Tag Archive for: physical therapy

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.

sciatica

Struggling with Sciatica? Why What You’ve Tried Might Not Be Working

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Struggling with Sciatica? Why What You’ve Tried Might Not Be Working

If you’ve ever experienced a sharp, shooting pain that travels from your lower back down your leg, you’ve likely been told you have sciatica. And if you’re like most people, you’ve probably tried a few things – rest, stretching, physical therapy, chiropractic care, maybe even a cortisone shot – only to find the pain returns just as quickly as it went away.

So what gives?

Sciatica can be one of the most frustrating and confusing conditions out there. It’s painful. It’s limiting. It can move around. It can be there one day and not the next. And it’s quite often misunderstood – even by medical professionals.

Let’s break down what sciatica really is, why it keeps coming back, and what you can do to finally find lasting relief – naturally – and without having to rely on pain pills, injections, or surgery.

What is sciatica?

Technically, sciatica refers to pain that radiates from the lower back through the buttocks and down the back of one or both legs. This radiating pain is caused by compression or irritation of the sciatic nerve – or one of its nerve roots – in the lumbar spine.

But these days, “sciatica” has become a bit of a catch-all term for any pain that extends beyond the back. Some people don’t feel it in their back at all – they only feel it in the buttocks or hip. Others feel it strictly in their butt. And some feel it all the way down into their lower leg or ankle. The location and intensity of your symptoms will depend on how irritated the nerve is – and symptoms can even change throughout the day.

So what causes this nerve irritation? That’s the part many people miss.

It’s not always a disc herniation, even though that’s a common assumption. And it’s rarely due to your piriformis muscle – despite what Dr. Google might suggest when you search “sciatica.”

Most of the time, sciatica symptoms are mechanical in nature. In other words, they’re caused by poor movement patterns that, over time, lead to stiffness in your spine. This stiffness creates compensations that can begin to irritate nearby structures – sometimes that’s a disc that’s slightly out of place or degenerated, and sometimes it’s not a disc at all. Either way, the underlying issue is the same: stiffness and poor movement habits that cause irritation in the spine. And when one of the structures getting irritated happens to be a nerve – you get sciatica.

The MRI trap

Now that you understand the true, underlying cause of sciatica – let’s talk about MRIs for a moment. While they can be helpful in ruling out serious conditions, they’re often overused – and in many cases, misleading – when it comes to non-specific low back pain, including sciatica.

Studies show that people without any back pain at all frequently have bulging or herniated discs on MRI. So when someone with sciatica gets imaging done and sees a disc issue, it’s easy to assume that’s the problem. But correlation doesn’t always mean causation.

The result? People end up chasing structural problems that may have nothing to do with their pain. And meanwhile, the real issue – often a mechanical one – is left unaddressed.

Why traditional treatments often fail

Traditional treatments often fail for sciatica for a few reasons. If you miss the root cause – which is mechanical about 80% of the time – and instead chase the symptoms and compensations (tight muscles, weak muscles, inflammation, etc.) – you’ll find yourself running in circles with little to no relief – and certainly not the lasting kind.

Another reason treatments fail is because of the MRI trap. In other words – allowing your MRI to dictate your treatment plan instead of making sure the findings actually correlate with what’s going on with you in real life.

If you’ve sought help for sciatica and were only prescribed rest, painkillers, anti-inflammatories – or in more severe cases, a cortisone injection – then you’ve only been chasing symptoms. And pain relief is not the same as healing. If the mechanical or movement issue that’s irritating your sciatic nerve hasn’t been resolved, the pain will almost always return. Sometimes worse than before.

That’s why it’s not uncommon for someone to feel amazing after a cortisone shot – only to be back in pain three weeks later. Or to get surgery for a herniated disc – only to find out months later that the pain is still there, or now shows up at another level in the spine.

So what actually works?

