Tag Archive for: physical therapy

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

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

5 Signs Your Headaches May Be Coming from Your Neck

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Is Your Neck the Hidden Cause of Your Headaches? Here’s How to Tell

By Dr. Carrie Jose, Physical Therapy Specialist | CJ Physical Therapy & Pilates, Portsmouth, NH

Headaches are one of the most common and frustrating problems people face — affecting almost half the population at some point in their lives. If you get them regularly, you already know how much they can interfere with your work, sleep, and overall energy.

What makes managing headaches so tricky is how often they’re misdiagnosed. Many people are told they have a primary headache disorder — like migraines, tension headaches, or cluster headaches — when the real problem is secondary, meaning it’s caused by something else in your body.

One of the most overlooked culprits? Your neck.
A type of secondary headache known as a cervicogenic headache actually originates from your cervical spine (neck). It’s often mistaken for migraines or tension headaches — but the treatment approach is very different.

5 Signs Your Headaches May Be Coming from Your Neck

1. Your headaches worsen with certain neck movements

If turning or tilting your head seems to trigger your headaches — or if they start after holding your head in one position too long (like sitting at a desk or bar) — that’s a clear sign your neck could be the source.
When specific motions or postures worsen your pain, it’s a strong indication your headaches are cervicogenic.

2. You notice stiffness or restricted motion in your neck

If your neck feels stiff or it’s hard to look over your shoulder, that loss of mobility could be fueling your headaches. When neck joints don’t move freely, surrounding muscles and nerves can become irritated — creating pain that mimics a tension headache. Restoring neck mobility can relieve this irritation and stop headaches at their source.

3. Your neck muscles are frequently tender or tight

Persistent tightness around your neck and shoulders often goes hand-in-hand with cervicogenic headaches. This can come from posture issues, stress, or fatigue — but often there’s a deeper mechanical cause.
When that’s addressed, the tightness and resulting headaches fade naturally.

4. You feel your headache at the base of your skull or down one side

If your headaches begin at the base of your neck and travel upward or down into your shoulder blade, it’s almost a sure sign your neck is involved. These patterns match the nerve pathways from your cervical spine — a common clue for cervicogenic headaches.

5. Massage or chiropractic adjustments help — but only temporarily

If you feel better after a massage or adjustment, but your headaches return, that’s a strong clue your neck needs a mechanical assessment. Hands-on care offers short-term relief — but combining it with corrective exercises that restore neck mobility and strength provides lasting results.

What to Do Next

If you’ve been battling stubborn headaches and haven’t had your neck evaluated — it’s time. Cervicogenic headaches are often overlooked but very treatable when you address the true source.

The good news? If your headaches are caused by your neck, you can manage them naturally — without pills, injections, or procedures.

Working with a specialist who understands the mechanical causes of neck-related headaches can help you find lasting relief and regain control of your life.

Ready to discover if your headaches are neck-related?
Request a Free Discovery Consultation at CJ Physical Therapy & Pilates in Portsmouth, NH, or call 603-380-7902to speak with our team.

About Dr. Carrie Jose

Dr. Carrie Jose is a Doctor of Physical Therapy and Mechanical Pain Expert, specializing in helping people in the Seacoast area find natural, long-term solutions for pain — without relying on pills, injections, or surgery.

She is the owner of CJ Physical Therapy & Pilates in Portsmouth, NH, and writes regularly for Seacoast Media Group on topics related to physical health, pain prevention, and natural movement.

Holding Knee with Arthritis

Want to Avoid a Total Knee Replacement? Start Here.

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Every year, around 700–800,000 Americans undergo total knee replacement surgery – and that number continues to climb.

Here in Portsmouth, NH, we see this trend too – but what if many of those surgeries weren’t actually necessary?

It’s true that knee replacements have an excellent success rate, with more than 90% lasting 20 years or more. But here’s something most people don’t realize…

Only 15% of people who show signs of osteoarthritis on X-ray actually have symptoms. That means the majority of folks walking around with “bone-on-bone” arthritis don’t have any pain at all. Meaning, “severe arthritis” showing up on an X-ray isn’t the be-all-end-all diagnosis you thought it was.

