Tag Archive for: physical therapy Portsmouth new Hampshire

Why We Age Faster Than We Should – And How Medicine 3.0 Changes Everything

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Why We Age Faster Than We Should — And How Medicine 3.0 Changes Everything (Portsmouth, NH)

If you haven’t yet read “Outlive: The Science and Art of Longevity” by Dr. Peter Attia, I highly recommend it—especially if living your healthiest years right now matters to you. Dr. Attia, a physician known for his work in healthspan and preventative medicine, explains why our current medical system (what he calls Medicine 2.0) focuses too heavily on treating disease instead of preventing it.

In “Outlive,” Attia introduces Medicine 3.0, a proactive and prevention-based approach to longevity. Instead of waiting for disease to show up, Medicine 3.0 focuses on early action, long-term strategy, and building the physical capacity needed to stay healthy and independent through your 60s, 70s, and beyond.

Central to Attia’s philosophy are the “Four Horsemen” of chronic disease:

  • metabolic dysfunction
  • cardiovascular disease
  • cancer
  • neurodegenerative decline

These conditions often appear in our 50s and 60s—but the biological changes that cause them begin years (often decades) earlier. That’s why the most powerful time to intervene is long before symptoms appear. And that applies directly to the work I do every day as a mechanical pain specialist here in Portsmouth, NH.

Where Most People Overlook Longevity: Musculoskeletal Health

You can fuel your body with nutrient-dense food, build strong muscles, and improve your cardiovascular capacity—but if you’re dealing with chronic back pain, knee pain, hip pain, or shoulder pain, it becomes nearly impossible to maintain the type of movement needed for long-term health.

Just like the Four Horsemen, musculoskeletal problems usually develop silently from small mechanical issues that go unaddressed for too long. When identified early, nearly all of these issues are fixable—and often preventable.

This is exactly where Medicine 3.0 and mechanical pain science overlap:

  • early intervention
  • optimizing function
  • preventing decline
  • treating problems while they’re small—not after they become debilitating

Below are five Medicine 3.0 principles that apply directly to your muscles, joints, and mobility.

1. Movement Quality Matters More Than You Think

Longevity isn’t just about being active—it’s about moving well. Poor movement patterns, stiffness, or instability eventually lead to breakdown, even if you’re exercising consistently.

  • Medicine 2.0: Wait until something hurts
  • Medicine 3.0: Optimize movement before pain appears
  • Good joint mobility, core stability, balance, and coordination are fundamental for long-term health, independence, and injury prevention.

2. Small Aches Become Big Ones When Ignored

A tight low back after sitting…
An achy knee after pickleball…
A stiff neck when you wake up…

These are early warning signs. Medicine 2.0 teaches you to ignore them until they become severe. But by that point, the problem is harder—and more expensive—to solve.

Mechanical issues are easiest to fix early, and addressing them now protects your joints, prevents chronic pain, and helps you stay active well into older age.

3. Your Mobility Declines Long Before You Notice It

Just like cardiovascular decline, mobility fades slowly over decades. You lose hip extension, ankle mobility, rotational strength, and postural control long before you notice anything in daily life.

The good news?
Mobility is highly trainable, even into your 70s and 80s.

The key is to address restrictions early—not once you already “feel old” or start modifying activities due to stiffness.

4. Strength Training Doesn’t Work When Form Is Poor

Strength training is one of Attia’s non-negotiables for longevity. But strength training performed with poor mechanics can do more harm than good.

Learning to:

  • hinge properly
  • stabilize your hips
  • engage your core
  • align your spine

…keeps your joints safe and allows you to build strength without injury.

The best time to learn proper mechanics is before something breaks down—not after you’re dealing with a herniated disc or chronic tendon pain.