The key to lasting relief from sciatica is identifying and correcting the true source of nerve irritation. And most of the time, that comes down to improving how your spine, pelvis – and sometimes even your hip – are moving. This has to happen first before you focus on things like core strength or correcting muscular imbalances.

Yes, inflammation can be a factor – and when it’s present, it can make mechanical therapy less effective. The good news is we now have natural treatment strategies, like shockwave therapy and EMTT, that can help calm inflammation – without having to rely on anti-inflammatories or cortisone shots.

A physical therapist who is specially trained – and skilled at identifying mechanical problems – is the best person to evaluate your movement patterns and determine exactly what’s triggering your pain. Often, a very specific movement or series of movements can not only relieve pressure on the sciatic nerve, but also help restore normal function so the pain doesn’t come back.

A mechanical approach to treating sciatica is drastically different from traditional physical therapy methods that focus mostly on stretching, strengthening, or even hands-on work. And while stretches and manual therapy might feel amazing and seem helpful in the short term, they still fail to address the real, underlying mechanical cause of your sciatica.

You need to identify the faulty movement patterns in your spine and reduce the tension on your nerves. Once you do that – your body can take over and heal itself naturally.

The best part about this type of approach? It’s repeatable – and something you can eventually manage completely on your own. That’s how you keep your pain gone and get long-lasting relief.

Bottom line: treat the source, not just the symptoms

If you’re dealing with sciatica – or think you might be – don’t settle for short-term relief. Look beyond the symptoms. Find someone who can assess your movement, test what improves or worsens your pain, and give you a clear plan of action.

Because when you treat the root cause – not just the nerve – you don’t just get relief. You get your life back.

Are you local to Portsmouth, NH and looking for help?

Speak 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.

Why Your Back Pain Isn’t Going Away – Even After Rest, PT, and Chiro

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In my 23-year career, back pain is probably the one problem that frustrates people the most. It affects your sleep, your mood, your energy, and your ability to enjoy the things you love. Plus, it becomes even more frustrating after you’ve tried all the “right” things – like physical therapy, chiropractic treatment, and even good old-fashioned rest.

If this sounds like your story, you are not alone. I work with people every week who have done everything they were told to do – and they’re still in pain. And it’s not because they didn’t try hard enough. It’s because the true root cause of the problem was missed.

I always say… If your treatment plan isn’t working, you either have the wrong diagnosis or a poor treatment strategy.

Let’s take a closer look at why some of the most common treatments for back pain – rest, physical therapy, and chiropractic care – don’t always work.

Rest is Not a Cure

When your back hurts, resting feels like the safest and most natural thing to do. And for an acute injury, some rest is helpful. But debilitating back pain episodes aside, resting for more than a day or two can actually make things worse.

Your spine needs movement. Movement keeps your discs hydrated, your joints nourished, and your muscles coordinated and strong. Avoiding movement out of fear can lead to stiffness, weakness, and more pain – not less.

Your nervous system relies on movement – and your body’s response to it – to help it learn and recover after injury. If you shut everything down at the first sign of pain, your brain can start to associate movement with danger. That’s how chronic pain problems begin.

The reality is, if rest alone cured back pain, we wouldn’t have so many people still suffering from it.

Your Physical Therapy Isn’t Prescriptive

The research tells us that exercise is one of the most effective treatments for back pain – which is why physical therapy should be the gold standard. Physical therapists are trained to be movement experts. They should be prescribing exercises that are designed to take your back pain away – and keep it gone – while using hands-on work and modalities selectively to help you move with less pain and more efficiency.

But sadly, this doesn’t always happen. I often see clinics that rely heavily on passive modalities like ultrasound or electrical stimulation for short-term relief. Then the exercise “prescription” ends up being a generic list of stretches and core exercises you could find on YouTube.

If your physical therapy didn’t work, it’s possible the true root cause of your back pain wasn’t correctly identified. Many cases of back pain are due to “derangement syndrome” – when something in your spine (like a bulging disc) disrupts normal movement. Unless you correct the way your spine moves – and learn how to maintain that correction – the pain keeps coming back.