So why do so many end up under the knife?

Because structural findings on imaging – like arthritis, bone spurs, or meniscus tears – are often blamed for pain that may actually have another cause. If you want to avoid knee replacement surgery, it’s critical to understand what’s really behind your pain and whether you’ve exhausted all your options first.

Here are three key things to look at before you resign yourself to surgery.

1. Don’t Let an X-ray Decide for You

Too often, people are told they need a knee replacement because their X-ray “looks bad.” But your level of pain and function – not your imaging – should be what drives your decision.

If you can still walk, climb stairs, and do most of your favorite activities with manageable discomfort – why rush into major surgery with months of recovery and potential complications?

Knee replacement can be life-changing for those in severe, unrelenting pain – but if you’re still functioning relatively well, it’s worth holding off. You may find that a targeted approach to movement, strength, mechanics, and healing can relieve your pain and keep you active for years – without surgery.

And if you’ve already tried physical therapy and exercise but still feel limited, regenerative treatments like Shockwave Therapy and EMTT (Extracorporeal Magnetotransduction Therapy) can help bridge the gap. These non-invasive technologies work by stimulating tissue repair, reducing inflammation, and improving circulation – essentially helping your body heal itself. For many people with chronic knee pain or mild arthritis, regenerative therapy has been a game changer – providing relief and better mobility without needles, surgery, or downtime.

In short, before deciding your knees are “too far gone” just because an X-ray told you so – explore whether your body still has the capacity to heal. You might be surprised at how much function and comfort you can restore with the right approach.

2. Check Your Back (Yes, Really)

One of the most overlooked causes of persistent knee pain is your spine.

A study published in the Journal of Manual and Manipulative Therapy found that over 40% of people with isolated limb pain responded to treatment directed at their spine – even when they didn’t think their back was involved. Plus, even without this study, I’ve seen this all too often in real-life practice.

That means your “knee pain” could actually be coming from irritation in your lower back or nerves. If your knee pain comes and goes, varies with position, or you also experience back stiffness or leg tingling – don’t ignore it or assume it’s all in your knee.

Getting evaluated by a Portsmouth, NH mechanical pain specialist who can test whether your pain is spine-related or knee-related can save you from years of ineffective knee treatments…

3. Assess Your Mobility, Not Just Your Arthritis

If your knee is truly arthritic and severely damaged, it will usually feel stiff and restricted all the time. But if your stiffness fluctuates – maybe it loosens up after you stretch, or feels fine one day and tight the next – that’s a big clue your pain could be mechanical – not degenerative.

Sometimes, a small meniscus fold or mechanical joint restriction is the real culprit, and when the joint is moved the right way, the restriction disappears – along with your pain. Unfortunately, this won’t show up on an X-ray or MRI – and many clinicians miss it unless they’re trained in mechanical diagnosis.

Before agreeing to surgery, find out whether your joint motion can be restored naturally. When you regain full, pain-free movement, your knee may not need replacing after all.

The Bottom Line:

Knee replacements absolutely have their place. For some people, they’re the best path to relief and mobility. But far too many people jump to surgery because they were told their X-ray “looked bad” instead of being evaluated properly for the true source of their pain.

If you’re over 40, dealing with nagging knee pain, and want to avoid surgery as long as possible – start by getting your back checked, your movement analyzed, and your regenerative options explored by someone trained in mechanical pain and tissue healing.

You might just find there’s still plenty of life left in your knees – and the added bonus will be you avoiding a major surgery.

Are you local to Portsmouth, NH?

CLICK HERE to request a free discovery visit with one of our specialists in downtown Portsmouth.

Dr. Carrie Jose, Physical Therapist and Mechanical Knee Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or reserve a seat in her upcoming Masterclass on How to End Knee Pain Naturally – CLICK HERE.