5. Imaging Shows Structure—But Not the Full Story of YOU

X-rays and MRIs show bones and tissues, but they don’t show mechanical dysfunction, such as why:

  • your back hurts more with sitting
  • your hip improves with walking
  • your knee flares after lifting

Most musculoskeletal pain is mechanical in nature, meaning it responds best to mechanical solutions like movement, load management, and corrective exercise—not just medication or rest.

This aligns perfectly with Medicine 3.0:
Treat the whole person, not just the scan.

The Bottom Line: You Have More Control Over Your Future Than You Think

Medicine 3.0 teaches us that aging isn’t something that just “happens”—it’s something we can influence with early, strategic action.

Nowhere is this more true than in your musculoskeletal system.

When you:
✔ take small signals seriously
✔ strengthen intelligently
✔ move with intention
✔ address problems early
✔ ask for help before pain becomes disabling

…you protect your ability to stay healthy, active, independent, and fully engaged in life for decades to come.

About Dr. Carrie Jose

Dr. Carrie Jose, DPT, is a Physical Therapy Specialist and Mechanical Pain Expert and the owner of CJ Physical Therapy & Pilates in Portsmouth, NH. She writes for Seacoast Media Group and helps active adults stay mobile and pain-free without medications, imaging, or surgery.

To get in touch or request a discovery visit, visit cjphysicaltherapy.com or call 603-380-7902.

Stretching for lower back pain in Portsmouth NH that may not relieve stiffness

3 Reasons Your Lower Back Stretches Aren’t Working

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Why Your Lower Back Still Feels Tight — Even When You Stretch Every Day

If you’re dealing with lower back pain in Portsmouth NH and stretching every day — but still feel tight, stiff, or sore — you’re not alone.

At our physical therapy clinic in Portsmouth, New Hampshire, we see this all the time. People are consistent. They’re motivated. They stretch daily.
And yet — their back still feels tight, restricted, or painful.

The truth?
Stretching your lower back isn’t always the solution. And in many cases, stretching can actually make back pain worse instead of better.

If your lower back still feels tight despite everything you’ve tried, here are three common reasons why stretching may not be helping — and what you can do instead.

1. Your Stretching Technique Is Working Against You

Most people assume that simply doing the stretch is enough.
But how you stretch is just as important as what you stretch.

At our Portsmouth physical therapy office, we often see people stretching while:

  • Holding their breath
  • Tensing their glutes or shoulders
  • Forcing positions instead of easing into them

When your body feels strained, your nervous system responds by tightening — not relaxing. This makes tight muscles even tighter.

If this sounds familiar, try slowing your stretches down. Focus on calm breathing, gentle movement, and releasing tension instead of forcing range of motion.

Sometimes it’s not what you’re doing … it’s how you’re doing it.

2. You’re Stretching the Wrong Thing for the Problem You Actually Have

Generic stretches like child’s pose, hamstring stretches, or forward bends may help if your stiffness comes from:

  • Sitting all day
  • Muscle fatigue
  • General stress

But if your pain is mechanical — such as:

  • Disc irritation
  • Sciatic nerve involvement
  • Poor movement patterns
  • Hip or pelvic imbalance

… those same stretches may not help at all. In fact, they can aggravate lower back pain even more.

This is why one-size-fits-all routines fail.

As a mechanical pain specialist, I assess:

  • Which movements make pain better or worse
  • How your back responds to direction of motion
  • How your body compensates

This allows us to prescribe exact stretches and exercises for your condition — not generic ones. That’s what true corrective physical therapy looks like.

If your current routine hasn’t changed your symptoms, the issue may not be effort — It may be accuracy.

3. Your Lower Back May Not Need Stretching At All

This surprises many people.

A back that feels “tight” is often reacting to weakness or instability nearby —
especially in the hips, pelvis, or core.

When your body feels unsupported, it tightens muscles as a protective reflex.

If your back stiffens after:

  • Core workouts
  • Prolonged sitting
  • Busy days
  • Certain movements

…your real issue may be weakness, not flexibility.

In these cases, strengthening the right muscles — and teaching them to work together — provides far more relief than stretching ever will.

