Tag Archive for: physical therapist

MRI

How MRI’s Lead Back Pain Sufferers Toward Unnecessary Procedures

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One of the most popular questions and concerns I hear from clients at our specialized physical therapy practice in Portsmouth, NH is whether or not they need an MRI when they are experiencing back pain or sciatica. It’s pretty standard protocol, but is it necessary? In most cases, no.

About 70 to 80% of back problems, even sciatica, are considered mechanical in nature and quite normal.

That means there isn’t anything “serious” causing your pain. Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist and will typically require advanced medical intervention.

An MRI can be useful in these cases to get more clarity before medical intervention begins.

But when your back pain is mechanical in nature, an MRI is more often than not misleading and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment, you most likely have mechanical back pain. The root cause of mechanical back pain cannot be diagnosed by an MRI.

And if your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen so many Portsmouth physical therapy patients with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually not the root cause of your back pain. What typically happens is the MRI finds them, and your back pain gets blamed on them. But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain.

Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain. That’s how we know the root cause of your back pain is coming from something else.

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.”

If you notice that certain positions or movements relieve your back pain, or you feel better after walking and exercise, your back pain is likely mechanical in nature, and you don’t need an MRI to diagnose you. Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does not respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc only to find that it didn’t help their problem, or it came back again with a vengeance.

And once you have surgery, mechanical back pain can actually become more difficult to fix because your tissues and ligaments are now compromised from surgical scarring, no matter how minimally invasive they say your surgery will be.

You can sign up for a FREE 30 minute Discovery Session with one of our specialist physical therapists in Portsmouth, NH right here.

Neck stretches

Why Your Neck Stretches Aren’t Working

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Do you suffer from chronic neck pain and ever wonder…

Why don’t my neck stretches work?

Even though you’ve Googled and YouTubed them about a hundred times…

There are a few reasons why stretching your neck might not be doing anything to help get rid of your neck pain.

  1. Your technique could be off
  2. You could be doing the wrong stretch
  3. It could be that you just shouldn’t be stretching your neck at all!

Let’s go over the different reasons why your neck stretches might not be working… and most importantly… what you can do about it.

1. You’re doing it wrong.

Although research studies are inconclusive regarding how long you should hold a particular stretch, most people feel good when they hold a stretch for 30-60 seconds. When it comes to technique, one of the biggest problems I see is not relaxing enough. If you’re tense, or gripping your muscles at the same time you’re stretching, it won’t work very well. It’s important to breathe and move easily into the stretch. If you try to force it or push through pain, you’ll likely tense up.

Now let’s say you’re doing everything right (not tensing or gripping) but your stretches still don’t seem to work.

Some people (myself included) respond better to “moving stretches”. This is where instead of holding one static position for a prolonged period – you repeatedly move through one or several end-range stretches. Neck rolls are a great example of this.

If your neck stretches haven’t been working, try adjusting the way you’ve been stretching… if it works… then you were likely just using the wrong technique.

2. You’re doing the wrong type of stretch.

This one could be a little tougher to figure out on your own. There is a difference between corrective neck stretching and stretching to feel good.

For example, let’s say your neck is tightening up because you’ve been under a lot of stress or you just did a lot of activity that impacts your neck. Generic neck stretches such as bringing your chin to your chest, or pulling your chin to the opposite shoulder (known as an “upper trap stretch”) may be all you need.

In fact, I do stretches like this regularly because I’m constantly leaning over to help patients. I stretch my neck to PREVENT it from having problems and because it feels good.

But let’s say you already have a neck problem, or you have pain or numbness running down your arm.

In these instances, generic neck stretching could make you worse.

You likely need corrective stretches, like what we prescribe for patients in our office.

Corrective stretches are specifically prescribed to address your particular problem in your neck – and are very different from the generalized stretches that are designed to feel good and relieve tension.

If you think you might need corrective stretches for your neck – DO NOT google them – you must see a specialist and have them prescribed to you.

3. You shouldn’t be stretching your neck at all!

This is a very common problem we see… folks come in with complaints of chronic tightness and discomfort in their neck and no matter how often they stretch or massage, it doesn’t go away.