Love to Hike? 7 Strategies for Healthy Knees

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Love to Hike? 7 Strategies for Healthy Knees

Hiking isn’t just good for the soul – it’s one of the best forms of exercise for longevity. Long, steady hikes typically put you in Zone 2 cardio, that sweet spot where your heart rate is elevated but you can still hold a conversation. Research shows Zone 2 training is one of the most powerful ways to build endurance, improve metabolic health, and protect your heart as you age. When you combine that with fresh air, nature, and the mental reset that hiking provides, you’ve got a recipe for living longer and healthier.

But here’s the catch…

If your knees hurt, you’re far less likely to get out on the trails and enjoy those benefits. For many adults in their 40s, 50s, and beyond, it’s knee pain – not lack of motivation – that sidelines them. Personally, I love to hike. My pup Bodie and I have already tackled 33 of the 48 White Mountain 4,000-footers together – and the last thing I want is for knee pain to derail that journey. Over the years, both in the clinic and on the trails, I’ve learned that protecting your knees isn’t just about avoiding injury – it’s about building mobility, balance, and strength so you can keep hiking and keep hitting that Zone 2 target for decades.

Here are 7 of my top strategies to keep your knees healthy on the trails:

1. Strengthen More Than Just Your Legs

Most hikers know strong legs matter. But what often gets overlooked is the role of your hips and core. Your glutes and hip muscles stabilize your pelvis, which in turn keeps your thigh bone – and your knee – aligned. If these areas are weak, your knee takes the brunt of every single step. On a typical 4K-footer, I rack up around 27,000 steps. Imagine your knee compensating on each one. Prioritize exercises that target glutes, hip stabilizers, and core muscles. Think bridges, planks, side steps, and single-leg work. The stronger your foundation, the better your knees will perform under pressure.

2. Keep Your Knees (and Hips) Mobile

Lack of mobility in your knees and hips – even a subtle loss – can impact the way your knees function. Your knees should fully straighten, bend deeply, and even hyperextend a little. Without this range, your knees can’t absorb the demands of steep inclines, rock scrambles, or uneven terrain. But don’t just focus on your knees – your hips and ankles need to move freely too. When one joint stiffens, another (often your knee) has to compensate. If your knees feel achy, check to make sure stiffness isn’t the reason.

3. Optimize Your Balance

Uneven trails, water crossings, and rocky descents demand excellent balance. Without it, your knees may end up working overtime to stabilize you. You can improve balance by practicing single-leg activities, such as standing on one foot while brushing your teeth, then progressing to single-leg squats and step-downs. Dynamic drills like walking heel-to-toe on a line or using a balance pad to mimic trail conditions can also be effective.

4. Train Eccentric Strength (Downhill Prep)

Most people’s knees flare up going downhill, not uphill. That’s because downhill hiking demands eccentric strength – the ability of your quads and even hips to control your descent while resisting gravity. Exercises like slow step-downs, controlled squats, and reverse lunges train your body for this exact stress, protecting your knees from strain when descending steep terrain.

5. Don’t Neglect Recovery

It’s easy to focus only on training for the hike, but recovery is just as important for keeping knees healthy long-term. Muscles and connective tissues adapt and get stronger when you give them time to repair. Simple recovery practices like foam rolling, stretching, and staying hydrated and prioritizing sleep all help reduce inflammation and improve resilience for the next hike. And if your knees are particularly sensitive after a hike – regenerative treatments like shockwave therapy and EMTT can help your joints recover quickly and naturally.

6. Choose Footwear That Supports Your Mechanics

Footwear can make or break your knees on the trails. Poor support or worn-out soles force your knees to work harder with every step. Good shoes aren’t just about cushioning – they should work with the way you move and give you stability when the trail gets rough. Keep in mind that your feet often widen and swell as you hike, which can change how your shoes fit and affect your mechanics. Choosing shoes with enough room in the toe box and proper support for your arches can prevent your knees from picking up the slack. Don’t forget the basics either – replacing trail shoes regularly (every 300–500 miles) is just as important as any strengthening exercise.