Physical therapy must be prescriptive in nature. If you just want general exercises, you can find them online or go to the gym. Your back might eventually feel better – but you’ll never know what fixed it, and you’ll have no way to fix it again when the pain returns.

Chiropractic Adjustments Aren’t Always Enough

Chiropractic care can sometimes be the difference between being unable to move and finally being able to straighten yourself out – especially during an acute episode of back pain. But most chiropractic care is passive. It has its place, but problems arise when people rely solely on adjustments to stay out of trouble. Chiropractic care should be paired with prescriptive, active movement that retrains your nervous system and gives you tools to manage your pain.

Another issue I see is people who have relied on adjustments for years. Eventually, they realize the pain keeps coming back. That’s often because the joint being mobilized provides only temporary relief, while the root cause isn’t being addressed. Chiropractic adjustments also aren’t very specific. Your spine often needs precise movements, in a specific direction, repeated over time. When it comes to disc or nerve problems, it can take thousands of reps of the right movement to resolve the irritation and get the pain to stop. A chiropractic adjustment can sometimes disrupt that carefully prescribed movement plan – and then you’re back at square one.

This all might sound a bit “technical” to you, and that’s because it is. It’s also why so many people still suffer from back pain despite trying everything.

But don’t overthink it. Ask yourself: Is chiropractic care still helping? Are you relying on the adjustments less and less? If yes, you’re on the right track. If not, it may be time for a new approach.

What to Do Instead

There’s no one-size-fits-all solution for back pain. But successful treatment usually starts by asking better questions and taking the time to uncover the real root cause.

Is it your muscles? Your joints? A disc? A nerve? Or the way your brain and nervous system have adapted over time?

A thorough, mechanically based assessment often reveals things that X-rays and MRIs miss. In fact, imaging can sometimes lead to too much information – and send you down a path of unnecessary treatments that should be reserved as a last resort.

Once the true source of your problem is found, a plan that emphasizes active movement, education, and progressive activity is far more effective than passive treatments or rest alone. Passive treatments can help reduce symptoms quickly, but long-term success depends on learning how to care for your back with the right tools, the right guidance, and the right movements.

If your back pain isn’t going away – even after rest, PT, or chiropractic – it’s not a sign that you’re broken or destined for surgery. It could just mean the true cause of your pain hasn’t been found yet.

If you’re tired of chasing quick fixes and want real answers, we can help. Schedule a free Discovery Visit to uncover the root cause of your back pain and find out if we’re the right fit to help you get lasting relief.

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.

Back MRI

Are your Back MRI results reliable? Research says otherwise.

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

Not necessarily.

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

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

Let me explain.

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

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

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

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

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

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

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

Take home point…

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

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

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

Are you local to Portsmouth, NH?

Consider speaking to one of our specialists by clicking here.

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

5 Natural Ways to Keep Your Knees Healthy and Moving This Summer

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When you live in New England, summer is a short and precious season. And you don’t want something like nagging knee pain ruining it for you. Whether you’re walking the beach, gardening, playing a round of golf or pickle ball, or tackling your favorite hiking trail – knee pain can quickly turn your favorite summer activities into frustrating experiences. 

The good news?

There’s a lot you can do – starting right now – to protect and support your knees naturally. 

Here are five of my top tips for helping people keep their knees healthy and mobile – so you can enjoy your summer instead of worrying about knee pain:

  1. Strengthen Your Hips and Core

Your knees don’t operate in isolation. They rely on surrounding muscles – especially your hips and core – for proper support and alignment. When these areas are weak, your knees can become stiff and painful due to the extra strain they have to endure to compensate. Strengthening your hips and core improves not only how your knees feel and function, but how your entire body moves. And the better you move as a whole, the less likely you’ll be to place unwanted stress on your knees.