Did you know that chronic neck tightness can be a sign of a weak core?

It’s quite common – and if that is the case for you – no amount of stretching will help – and could even aggravate your problem!

The deep, stabilizing muscles of your neck are connected by fascia to the deep muscles of your core. If your deep core is not working properly, then your neck will often kick in and try to help.

Ever notice that your neck is always sore or tight after a good ab workout?

This could be a sign that your neck is compensating for your core.

Stop stretching your neck, learn how to strengthen your core the right way, and see a specialist who can help you.

In our office, our team of specialists work alongside our Pilates instructors to help folks improve their core strength from the inside out – so that their necks and backs stop getting involved.

If you’re dealing with chronic neck problems that aren’t’ responding to stretching…

There’s a good chance you could be not stretching correctly, the stretches aren’t right for you, or you’ve completely missed the root cause of your neck pain and you shouldn’t be stretching at all!

Want to work with our team of specialists and finally get some help for your neck problem?

CLICK HERE to request a free Discovery Session with one of our specialists.

They’ll set up a time to talk to you about what’s going on with your neck. If you’re a good fit for what we do, then they will help you get started!

This is only for people serious about getting help…

And for those that are finally ready for a long-term solution to their pain – one that will put an end to constantly relying on pain pills – and help you avoid expensive procedures and risky surgery.

Request a Discovery Session 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.

 

5 Tips for Staying Active and Mobile as you Age

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Most of our clients are in their 50’s, 60’s and 70’s, and they want to stay as active as possible as they age. However, as we get older, our bodies do need more care and maintenance to age well and avoid injury. Here are some tips we like to give our clients to help them stay active and mobile, prevent injuries, and continue doing everything they love!

1. Keep Moving

I always tell my clients: “You don’t get stiff because you get old, you get old because you get stiff.”

If you want to stay healthy and mobile, you need to keep moving. One of the biggest questions I hear from folks aged 50+ is what to keep doing or stop doing because of arthritis. Remember, arthritis is normal as you age and it’s rarely a reason to stop doing certain exercises. Research has shown that activities like running, when done consistently and with proper form, can actually prevent knee arthritis! A similar and equally effective exercise is walking. Consistent walks will build up your strength and endurance, something that declines as you age, and it helps your balance and coordination. If you walk outside, you can get some fresh air and Vitamin D, which is highly beneficial for a strong immune system – something we all need right now.

2. Maintain a Healthy Diet

What you eat directly affects your ability to keep moving. If you’re not keeping your bones and heart healthy, you’re not going to be able to exercise! Greens like kale, spinach, and arugula are awesome for your bones. Along with citrus fruits, fish, and nuts, these foods help your bones stay strong and durable, which is a big concern for our clients with osteoporosis.

When it comes to taking care of your heart, your diet can have a huge impact. According to Health magazine, “The risk of a heart attack climbs for men after age 45 and for women after age 55.” So as you enter middle-age, be sure to increase the presence of foods in your diet like unsalted nuts, unprocessed oatmeal, raisins, blueberries, and even dark chocolate (over 70% cacao) to help keep your heart healthy! If you have any comorbidities such as diabetes or kidney problems, be sure to check with your doctor or dietician before making any drastic changes to your diet.

3. Work on your Balance

Balance is one of the first things to go as a person gets older, and it’s one of the most crucial factors in helping you prevent falls and avoid injury. Slips and falls due to poor balance can lead to broken bones and fractures, which can be harder to recover from as you age. But if you’re diligent about exercising with the intention of improving your balance, you can maintain (and even improve) it far into your later years. As already mentioned, activities like walking regularly can help, along with activities such as Tai Chi and Yoga. And now, with everything so accessible via Zoom, you can take advantage of these types of activities right from your living room!