7. Get Checked Before It’s Too Late

One of the most overlooked strategies for preventing knee pain is early intervention. If you notice stiffness, swelling, or pain that doesn’t improve with movement, it’s better to get evaluated sooner rather than later. The longer you push through, the more compensations build up – and the harder it is to fix. In the same way you wouldn’t wait for your car to break before servicing it – you don’t want to wait for your knees to fail before seeking help.

Knee pain doesn’t have to stop you.

Hiking is one of the simplest and most enjoyable ways to support your health. It builds strength and endurance, keeps your heart and lungs working efficiently, and connects you to nature. But none of those benefits matter if knee pain keeps you on the sidelines. By strengthening your hips and core, improving mobility, training balance and eccentric control, choosing the right footwear, recovering properly, and seeking help early if pain persists – you’ll give your knees the best chance to keep carrying you up (and down) the trails for years to come.

 

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.

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6 Reasons Your Muscles Are the Secret to Staying Young

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

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

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

Here are six important ways your muscles act like medicine:

1. Muscles Fight Inflammation

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

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

2. Muscles Stabilize Blood Sugar

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

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

3. Muscles Strengthen Bones

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

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

4. Muscles Protect Your Brain

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

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

5. Muscles Support Heart Health

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

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

6. Muscles Extend Longevity

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

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

The Bottom Line

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

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

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

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

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

Beyond Cortisone: Healthier Options for Lasting Shoulder Pain Relief

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Shoulder pain can be one of the most frustrating problems to deal with.

At first, it’s just an annoyance. But when it starts interfering with your sleep or preventing you from doing the things you love, you can’t help but wonder if it’s time to do something more invasive – like getting a cortisone shot.

Cortisone injections can seem appealing – they’re quick, easy, and often provide relief. Anytime I see a post on Facebook asking, “What should I do about my nagging shoulder pain?” cortisone shots almost always come up as the go-to answer. But just because they’re common doesn’t mean they’re the best solution. In fact, relying on them too often could actually make your shoulder worse.

Why Cortisone Falls Short

Cortisone shots are meant to reduce inflammation – and if inflammation is truly what’s driving your shoulder pain, they can help. The problem is that in most cases, inflammation is only a symptom. The real culprit is usually mechanical: poor movement patterns, overuse, or imbalances that leave the structures in your shoulder irritated and overworked. In those situations, cortisone might give you short-term relief, but the pain will always come back until the root mechanical problem is fixed. Even worse, repeated cortisone shots can actually weaken your tendons and damage your cartilage over time.

So what do you do if you’ve got persistent shoulder pain but don’t want to rely on cortisone?

Thankfully, there are healthier and more effective options available – in the family of regenerative medicine. These treatments don’t just cover up inflammation, they actually stimulate your body’s ability to heal it – which works whether your primary problem is mechanical (secondary inflammation) or chemical (primary inflammation).

Let’s say you truly do have primary inflammation. Instead of turning to cortisone to simply wipe it out, more advanced and cutting-edge clinics are now using something called EMTT – short for extracorporeal magnetotransduction therapy. EMTT delivers high-frequency magnetic energy that penetrates deep into your joints and cells, essentially helping to “reset” them. This improved cellular activity enhances fluid exchange, allowing your body to naturally flush out the excess inflammation. What makes EMTT especially exciting is that it doesn’t just calm inflammation – it also stimulates tissue repair and regeneration. In other words, you’re not only getting relief from pain and swelling, you’re supporting long-term healing of the underlying problem.

And then there’s shockwave therapy – one of the most popular and well-studied regenerative treatments for musculoskeletal problems, including shoulder pain.

Shockwave uses sound waves to stimulate blood flow, encourage cellular repair, and break down stubborn scar tissue. It’s particularly effective for chronic tendon problems and rotator cuff injuries that just won’t heal on their own. What’s even better is when you combine shockwave therapy with EMTT. The two therapies complement each other beautifully – shockwave targets the injured tissue directly, while EMTT boosts cellular repair and helps the benefits of shockwave last longer. This combination can be especially powerful when arthritis is involved or when multiple structures in the shoulder are inflamed and irritated.