  1. Optimize Your Knee Mobility

One of the most important principles I share with patients is “mobility before stability.” If your joints are stiff, the muscles around them can’t function properly. When it comes to knees, that little bit of hyperextension or “give” at the end of your range isn’t just normal – it’s often a critical yet overlooked aspect of healthy knee function. I see this missed all the time in rehab protocols, especially after procedures like arthroscopy. It may seem minor at the time, but years later, that unaddressed stiffness can cause big problems. I also frequently see issues when one knee is significantly less mobile than the other – often due to a past injury – which can lead to imbalance and compensation elsewhere. When you optimize your knee mobility, your knees will move and feel better. So keep them moving – and stop “protecting” them so much. You may be doing more harm than good.

  1. Stop Sitting So Much

You hear this advice all the time when it comes to back health – but did you know that sitting too much isn’t great for your knees either? Prolonged sitting – whether at a desk, in the car, or lounging – can lead to stiffness and reduced circulation in your knees. It also tightens your hip flexors and hamstrings, which can place abnormal stress on your knee joints. Knees don’t like being in one position for too long. If you notice that your first few steps after sitting feel achy or painful, it’s a sign you need to move more. Make it a point to stand up, stretch, or take a short walk at least once every 30 minutes. These quick breaks go a long way in supporting knee health – and your spine will thank you, too.

  1. Choose Supportive Footwear

Footwear plays a significant role in how your knees feel. The shoes you wear impact how forces travel up through your legs – and summer favorites like flip-flops often provide little to no support. Poor footwear can alter your gait and posture, placing unnecessary strain on your knees. When choosing shoes, look for options that are comfortable and offer good arch support and cushioning – especially if you’ll be walking or standing for long periods. Also consider the width of your shoes, as feet tend to swell and widen in the heat during extended activity. Supportive sandals do exist – just be mindful of when and how long you wear less supportive styles.

  1. Work on Your Balance

Balance isn’t just important for fall prevention – it also plays a key role in how well your joints absorb and distribute force. Good balance ensures that your feet, ankles, and core work together to stabilize your movements. When that coordination is off, your knees often have to compensate, which can lead to pain and unwanted wear and tear over time. Simple balance exercises – or activities like yoga, which emphasize control and stability – can help retrain your neuromuscular system and reduce unnecessary strain on your knees. You’ll notice the benefits of improved balance in all areas of life, but especially during favorite summer activities like hiking, pickleball, beach walks, and paddleboarding.

If you’re dealing with persistent knee pain – even one or two of these strategies could make a noticeable difference.

And if your knee pain is keeping you from being active or doing your favorite summer activities, it might be time to seek expert help. A physical therapist who specializes in mechanical pain can assess your movement and identify the root cause – so you can get back to doing what you love – and without having to rely on pills or surgery.

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.

Back Pain

Could Back Trouble Be the Root of Your Knee Pain?

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One of the most important things to get right when it comes to successfully resolving knee pain is to make sure you’ve correctly identified the root cause.

Sometimes, your knee pain is due to a problem within your knee joint – such as with arthritis or torn cartilage. But other times (and more often than you think) – the source of your knee pain can be coming from elsewhere – such as your lower back. 

Did you know that 25% of the time, your knee pain is due to a problem within your back – even when you don’t have any back pain?

One of the tell-tale signs you’ve misidentified the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, stretching – even physical therapy – but no matter what – your knee pain just won’t seem to go away. If the root source of your knee pain is within the knee joint – and you address your joint with any combination of the above mentioned interventions – it will help.  

But how do you figure out if the root cause of your knee pain is in your lower back? 

Pay attention to how your knee pain behaves. When your lower back is the source, you’ll typically have difficulty pinpointing exactly where your knee pain is. It may feel dull, achy, or even numb at times. It might move around, or perhaps travel up or down your thigh. One day your knee might feel great, and you’ll think the problem is finally gone – while other days it could feel excruciating. When your knee pain is more vague and moves around a lot, or it comes and goes throughout the day for no apparent reason, there is a good chance that your back is the root source. With true knee pain, you can usually point to where it hurts and describe pretty well when and where it will bother you.