4. Strengthen your core

Having a strong core is beneficial at any age, but especially as you get older. Strong abs, hips and buttocks (all part of your core) help you to sit and stand more upright, prevent back and neck pain, and will help you feel stronger and more confident in just about everything that you do. In our office, our favorite core-strengthening activity is Pilates. We especially love it for folks aged 50+ because it’s easy on your joints and it helps to promote flexibility at the same time. We use specialized machines that are beneficial for folks recovering from an injury, and we’ve got Zoom classes requiring no equipment at all that people can do from home. Yet another reason to love Pilates is that it doesn’t just work your core, but your entire body. You can even do portions of Pilates in standing, which helps your balance and coordination! If you’ve never tried Pilates before, we’d love to help you get started.

5. Educate Yourself

Knowledge is power, and a lack of knowledge is one of the biggest reasons I see people decreasing their activity levels unnecessarily. People think that issues like arthritis, bulging discs, or a torn meniscus are reasons to decrease or cease certain activities altogether. But that’s not necessarily true! Most of the things I just mentioned are normal occurrences as we age, and having them show up on an x-ray or MRI is not a reason to change an activity you’ve been doing successfully for years. Plus, regular movement and exercise actually helps these problems.

If you have pain, that’s a different story. Talk to an expert who can help you figure out what’s going on so that you can quickly get back to your activities and not make your pain any worse. Whatever you do, try to avoid Dr. Google. It can send you down a rabbit hole and not all the advice you read will apply directly to you. If you’re dealing with pain that is keeping you from your favorite activities, reach out to experts like us. We offer a FREE 30 minute Discovery Session just so you can ask questions, get honest answers, and figure out if we’re the right fit for your lifestyle. 

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.

“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.

Considering Back Surgery? Read this First

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Approximately 500,000 Americans undergo back surgery to relieve their pain every year, and according to the Agency for Healthcare Research and Quality (AHTQ), this costs approximately $11 billion annually. The worst part — it turns out only 5 percent of these people actually need back surgery. And for many folks — the pain just ends up coming back.

So why are we spending so much money on back surgery when the majority of people don’t actually need it?

First of all, back pain is not fun. It can be excruciating, debilitating, and can have a significant impact on your life and happiness. If you’re told surgery will fix your problem (and it often does take your pain away in the short-term), why wouldn’t you choose this option? 

Well, if you knew the facts, you might be willing to hold off on a surgical “quick fix” and investigate options that are less risky. The research shows over and over that 80% of the population suffers from “non-specific low back pain,” meaning, it’s not from something structural like a tumor, broken bone, or deformity. The research also shows that non-specific low back pain does NOT benefit from surgery! The better solution for the majority of back pain sufferers is correctly prescribed movement followed by regular exercise to maintain your strength (especially your core) and postural endurance.

So again, why are we spending so much money on back surgery when the research and data clearly show it’s not the best course of action for the majority of back pain sufferers? 

There are a few reasons. First, most of the time we just don’t know any better.

Back pain is typically diagnosed with imaging (X Rays and MRI’s). Although these highly specific tests are critically beneficial after a major trauma or accident, or when you suspect something more serious is going on (like a tumor or broken bone), they are not the best way to diagnose non-specific low back pain. That’s because these tests are designed to show you everything – including all the normal, age-related changes that occur in your spine such as arthritis, degenerative discs, stenosis, and even bulging discs.

The truth is that 60-80% of people walk around with these findings in their spine all the time and have absolutely zero pain.

That means that your back pain is likely coming from something else, typically, a bad movement pattern or habit. Poor posture and movement habits can exacerbate a bulging disc or stenosis, and this is where the confusion comes in. Surgically “fixing” your bulging disc or stenosis will not correct your poor habits. That’s why so many people suffering from back pain get surgery only to find their pain comes back several months or years later. What you need to do is find the true cause of your low back pain and attempt to address that first before ever considering something like surgery.

The second reason back surgery is so common and over-prescribed is because it does a great job at taking pain away quickly where conservative therapy often fails. Conservative therapy really can help you get rid of back pain and keep it gone – but it has to be done correctly. And sadly, there are many well-meaning therapists, trainers, and movement professionals out there that lack the expert knowledge to get it right. If you don’t get the correct conservative treatment for your back pain, you’ll assume it didn’t work, and will be more apt to get surgery.