In addition to these technologies, there are also injectable regenerative therapies that are gaining more attention. PRP – short for platelet-rich plasma – is made from your own blood and concentrated into a powerful solution rich in growth factors. It’s especially helpful when your body’s natural healing process has stalled, such as with partial tears or long-standing tendon problems. In the shoulder, that might look like a stubborn rotator cuff injury that just isn’t getting better or a tear you’re hoping to avoid surgery for. Stem cell injections take things a step further, though they aren’t as widely used. These provide undifferentiated cells that can actually transform into the specific type of tissue your shoulder needs most. Stem cell therapy is typically reserved for more advanced problems – like severe arthritis or injuries that haven’t responded to other treatments. What’s exciting is that both shockwave therapy and EMTT can be used alongside PRP or stem cell injections to enhance their effectiveness, giving your shoulder an even better chance at long-term healing.

A Smarter Path to Healing

The difference between cortisone and regenerative medicine really matters. Cortisone works by suppressing inflammation, but regenerative therapies go a step further – they stimulate your body to actually repair the injured tissue. Instead of simply masking pain, these treatments target the root cause and help restore real function. While regenerative therapies aren’t usually covered by insurance, many people consider the out-of-pocket investment worth it. That’s because they encourage true healing, which leads to long-term success, rather than the short-term relief you get from cortisone.

If you’ve been struggling with nagging shoulder pain, it’s worth doing your research and asking the right questions. Is your pain chemical-driven by runaway inflammation? If so, cortisone might help, but EMTT could be a healthier and more effective option. Or is your inflammation secondary and rooted in a mechanical cause? In that case, you’ll want treatment that doesn’t just mask pain but instead works with your body’s natural ability to heal – without compromising the integrity of your tissues, which ultimately need to be loaded and strengthened. Too often, people resort to cortisone shots without asking these questions first, and it leads them down a road of temporary fixes and long-term problems.

In the end, the right approach depends on identifying the true cause of your shoulder pain.

When you choose solutions that promote healing rather than simply cover up symptoms, you give yourself the best chance for lasting relief and healthier shoulders for years to come.

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

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

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

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

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

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

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

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

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

Fuel Your Body With Anti-Inflammatory Foods

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

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

Prioritize Weight and Posture

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

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

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

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

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

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

Explore Longevity Treatments that Boost Healing

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

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

A Final Word of Encouragement

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

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

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

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

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

plantar fasciitis

Foot and Heel Pain: How to Move Beyond Short-Term Relief

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If you’ve ever stepped out of bed and felt a stabbing pain in your heel, there’s a good chance you were experiencing plantar fasciitis – one of the most common causes of heel pain in adults.

More than two million Americans struggle with it each year. Cortisone shots, orthotics, and rest are often prescribed, but these strategies usually provide only temporary relief – and in some cases, can even prolong the problem.

Recovering from plantar fasciitis starts with understanding why it happens in the first place. Once you know the root cause, the path forward becomes clearer – and today there are modern, natural options that focus on healing rather than simply masking pain. That’s the aim of this article. 

So let’s dive in: how do you move past short-term relief and get back to doing the activities you love, without heel pain holding you back?

What is Plantar Fasciitis?

The plantar fascia is a thick band of tissue running along the bottom of your foot, connecting your heel bone to your toes. Its job is to support your arch and absorb shock when you walk, run, or jump. When this tissue is overloaded, it can become irritated – and if that continues, the fascia begins to degenerate. The result is plantar fasciitis, marked by pain at the base of the heel, especially during the first few steps in the morning or after long periods of sitting.

Many assume plantar fasciitis is an inflammatory condition, but that isn’t the full picture. It’s more accurately a degenerative process, where the collagen fibers of the fascia weaken and lose their ability to tolerate load. This helps explain why treatments aimed only at reducing inflammation, such as cortisone shots, rarely provide lasting relief.