The Bottom Line: Lower Back Pain Is Fixable

If daily stretching hasn’t helped your lower back pain in Portsmouth NH, it’s time to stop guessing.

Your tightness may be happening because:

  • Your technique is off
  • Your stretches aren’t specific enough
  • Stretching isn’t what your body needs at all

Once the true mechanical reason behind your pain is identified, recovery becomes faster — and far less frustrating.

Get Expert Help for Lower Back Pain in Portsmouth NH

If your lower back stiffness or pain isn’t improving, working with a mechanical back pain specialist in Portsmouth NHmay be your next step.

Correct diagnosis leads to:
– Faster pain relief
– Fewer flare-ups
– Less trial-and-error
– Better long-term results

About the Author

Dr. Carrie Jose, DPT, is a Physical Therapy Specialist and Mechanical Back Pain Expert and the owner of CJ Physical Therapy & Pilates in Portsmouth, NH.

She regularly writes for Seacoast Media Group and helps residents throughout the Seacoast overcome back pain without medication, injections, or surgery.

To request a copy of her free guide: “5 Simple and Easy Ways to Get Rid of Back Pain”
Visit: www.cjphysicaltherapy.com
Or call: 603-380-7902

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.

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.

Shockwave Therapy

Four Non-Invasive Ways to Get Rid of Arthritic Knee Pain

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Knee arthritis is one of the most common and debilitating causes of joint pain for adults over 50. As the protective cartilage in the knee joint gradually wears down, many people experience stiffness, swelling, and chronic pain that can make everyday activities—like walking the dog, climbing stairs, or getting out of the car—feel frustrating and exhausting.

For years, conventional treatments such as traditional physical therapy, cortisone injections, and pain medications have been the go-to options for knee arthritis relief. While these approaches may provide temporary symptom relief, they often fail to address the underlying mechanical and inflammatory causes of knee pain. For many people, the results are short-lived—or nonexistent.

The good news? There are effective, non-invasive, and drug-free solutions available that focus on improving joint function, reducing inflammation, and supporting your body’s natural healing process—especially for those who want to avoid injections or surgery.

Here are four non-invasive ways to relieve arthritic knee pain naturally, used successfully by many adults in Portsmouth and throughout the Seacoast of New Hampshire.

1. Corrective, Therapeutic Movement Strategies for Knee Arthritis

Movement is one of the most accessible—and powerful—tools for managing arthritic knee pain. While it may seem counterintuitive to move a painful knee, not all knee pain is caused by arthritis alone.

In many cases, pain is driven by joint stiffness, poor mechanics, and long-standing compensatory movement patternsthat place excess stress on the knee. When the joint doesn’t move well, surrounding tissues are forced to work harder, increasing irritation and discomfort.

By identifying and correcting faulty movement patterns with specifically prescribed therapeutic exercises, it’s often possible to significantly reduce pain—even in arthritic knees. These targeted strategies focus on improving knee mobility, restoring proper alignment, and optimizing how forces move through the joint.

Working with a specialist trained in mechanical pain assessment is key. Once the right movements are identified, they can be used long-term to help manage symptoms—without ongoing costs, medications, or injections.

2. Weight Management to Reduce Knee Joint Stress

Excess body weight places a significant load on the knee joints during everyday activities like walking, standing, and climbing stairs. In fact, research from Wake Forest University led by Dr. Stephen Messier found that for every pound of weight lost, there is a four-pound reduction in knee joint stress during daily movement.

That means losing just 10 pounds can reduce pressure on your knees by 40 pounds with every step.

Healthy, sustainable weight management—through smart nutrition and regular movement—can dramatically reduce knee pain and improve function. Beyond your knees, weight loss also decreases strain on the hips, ankles, and lower back, supporting overall joint health and long-term mobility.

3. Adopt an Anti-Inflammatory Lifestyle

While knee arthritis is often described as “wear and tear,” chronic inflammation plays a major role in pain, stiffness, and joint degeneration.