So how do you know you’re getting correct and effective conservative treatment? Quite simply, it will work, and fairly quickly! 

Remember, 80% of all low back pain responds to the right conservative treatment. You’ll notice obvious improvement in your back pain within 2 weeks. If you fall into the 20% where conservative treatment doesn’t work as well, it will be pretty obvious to a back pain expert almost immediately. In our office, for example, we have special movement screens and tests that we perform on everyone to determine if you’re in the 80% or the 20%. If you fall into the 20%, we know right away and can send you to your doctor, or a surgeon, for one of those highly specific tests to see what’s really going on.

The take home point is this: If you currently suffer from on and off back pain, have tried every treatment you can think of, and are just tired of it because it really hurts – I completely understand why back surgery would be an attractive option for you right now.

But please consider the facts and research first before you make the decision to go under the knife. Back surgery has its risks, and there is no going back from the unimaginable happening. If you have back pain that you’re ready to solve for good — sign up for a FREE 30 minute Discovery Session with one of our specialists today! 

 

Stressed out? Tips to Keep the Holiday Season Happy and Healthy

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It’s the middle of December, which means we’re in full holiday swing. Although this is meant to be a time of celebration and joy, many people I speak with just can’t seem to avoid the stress. And it’s not just because we also happen to be dealing with a pandemic… although that’s definitely not helping! Unfortunately, stress levels tend to increase around this time every year. In our office, the phone is ringing off the hook right now from people tweaking their necks and backs. Why? Well, stress! Stress makes us move faster than we are inclined to — or slower than we’re inclined to — and it puts our nervous systems on high alert (otherwise known as “fight or flight”).  It’s a recipe for both mental AND musculoskeletal aches and pains. But the good news is that it’s not as difficult as you think to combat stress and give yourself the happy and healthy holiday season you deserve.

Here are my favorite ways to combat stress any time of year, not just during the holidays or a pandemic:

1. Breathe

I know this might sound cliche, but breathing is one of your best friends when it comes to quickly reducing and interrupting stress. As little as 30 seconds can make a dramatic difference! When you breathe deeply it sends a message to your brain to calm down and relax. The best part is you can do this anywhere — in the car, at the office, while shopping, even in the bathroom. Although breathing may not eliminate stress permanently, it does interrupt it. And interruption is key when it comes to managing stress — both emotional and musculoskeletal.  When you interrupt the ability for the cumulative forces of stress to accumulate, you decrease the toll it can have on your body and brain.

 

2. Practice Gratitude.

Did you know that gratitude helps lower cortisol levels in our bodies by about 23 percent? Prolonged stress causes elevated cortisol levels, which causes lots of different health problems such as heart disease and high blood pressure. Research shows that when we think about something we appreciate (i.e. practice gratitude), the parasympathetic nervous system (the calming one) is triggered. Our parasympathetic nervous system is responsible for returning the body to its automatic and natural rhythm. So when the parasympathetic nervous system is activated, your heart rate and cortisol levels lower — which is the opposite of what happens when you’re stressed out. Your sympathetic (fight or flight) and parasympathetic nervous systems work together in opposition, and can’t both be in charge at the same time. So when you consciously practice gratitude, you actively lower your stress!

 

3. Move!

Any kind of movement is going to help you control stress for a few reasons… First, it gets your blood flowing which contains endorphins — natural chemicals of the body designed to decrease pain AND stress. Second, movement helps to end the “flight or fight” response of the body. In ancient times, our fight or flight response protected us from danger (like a lion chasing us), by triggering us to run away. Running away (movement) would signal the end of the stress cycle caused by fight or flight by letting the brain know we were safe and out of danger. In our modern worlds, triggers of stress are not as obvious as a lion trying to eat us and tend to be more unassuming and cumulative. The end of the stress cycle is not always clear and can just keep going. Therefore, purposeful movement can help to decrease stress by physiologically ending your natural fight or flight response! Something as simple as walking can do this for you. But even jumping jacks or dancing in your living room can feel good and get your heart rate up enough to do the trick.  