So how does a misdiagnosis like this even happen?

One of the biggest culprits is imaging. If you’re over age 40, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears. Studies have shown that arthritic changes and meniscus tears are a normal part of aging, so they will show up on your images whether you have any knee pain or not. While I have many stories about people getting the root cause of their knee pain wrong – one in particular stands out in my mind that I want to share with you. 

I remember a 56 year old tennis player who had knee surgery to “clean out” some wear and tear from arthritis and a meniscus tear. This was after trying several months of physical therapy that had “failed”. She was told the procedure was routine and that her recovery would be quick. Sadly, after three months, she was still limping around and her knee was feeling worse than pre-surgery. The pain had moved, it spread more to her thigh now and it ached a lot more at night and when she wasn’t moving around. She could play tennis, but her knee felt more tired now and her leg would just ache. When she came to me for a second opinion, the very first thing I did was screen her lower back for problems. She thought this was weird at first because she had never had any real back pain. But it turns out that when we started moving her back around and testing it – her knee pain reacted to this. The root cause of her knee pain was actually in her spine. So it made sense all the physical therapy she had for her knee, and the knee surgery didn’t work.

If you’ve been suffering from knee pain for a while, and typical treatments don’t seem to be working, it’s worth considering that the root source of your problem could be your lower back. 

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your thigh – it’s worth getting your lower back checked by a mechanical pain specialist before give up all together – and especially before jumping into any surgery or procedure on your knee.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or sign up for her upcoming Masterclass for Knee Pain Sufferers CLICK HERE.



For the Dad Who Has Everything… Except Good Knees

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It’s that time of year when we celebrate the dads in our lives – and if the one in your life is anything like mine – then he’s probably a little tough to shop for. Maybe he already has all the tech toys and grilling gadgets he wants. Maybe he’s not one to ask for much. But if there’s one thing a lot of dads over 40 don’t have – but wish they did – is good knees.

Knee pain is one of the most common complaints I hear from the men over 40 who walk into my clinic – and it’s also the most common form of osteoarthritis. For some, it’s been a nagging issue for years. For others, it creeps in gradually – starting with a little stiffness when getting up from the couch, or a strange “click” here and there. Then one day, it hits you… Playing golf isn’t fun anymore, and going up and down stairs now feels more like a chore – because your knees just hurt all the time.

Yes, knee pain does become more common as we age – but not necessarily for the reasons you think.

People love to blame arthritis and “wear and tear” for just about everything. And while a previous injury or underlying arthritis might be present, they’re not always the primary culprits. What most people don’t realize – including dads – is that the root cause of knee pain is often mechanical. In other words, it has more to do with how your body moves (or doesn’t move) than what’s actually going on inside the joint.

Let me explain.

Your knees sit between your hips and ankles – two areas that are meant to move a lot and absorb shock. But if the hips or ankles aren’t doing their job properly (which is surprisingly common), that stress has to go somewhere – and the knees usually pay the price. Over time, poor mechanics can lead to pain, inflammation, and breakdown of the joint. But here’s the good news – if the pain is mechanical, it’s very treatable – and sometimes even reversible – all without drugs, injections, or surgery.

So why don’t more dads know about this?

For one, we’ve normalized knee pain – especially in men over 40. There are societal and cultural beliefs like, “You’re getting older, it’s supposed to hurt a little.” Or worse, “If it hurts too much, you can always replace it.” That kind of thinking is unproductive, unnecessary, and can even be dangerous. Yes, knee replacements are sometimes the right call – but far too often, they’re offered before the right conservative options have been fully explored. And with so many cutting-edge, non-invasive technologies now available that promote longevity and let you keep your original parts – dads should absolutely be exploring these options first.

But another big reason? Men – especially dads – tend to avoid asking for help. They’re used to being the fixers, not the ones getting fixed. Many try to “tough it out,” hoping the pain will go away on its own. Others pop ibuprofen or throw on a brace and carry on. But these strategies are just band-aids. They might provide temporary relief, but they don’t address the actual cause of the pain – and in some cases, they can even make things worse.