Reducing inflammation through lifestyle changes—especially nutrition—can lead to noticeable improvements in how your knees feel. An anti-inflammatory diet emphasizes whole, unprocessed foods rich in antioxidants and healthy fats, including:

  • Fatty fish like salmon, sardines, and mackerel
  • Dark leafy greens such as spinach and kale
  • Berries, walnuts, chia seeds, and flaxseed
  • Extra virgin olive oil
  • Anti-inflammatory spices like turmeric and ginger

At the same time, limiting refined sugars, processed grains, and fried foods is essential, as these are known to promote inflammation.

Beyond diet, other daily habits that help reduce inflammation include getting 7–8 hours of quality sleep, managing stress through walking or breathing exercises, and staying well-hydrated. These foundational changes not only support knee arthritis relief—but overall health and energy as well.

4. Explore Non-Invasive Regenerative Therapy for Knee Arthritis

One of the most exciting advances in non-surgical knee arthritis treatment is the use of non-invasive regenerative therapies, including Shockwave Therapy and EMTT (Extracorporeal Magnetotransduction Therapy).

These cutting-edge technologies work with your body’s natural healing mechanisms rather than masking pain.

  • Shockwave Therapy uses mechanical sound waves to improve blood flow, break down damaged tissue, and stimulate dormant healing cells within the knee joint.
  • EMTT uses high-frequency electromagnetic energy to reduce inflammation at the cellular level, boost mitochondrial activity, and accelerate tissue repair—making it especially effective for chronic joint inflammation and bone marrow lesions commonly seen with knee arthritis.

Recent research supports the combined use of these therapies. A 2021 clinical study published in Orthopedic Reviewsfound that using Shockwave Therapy and EMTT together led to greater improvements in pain relief and functional mobility than either treatment alone, with longer-lasting results.

For individuals who have already tried traditional physical therapy or cortisone injections without success, this non-invasive combination offers a powerful, drug-free alternative—without surgery.

Take Control of Your Knee Arthritis Pain—Naturally

If you’re living with knee arthritis and feel like you’ve exhausted your options, don’t lose hope. Pills, injections, and surgery are not your only choices.

By combining corrective movement strategies, healthy weight management, anti-inflammatory lifestyle changes, and advanced non-invasive regenerative therapies, many people are able to reduce knee pain and regain confidence in their movement—naturally and safely.

The key is addressing the root cause of your pain and choosing solutions that support long-term joint health, not just short-term relief.

About the Author

Dr. Carrie Jose, Doctor of Physical Therapy and Mechanical Pain Expert, is the owner of CJ Physical Therapy & Pilates in Portsmouth, New Hampshire. She specializes in helping adults over 40 overcome chronic knee, hip, and back pain—without relying on medication, injections, or surgery.

 

Knee Pain

Top Causes of Knee Pain and How to Get Lasting, Natural Relief

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Knee pain affects millions of people worldwide, often interfering with daily activities such as walking, squatting, climbing stairs, and even getting in and out of the car.

It is one of the most common musculoskeletal complaints, second only to back pain. Whether your knee pain started suddenly or has worsened over time – you might be wondering – what’s really causing it? And can you get rid of it naturally?

The good news is that, in most cases, yes. Many common causes of knee pain can be addressed without medications, injections, or surgery. Here are some of the top reasons behind knee pain and what you can do to find lasting, natural relief that doesn’t involve medication, injections, procedures, or surgery:

1. Patellofemoral Pain Syndrome (Runner’s Knee)

Also known as “runner’s knee,” patellofemoral pain syndrome (PFS) is characterized by pain in the front of the knee, usually just below or behind the kneecap. This condition is often caused by improper movement patterns and muscle imbalances that place excessive pressure on your kneecap, leading to inflammation and discomfort.