I hope these tips help you feel confident that it is indeed possible to combat any kind of stress you might be feeling right now. Stress is normal, but dealing with it longer than you should doesn’t have to be. And if you’re experiencing any kind of back, knee, hip, or neck pain that is adding to your stress – check out our FREE, expert-authored guides to dealing with all types of pain. Each guide is sent directly to your email inbox so you can reference them at any time! 

Tips to Combat Arthritis this Winter

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People tell me all the time: “I don’t need to check the weather anymore, my joints tell me what’s coming.” And as winter approaches, I know I’m going to be hearing more and more of this.

So why is it that arthritis sufferers tend to be impacted more during the colder, wetter months?

The actual science on this is inconclusive. Some studies have completely debunked the myth that weather can affect your joint pain, while others have shown that arthritis sufferers do indeed have what we call “weather sensitivity” — and they feel worse in the cold, especially when it’s about to rain or snow. The working theory behind this is related to barometric pressure. As a storm system develops, barometric pressure (atmospheric pressure) begins to drop. Some scientists believe that this results in expansion and contraction of tissue in and around your joints (tendons, muscles, bones, and even scar tissue). If those tissues are already sensitive due to arthritis, this could irritate them further. Additionally, the lower temperatures of winter are thought to increase the thickness of fluid inside your joints, making them stiffer and perhaps more sensitive to pain during movement.

Regardless of whether this phenomenon is myth or fact, it doesn’t make your pain any less real! The good news is there are things you can do to minimize pain related to arthritis as winter gets closer. 

There are two types of arthritis, inflammatory and non-inflammatory. Rheumatoid arthritis is the most common form of inflammatory arthritis, and osteoarthritis is the most common form of non-inflammatory arthritis. Although they have very different causes, weather changes can still have an impact, and there are still things you can do to minimize that impact.

Both forms of arthritis are characterized by one or more of your joints being inflamed.

Inflamed joints do not like to be compressed or irritated. It’s often why people will tend to rest and decrease their activity when they have pain. Add cold winter temps and weather to the mix (along with a pandemic), people just naturally do less this time of year. They think if they take the weight off their joints, or move less, they are protecting their joints. That’s actually not true. What protects your joints is strength and flexibility. The more mobile you are, the less likely your joints will get irritated, even arthritic ones. Have you ever worn a piece of clothing that’s too tight? You get irritated. Same with your joints! If they aren’t free to move, they get angry. The muscles around your joints and how strong they are also play a huge role in minimizing irritation.

In the absence of strength and stability, your body will do what it needs to compensate. The structures around your joint will contract to make your joints stiff and tighter in an attempt to give your joints the stability they are lacking. But arthritic joints don’t want to be stiff and tight, they want to be free and mobile! So if you suffer from arthritis, it’s critical that you have good mobility and good strength — period.

In general, the most important thing you can do for your arthritis any time of year, not just in winter, is to keep moving.

And you will move better when you’re strong and flexible. Movement gets blood flowing, which is our best and most natural form of anti-inflammation. Walking is the easiest and most practical way to get healthy movement daily, but biking and swimming are great choices too. You’ll also want to engage in some form of activity, such as Yoga, Pilates, or Tai Chi, that allows you to move your limbs, body and joints in a full range of movement. Cardiovascular activities like walking and biking won’t do that. Pilates is great because it emphasizes both full body strength (which helps balance out your joints) and it promotes flexibility at the same time. It’s why we like to use it in our office. Although it’s easy to just stretch and get more flexible, it’s important that you incorporate strength training into your routine also. Achieving good mobility AND strength is the secret to combating arthritis. Folks tend to only focus on the flexibility part, which is one of the common mistakes I see. 

I hope this helps you better understand why your arthritis might feel worse in winter, and what you can do about it! If you’re suffering from any kind of back or knee pain that is preventing you from being more active and mobile and therefore worsening your arthritis, check out our FREE Back Pain and Knee Pain guides. Just click to have the guide sent straight to your inbox with no obligations or strings attached!

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.

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.