attachments to the base of your skull – they can be a common cause of your headaches.

4. Location of your Pain

A headache that stems from the base of your skull and stays on one side of your head – often radiating into your temple or behind your eye – is a common sign that your headache is coming from your neck. If you tend to get associated shoulder or arm pain at the same time as your headache – it’s another indicator your headache could be cervicogenic. That’s because the nerves in your neck extend into these areas and are capable of radiating pain into these locations. If you suffer from chronic headaches, pay attention to where the pain is coming from or where it’s radiation. If it’s extending beyond your head – there’s a good chance your headaches are coming from your neck.

5. Massage and Chiropractic Manipulations Help.

If you find temporary relief from your headaches any time you get a massage or see a chiropractor, it’s almost certain your headaches are cervicogenic. While it’s great you’ve found pain relief – the problem with relying on these modalities is that they are completely “passive” – meaning – you don’t have an active role in the process of relieving your headaches. Passive modalities work great when paired with specialized, corrective exercises you can do on your own that are designed to prolong the effects of these treatments. But when passive treatments are used in isolation – the headache relief tends to be short-lived. The take home point here is that if you find treatments like massage and chiropractic treatment help – your headaches are almost certainly coming from your neck.

If you suffer from debilitating headaches and haven’t yet gotten your neck thoroughly checked out as a source – you should. Because when your headaches originate from a source in your neck, it’s entirely possible to learn how to treat it and manage it naturally and on your own. But you’ll need to work with a specialist who understands cervicogenic headaches as well as the associated mechanical joint components influencing them.

Are you local to Portsmouth, NH? CLICK HERE to speak with one of my specialists for free.

Want to lose weight in the New Year? Don’t let knee or back pain get in your way.

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If you google “Top 3 New Year’s Resolutions” – you’re sure to find “losing weight” as one of them. While I’m not a dietician or nutritionist, I know that the majority of weight loss has to do with what you eat. However, exercise plays a role too, and that I am an expert in. 

Exercise stimulates endorphins and makes you feel better all around. The better you feel, the easier it will be to stay motivated about your weight loss goal.

Exercise also helps you burn more calories – which certainly isn’t going to hurt your weight loss journey.

But if you’ve got unchecked knee or back pain, not only will you find it challenging to exercise, you are going to be more stressed about it. Stress increases cortisol which interferes with your ability to manage weight. And if you can’t exercise at all because of pain, that will make it even harder to manage stress, never mind your weight. You can see how this vicious cycle from unwanted knee and back pain could completely derail your New Year’s goals.

Here are four tips to help you not let knee or back pain get in the way of your weight loss in the New Year:

1. Mobility Before Stability

Your muscles can’t function at their best if you don’t have optimal joint mobility. In other words, you don’t want to strengthen around a joint that isn’t moving at its best, or you’ll encourage compensation. If your nagging back or knee pain is due to inadequate mobility, you’ll run into problems. You will be in more pain if you suddenly increase your exercise or activity level. We saw this happen at the beginning of the pandemic. People started walking and exercising more and we saw a huge influx of unexpected back and knee pain as a result. Their joints weren’t accustomed to moving so much and it highlighted the lack of mobility and compensations. Don’t let the same thing happen to you. Make sure all of your joints, including your spine, can move fully and freely without any pain before you begin a new exercise program.

2. Pace Yourself

It’s very tempting to go “all in” on your new exercise or weight loss goal… but remember… the tortoise (not the hare) won the race. It’s important to not beat yourself up if you’re not seeing immediate results. If you’ve been out of shape for a while and doing something completely new, expect to be sore. But if you’re limping around for days or experiencing sharp pain in your back or knee, there is a chance you overdid it or worse case injured yourself.

My general rule of thumb is to monitor your soreness on a scale of 1 – 10. I tell my clients to not let their pain go above a five when they are pushing themselves or returning to an exercise they haven’t tried in a while. If you find that your pain level goes above a 5, or persists at that level (or higher) for more than a day, there’s a chance you’re overdoing it and setting yourself up for an unwanted injury. When in doubt, listen to your body. And if you’re not sure what it’s saying – enlist the help of an expert.

3. Stay Hydrated

Most people don’t drink enough water during their regular day, never mind when they increase their activity level. Drinking lots of water has two great benefits: It will give you the extra hydration you need if you’re planning to be more active; and it will help you lose weight by curbing your appetite. Some additional benefits of staying hydrated include increased muscle strength and stamina, more lubrication in your joints, more supple skin, better cardiovascular function, and improved energy and mental alertness. One really easy tip to jumpstart your day is to begin with 10 oz of water first thing upon waking. And a good rule of thumb when you’re trying to stay adequately hydrated is to drink at least half your body weight (in ounces) of water every day.  

4. Get Assessed by a Mechanical Pain Expert

If you’ve got nagging back and knee pain, see a mechanical pain expert before you begin your new exercise routine. Your first thought might be to go see your medical doctor. However, it’s important to understand how different medical professionals assess different problems. Medical doctors are trained to screen your whole body and typically rely on imaging to make their diagnosis. This is a great approach if you’ve had an accident or trauma. Or if you are presenting with what could be a serious pathology. But for 80% of musculoskeletal pain – including knee and back pain – X-rays and MRI’s are overkill.  They put you at risk of being led down a path of unnecessary referrals, treatments, and procedures. They will definitely put you at risk of being told not to exercise at all.

A mechanical pain expert, on the other hand, is trained to assess your pain with movement tests – not imaging. This is going to reveal a much more realistic picture of what you can and can’t do. It will also reveal what movements will make you better or worse. This allows you to go into a new exercise routine with a more informed approach. Also, with a plan to exercise around your pain and make it better.

Is exercising and losing weight is part of your New Year plan? If so, I hope these tips help you go into 2023 with confidence. If you’ve got lingering or unwanted knee or back pain that’s not going away on its own – get it checked.

 

Are you local to Portsmouth, NH? – CLICK HERE to speak with one of my specialists. We will ask you about what’s been going on – and see if we would be a good fit to help!

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].