To alleviate PFS, it’s important to avoid excessive kneeling, squatting, or repetitive knee bending until the pain subsides. For long-term relief, focus on strengthening the muscles surrounding your knee, particularly the hips and thighs, to improve stability and reduce stress on your kneecap. Corrective exercises that promote proper kneecap tracking, such as step-ups and lateral band walks, can help to further optimize knee function and prevent future flare-ups.

2. Iliotibial Band Syndrome (ITBS)

ITBS causes pain on the outer side of the knee and is commonly seen in runners and cyclists. The iliotibial (IT) band is a thick band of connective tissue running from the hip to the knee, and when it becomes tight or inflamed, it can lead to irritation and pain.

While many people resort to foam rolling for relief, this only provides temporary symptom management. To address ITBS at its root, focus on strengthening the glutes and core, as weak glutes often lead to overcompensation and excessive strain on the IT band. Correcting pelvic imbalances and optimizing hip mobility will also be key for long-term relief. Additionally, taking a temporary break from any aggravating activities will allow the inflammation to subside and the tissues to heal properly, provided you’re taking an active approach to tissue healing versus rest only.

3. Tendinitis (Jumper’s Knee)

Tendinitis occurs when the patellar tendon, which connects the kneecap to the shinbone, becomes inflamed. This condition is common in athletes and individuals who engage in frequent jumping or repetitive knee movements.

A common treatment for tendinitis is cortisone injections, but these only provide temporary relief and may contribute to further tissue damage over time. Instead, consider regenerative treatments like Shockwave Therapy, which naturally enhances your body’s ability to reduce inflammation and accelerate tendon healing. Once inflammation is managed, strengthening the hamstrings, glutes, and calf muscles will provide better knee support and reduce tendon strain. Incorporating eccentric exercises, such as slow step-downs, can also help build tendon resilience and prevent future injuries.

4. Osteoarthritis

Osteoarthritis (OA) is the gradual degeneration of cartilage in the knee joint. While it is a natural part of aging, experiencing constant pain and limited mobility does not have to be. Many people believe that knee arthritis inevitably leads to surgery, but the truth is that optimizing movement and reducing inflammation can be powerful tools in managing OA long-term, even with “bone on bone” OA.

Rather than relying on cortisone injections and pain medication, consider alternative treatments such as Regenerative Therapy (specifically EMTT) to target inflammation deep at the cellular level. From there, implementing corrective exercises that strengthen the muscles surrounding the knee – particularly your quadriceps, hamstrings, and glutes – can reduce joint stress and help prevent inflammation from returning. Since inflammation is the primary driver of pain in OA, addressing it naturally through movement and strength training can help you avoid major surgery while still finding lasting relief.

5. Meniscus Tears

The meniscus is a piece of cartilage that cushions the knee joint. Over time, wear and tear can lead to meniscus tears – which cause pain, stiffness, and occasional knee locking. Many people assume that surgery is the only solution, but research has shown that placebo surgery can be just as effective as actual meniscus surgery, suggesting that natural recovery is possible.

Managing a meniscus tear naturally involves first addressing the inflammation caused by the tear. As previously mentioned, EMTT and Shockwave Therapy (especially when combined) can be particularly effective in reducing pain and inflammation, often providing immediate relief. Beyond that, focusing on proper knee mechanics is essential. In many cases, the issue isn’t the tear itself, but rather a lack of mobility and movement in the knee joint that continues to aggravate it. A mechanical knee pain specialist can help identify and correct these dysfunctions. Once inflammation is controlled and knee mechanics are optimized, strengthening and conditioning the surrounding muscles can provide long-term relief without the need for injections or surgery.

Finding Long-Term Relief Naturally

For most cases of knee pain, the key to lasting relief is movement – not rest, avoidance, injections, or surgery. Whether your pain is caused by an overuse injury, muscle imbalance, or arthritis – addressing the root cause with targeted exercises and mobility work is essential. Reducing inflammation naturally is also crucial for long-term joint health. If you’re struggling to determine the root cause of your knee pain or finding the right treatment approach – consider working with a mechanical knee pain specialist who can guide you toward the best non-invasive, long-term solutions.