Why Traditional Treatments Fall Short

Cortisone injections have long been a standard treatment for heel pain. While they may reduce pain briefly, research shows the benefit is temporary – often only a few weeks or months. Repeated injections also carry risks. Cortisone does not repair the damaged fascia – in fact – it can weaken collagen and allow the problem to persist. Worse, by masking pain, injections often encourage continued activity that aggravates degeneration.

Custom orthotics are another common approach. These shoe inserts, often prescribed by podiatrists, can redistribute pressure and provide comfort in the short term. But research shows little difference between costly custom orthotics and high-quality prefabricated ones. More importantly, they do not address the underlying weakness or tissue degeneration. Once the initial benefit wears off, the pain often returns – and relying on orthotics indefinitely is impractical and prevents restoration of natural foot strength.

Both cortisone and orthotics may play a role in daily function. But if the goal is to truly heal the fascia and return to full activity, more is needed.

Stimulating Healing – Don’t Mask It

Instead of suppressing symptoms, you want to encourage true healing and pair it with corrective strengthening to keep the tissue healthy. Modern treatments such as shockwave therapy, EMTT, and PRP aim to jump-start your body’s own repair mechanisms instead of impeding them.

A good place to start is extracorporeal shockwave therapy, or ESWT. This non-invasive treatment sends acoustic waves into the fascia to create controlled “microtrauma,” which stimulates collagen regeneration and promotes tissue recovery.

An important complement is Extracorporeal Magnetotransduction Therapy, or EMTT. A 2022 multicenter study in the Journal of Clinical Medicine found that 80 percent of patients with chronic musculoskeletal conditions improved after EMTT, with more than 75 percent maintaining benefits six to twelve months later. In practice, EMTT appears to extend and amplify the positive effects of shockwave therapy by sustaining cellular activity long after treatment sessions.

For those needing an additional boost, platelet-rich plasma (PRP) injections are another option. Though invasive, PRP delivers concentrated growth factors directly into damaged tissue, enhancing the body’s natural healing. A 2023 randomized trial in BMC Musculoskeletal Disorders reported that PRP outperformed corticosteroid injections at reducing pain, improving function, and thinning the plantar fascia at six months. Case reports in the German Journal of Sports Medicine also show excellent outcomes when ESWT and PRP are combined, including full return to sport in runners who had failed other treatments.

Taken together, these therapies form a layered strategy: shockwave jump-starts the healing cascade, EMTT helps sustain it, and PRP provides an extra regenerative boost (if needed). When combined with a structured rehabilitation program, this approach offers a pathway to lasting recovery rather than temporary relief.

Beyond the Foot: Make the Healing Last

What many don’t realize is that chronic plantar fasciitis can also be linked to dysfunction higher up the chain. The pelvic floor, deep core muscles, and hip stabilizers all influence how forces travel through the legs and feet. If these areas are weak or poorly coordinated, the plantar fascia often absorbs stress it wasn’t designed to handle.

Clinical experience shows that individuals with weak core and pelvic floor control often develop altered gait mechanics, leading to excessive strain on the heel with each step. In these cases, treating only the fascia leaves the root cause unaddressed.

A comprehensive plan should therefore include strengthening of the core and pelvic floor, along with intrinsic foot training, alongside regenerative therapy. When these muscles are retrained to provide stability and load-sharing, the fascia is no longer forced to work alone. Over time, this reduces reinjury risk and creates a long-term fix. In essence, regenerative therapy jump-starts tissue healing, while strengthening ensures the fascia remains supported once it recovers.

The Bottom Line

Foot and heel pain can be stubborn, and plantar fasciitis in particular has a reputation for lingering. Cortisone shots and orthotics may provide temporary relief, but they do not restore the health of the fascia or solve the underlying problem. Regenerative therapies, especially shockwave, are supported by strong evidence for reducing pain and improving function in people with chronic plantar fasciitis. When combined with mobility, strength training, and – critically – core and pelvic floor retraining, they provide a durable solution that not only relieves pain but helps prevent it from coming back.

If your heel pain has been persisting for months, it’s worth considering a plan that goes beyond masking symptoms. Lasting relief comes when you treat both the tissue that hurts and the movement system that created the overload in the first place.

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.

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.