The real solution starts with a deeper understanding of why your knee pain is happening in the first place. Remember – 80% of all knee pain is mechanical in nature.

So if you or someone you love is dealing knee pain – here are a few important things to keep in mind:

  1. Rest isn’t always the answer.
    It might seem like common sense to rest an aching knee – but too much rest can lead to stiffness, weakness, and poor circulation. In many cases, strategic movement is far more helpful than immobilization.
  2. Pain doesn’t always mean damage.
    This is one of the most misunderstood aspects of musculoskeletal pain. Just because something hurts doesn’t mean it’s permanently damaged – and just because an X-ray shows “bone-on-bone” doesn’t mean surgery is inevitable.
  3. The site of the pain isn’t always the source.
    Knees often hurt because of a problem elsewhere – such as limited hip mobility, poor ankle mechanics, or even an undiagnosed problem in your spine. That’s why a full-body movement assessment is key to figuring out what’s really going on.
  4. Most knee pain is preventable – and fixable.
    With the right combination of movement-based therapy, strength training, hands-on treatment, and regenerative therapy – many people are able to not just reduce their pain – but eliminate it entirely.

So what does all of this have to do with Father’s Day?

If you’re looking to give your dad something meaningful this year, consider giving him a nudge to take care of himself.

Not with another gadget or tie – but with a shift in mindset. One that reminds him that pain isn’t something he just has to live with. One that encourages curiosity about his health, and reinforces that aging doesn’t have to mean giving up the activities he loves.

Because the truth is – most dads don’t want to sit on the sidelines. They want to stay active, strong, and capable. They want to travel, hike, golf, chase their grandkids around the yard, and keep doing the things that make life fun. And they can – if they learn to listen to their bodies and get the right kind of help.

So if the dad in your life has everything… except for good knees… Maybe this is the year to give him something more lasting than another toolset or polo shirt. Maybe this is the year to give him the reminder that his health is worth paying attention to. And that it’s never too late to move better, feel better, and get his knees back.

golf injuries

How to Stay Injury-Free on the Golf Course This Season

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Golf is a favorite pastime for millions – and now that the season is in full swing here in New England – many players are eager to hit the course as often as possible. But when back, knee, elbow, or shoulder pain creeps in – those 18 holes can quickly lose their appeal – and even become depressing. Pain doesn’t just interfere with your swing. It can drain the joy right out of your game.

The good news? Many of the injuries that golfers suffer from are preventable. With a bit of foresight, the right kind of movement, and smart preparation – you can keep your body strong and your game on point all season long.

Here are five of the most common injuries I see golfers facing – and what you can do to avoid or recover from them quickly:

1. Back Pain

This is by far the most frequent complaint among golfers. The constant bending, twisting, and rotational force of a golf swing can wreak havoc on your spine – especially if your back is stiff or you spend a lot of time sitting during the week.

The best way to keep your back pain-free? Focus on improving your spinal mobility – particularly extension and rotation. Even perfect swing mechanics can’t make up for a back that lacks movement. Try adding daily backward stretching and limit prolonged sitting – especially on the days you know you’ll be golfing. These small changes can make a big difference in keeping your spine mobile and resilient throughout the season.

2. Golfer’s Elbow (Medial Epicondylitis)

This injury happens when the tendons on the inside of your elbow become irritated – often due to repetitive swinging. But the root problem, however, frequently lies elsewhere. Weakness in your shoulder girdle or stiffness in your wrist can force your elbow to overcompensate.

To prevent and heal golfer’s elbow – don’t just focus on the elbow itself. Work on improving shoulder stability and wrist mobility as part of your regular conditioning. In more stubborn cases – regenerative therapies like Shockwave Therapy or EMTT can speed up healing and reduce inflammation – helping you stay on the course without resorting to cortisone shots or any downtime.