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 Surgery should be your Last Resort for Knee Pain

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Arthroscopic knee surgery is one of the most common surgeries performed – despite research telling us that it’s not nearly as effective as most people are led to believe. Furthermore, the science tells us that people who do undergo arthroscopic knee surgery are more likely to have knee arthritis that advances rapidly – resulting in a total knee replacement that quite possibly could have been avoided.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

Well… it is until it isn’t. 

The big problem is that arthroscopic knee surgery is actually not necessary for most cases of knee pain. If there is a complication – which exists even with “minimally invasive” procedures – you could end up being worse off than when you went in. Plus – if you never even needed the surgery to begin with – you just put your knee through unnecessary trauma that you’ve got to now heal from. This further delays you from addressing the root cause of your knee pain.

The truth is that most people can get full relief of their knee pain as well as full restoration of knee function without any type of surgery or procedure. This is true for 70-80% of all knee pain cases.

An early research study from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery at a higher rate than ever?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain beforehand. If you’ve gotten physical therapy and it wasn’t effective, people are led to believe that the physical therapy “didn’t work”. But more often than not, you just haven’t found the right physical therapist yet – or seen a physical therapy specialist who is an expert in mechanical knee pain. 

And then there’s the elephant in the room…

It’s very common for knee pain to be coming from somewhere other than your knee.

Knee pain can come from your ankle, hip, or back. One study showed that 25% of the time – knee pain is caused by a source in your spine – even when you don’t have any back pain. MRI’s add even more confusion to this. It’s entirely possible to have degenerative changes, a torn meniscus, or advanced arthritis in your knee – and still have your knee pain stemming from a source other than your knee. For example, in a study by Guermazi et al from 2012, they performed MRI’s on 504 people with pain-free knees. They found that 72% of these folks had bone osteophytes – indicating arthritis. And 25% of them had meniscus tears. So it’s important to not jump into knee surgery simply based on MRI findings.

My career has spanned over 2 decades, and I’ve seen many knee surgeries go wrong. Most of the time, it has nothing to do with the procedure itself, but everything to do with an incorrect diagnosis going in. If your knee pain can be resolved conservatively – and you put it through unnecessary trauma (surgery) – there’s a good chance you’re going to have more problems afterwards. If you get knee surgery when your knee problem isn’t even coming from your knee – then you’re definitely going to have problems afterwards.

The moral of this story is to make absolutely certain that 1) your knee problem is really a knee problem and 2) you’ve fully exhausted all conservative therapy options (including specialized physical therapy) before going under the knife.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Knee Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or request a copy of her Free Guide: 7 Easy Ways to Get Rid of Knee Pain – click here.

Knee Pain

How Mobility and Strength Are Key to Resolving a Meniscus Tear Naturally

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A meniscus tear is one of the most common knee injuries, and it’s known for causing significant pain, swelling, and restriction of movement that can seriously disrupt an active lifestyle.

While surgery may seem like the only solution – and perhaps that’s what you’ve been told – many people (80% in fact) can successfully avoid invasive procedures like cortisone and surgery if they want to. 

The key?

Focusing on specialized mobility and strength training of your knee. But first – what exactly is a meniscus tear and how does it cause problems for your knee?

The meniscus is a cartilaginous structure in your knee joint that acts as a shock absorber. It sits between your thigh bone (femur) and shin bone (tibia) and you have two of them: one on the inside of your knee joint (medial) and one on the outside (lateral). Together, they help distribute weight and cushion your knee during activities like walking, running, and jumping.

So how do meniscus tears happen?

You can get a meniscus tear suddenly from twisting or pivoting motions, or it can develop gradually over time due to age or wear and tear.