3. Knee Pain

Walking the course and rotating through your swing can put a lot of pressure on your knees – especially if you lack strength in your core and hips – or have unstable feet and ankles. Your knees aren’t designed to power your swing, but they often get overworked if other areas aren’t pulling their weight.

Most knee pain in golfers is mechanical, not structural. Meaning, it’s caused by faulty movement patterns rather than actual damage, even when imaging shows said “damage”. The good news? With the right strengthening and stabilization exercises, you can typically resolve your knee pain naturally – no injections or surgery required.

4. Rotator Cuff (Shoulder) Injuries

The rotator cuff is responsible for stabilizing your shoulder, and it’s highly involved during your golf swing. If it’s weak – or if your mid-back and core aren’t supporting it – your rotator cuff can easily become inflamed or irritated.

To prevent this, build strength not only in your shoulders, but also in your mid-back, lats, and core. These “powerhouse” muscles provide a solid foundation and reduce the strain on your shoulders. If your shoulder pain is persistent, regenerative Shockwave Therapy and EMTT (like in the case of golfer’s elbow) can be an excellent way to accelerate healing and reduce the need for medication, rest, or downtime.

5. Wrist and Hand Injuries

Sprains, strains, and other wrist or hand injuries are common in golf – often due to grip issues or poorly fitted equipment. But one commonly overlooked factor is your neck. Research shows that nearly half of all upper extremity pain can be traced back to the cervical spine – even if you don’t feel any neck pain.

If nerve irritation or stiffness in your neck is the true culprit – no amount of wrist strengthening will help – because the root cause has been missed. If your wrist or hand symptoms persist despite traditional mobility, strength and even manual work, it may be time for a full-body assessment by a mechanical pain specialist who can identify whether the issue is actually coming from somewhere else.

Final Thoughts

Golf injuries can be frustrating – but they’re often preventable and highly treatable when you know what to do or where to turn for the right help. By addressing problems early, using targeted movement strategies, and supporting your body with proper mechanics – you can keep playing pain-free all season long.

And when more advanced treatment is needed – especially for tendon or joint inflammation – non-invasive regenerative therapies like Shockwave Therapy and EMTT can offer fast, effective relief and accelerate recovery.

As a physical therapist who specializes in mechanical pain and movement dysfunction, I’ve helped countless golfers who thought their playing days were over – only to return to the course stronger and better than before. The key is addressing the true source of pain, not just masking the symptoms.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. To request one of her free guides for back or knee pain – visit her website: cjphysicaltherapy.com – or call 603-380-7902

Top 5 Arthritis Myths That Keep People in Pain

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If you or someone you love is living with arthritis — then you already know how frustrating it can be. Daily tasks become harder, favorite activities fall by the wayside, and you may start to wonder: “Will things ever get better?”

Even worse, many people living with arthritis fall victim to misguided advice.

Let’s look at five of the most common myths about arthritis management — and shed some light on what you can actually do instead:

Myth #1: “There’s nothing you can do — it’s just part of getting older.”

This is one of the biggest and most damaging myths of all.

While it’s true that arthritis becomes more common as you get older — and it’s considered a normal part of aging — it doesn’t mean you have to live with chronic pain or disability. In fact, many people with visible (even advanced) arthritis on X-rays and MRIs are living active, healthy lives with minimal to no pain at all.

Research supports this. A 2015 study published in Arthritis & Rheumatology found that more than 30% of adults over 60 had radiographic evidence of knee osteoarthritis — but only a portion of them had symptoms. In other words, just because your joints show signs of “wear and tear” doesn’t mean you’re doomed to pain.

The real issue is how you move — and how you use your joints. Strategic exercise, strength training, and natural therapies can drastically improve your mobility and reduce pain — regardless of your age or what your imaging says.

Doing nothing, on the other hand, is one of the worst things you can do.

Myth #2: “You should rest and avoid activity to protect your joints.”

If your joints hurt, don’t move them — right? That might make sense if you have an injury that requires an initial rest and healing phase. But that’s not the case with arthritis. When you avoid movement in an arthritic joint, you actually worsen your symptoms.

Too much rest leads to stiff joints, weakened muscles, and poor circulation — all of which contribute to more pain and less function over time. Movement helps lubricate joints, strengthen muscles, and prevent further degeneration.

I’m not sure why this myth is still so common — especially when just about every major orthopedic organization (including the CDC and the Arthritis Foundation) agrees that regular, low-impact physical activity is one of the best things you can do for arthritis.

The key is doing the right kind of movement. So if you’re struggling, work with an expert who can help you figure out the proper, targeted activity your body needs. But whatever you do — don’t fall for this myth.

Myth #3: “If your joint is bone-on-bone, surgery is the only option.”

Hearing the phrase “bone-on-bone” from your doctor can feel like a death sentence for your joint. And the typical recommendation? Joint replacement surgery.

But what if I told you that “bone-on-bone” isn’t always the actual reason for your pain — and that you’ve got options beyond a major procedure like surgery?

The first thing to understand is that what shows up on your imaging (like X-rays and MRIs) doesn’t always match up with your symptoms. A 2018 study in BMJ Open found that nearly half of people with severe osteoarthritis on imaging had little to no pain. And many people with significant joint pain showed only mild arthritic changes on their images.

Translation? “Bone-on-bone” isn’t necessarily the root cause of your problem. I’ve seen many people with this diagnosis successfully avoid major surgery and keep their original parts far longer than they thought possible.

When faced with this kind of diagnosis, the best thing you can do is pause — and explore your options. Surgery will always be there if you need it. But don’t rush into it or assume it’s your only option.

Myth #4: “Cortisone shots and medications are the best way to manage arthritis.”

Cortisone shots may provide short-term pain relief for arthritis — but they don’t actually fix anything. Worse, repeated cortisone injections have been shown to damage cartilage and accelerate joint degeneration over time.

One study published in JAMA (2017) showed that patients receiving cortisone injections for knee arthritis had worse cartilage loss at two-year follow-up than those who received a saline placebo — despite experiencing no significant difference in pain relief.

NSAIDs (like Advil) and prescription pain medications can also help dull pain, but they come with side effects — and, just like cortisone, do nothing to address the root cause of your symptoms.

If you’re relying on medication or repeated cortisone shots just to get through the day — or to delay surgery — it’s time to explore options that promote natural healing instead of just masking symptoms.

Shockwave Therapy and EMTT are two non-invasive regenerative therapies that do exactly that. These cutting-edge technologies enhance your body’s natural healing processes by targeting inflammation and tissue damage at the cellular level. And while more research is still needed, promising clinical evidence suggests these therapies may actually help reverse — or significantly delay — the progression of arthritis.

Do your own research — and be open to natural, forward-thinking treatment options that support your long-term joint health.

Myth #5: “Arthritis means you’ll never get back to the activities you love.”

This is one of the most heartbreaking myths — and it’s simply not true.

I’ve worked with countless clients who believed their days of hiking, gardening, traveling, or playing with grandkids were behind them — only to regain full function and freedom after following a personalized treatment plan.

And while surgery sometimes is the best option — especially if you’ve waited until your arthritis has become advanced — there’s a lot you can do to improve your outcome. Working with a specialist to build strength and prescribe targeted movement can make recovery faster and easier.

Plus, emerging research shows that using regenerative therapies like Shockwave and EMTT both before and after surgery may help accelerate healing and improve long-term outcomes.

Managing arthritis is absolutely possible when you take a natural, proactive, and personalized approach. You just need the right plan — and the right team to guide you.

Final Thoughts:

Arthritis is real — but don’t let myths and outdated advice keep you stuck. If you’re not sure where to start — or feel like you’ve already tried everything — speak with someone who specializes in mechanical pain and natural joint care. Often, the most effective solutions are the ones no one has told you about yet.

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.