But here’s the thing… Sometimes – especially when your meniscus tear develops slowly – it can be damaged without feeling any knee pain or symptoms. For example, a study published in the New England Journal of Medicine found that 35% of people over the age of 50 had meniscus tears on their MRI, but no knee pain or other symptoms. In another study, published in the Journal of the American Medical Association – it was reported that 60% of men and women over the age of 65 who had a meniscus tear on their MRI also had no symptoms in their knees. What is the significance of this? It means that it’s entirely possible to “live” with a meniscus tear and not have any knee pain – which means it’s also entirely possible to avoid surgery and cortisone shots.

So why do some meniscus tears cause pain when others don’t? 

When you have a meniscus tear – it has the potential to disrupt your knee’s natural mechanics – but not all tears do.

When the mechanics of your knee are compromised, that’s when you experience symptoms. Why? Because faulty knee mechanics (over time) will cause compensatory strategies to happen in the joint itself – as well as the surrounding muscles and structures.

This is what actually causes pain – not necessarily the tear itself.

Simply going in and “cutting out” the meniscus tear will not solve the problem of faulty knee joint mechanics. It’s why so many people end up with no relief at all after surgery – or just temporary relief of pain that returns anywhere from months to years later. In 80% of knee pain cases that involve a meniscus tear – the faulty knee mechanics are what truly cause the problems and pain – not the tear itself. That’s why focusing on the joint mechanics and mobility first is more important – because if you can restore that – the tear often becomes a non-issue – just like all the people in those research studies.

Now – when I talk about knee mechanics – I’m referring to both knee mobility and strength – and how they work harmoniously together. 

Mobility refers to the ability of your knee joint to move smoothly and freely through its full range of motion. Strength refers to the stability around your knee joint – which comes from muscles and tendons. When a meniscus tear causes your knee joint mobility to be blocked and disrupted – meaning it’s unable to bend and extend properly – it puts stress on the surrounding structures and muscles – causing a cascade of events that eventually lead to pain and swelling.

To achieve natural knee pain relief after a meniscus tear – restoring mobility is the first critical first step – followed by strengthening. But a lot of people get this wrong. That’s why it’s important you work with a mechanical knee pain specialist who understands the intricate nature of a meniscus tear and how it impacts your knee mechanics. You can’t just do random strength and mobility exercises. They need to be prescribed to you in a specific and strategic manner so that you can “free” the tear and restore your knee mechanics. In other words, YouTube and Google won’t be able to help you.

If you’re confused – I don’t blame you – but the research doesn’t lie.

For most people, especially those over the age of 40, there’s a 70-80% chance you can get full relief of your knee pain after a meniscus tear, without any type of surgery or procedure. This is not a popular opinion by the way. Arthroscopic meniscus surgery is one of the most common (and profitable) surgeries out there. If a meniscus tear appears on your MRI – a common recommendation will be surgery. But if that’s not what you want – I’m here to tell you it’s entirely possible to resolve pain and dysfunction from your meniscus tear naturally. But you’ll want to work with a mechanical knee pain specialist to do that. Reach out if you need help finding one in your area.

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 or sign up for her upcoming Masterclass for Knee Pain Sufferers – CLICK HERE or call 603-380-7902

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Why You Should Avoid a Cortisone Shot in Your Knee (And What to Do Instead)

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Knee pain can be debilitating, making simple tasks like walking, climbing stairs, or even standing up a painful experience.

For many, the quick fix seems to be a cortisone shot – an anti-inflammatory injection that offers temporary relief from knee pain. When injected into the knee, the cortisone (a type of steroid) targets the inflamed tissues and aims to reduce the symptoms of pain and swelling.

But there are significant risks and downsides to this approach to resolving knee pain that are often overlooked. Let’s take a look at why you should avoid a cortisone shot in your knee and what you can do instead…

The Problem with Cortisone Shots:

1. Temporary Relief, Not a Cure

Cortisone shots offer pain relief for a limited period, ranging from a few weeks to a few months. The problem? They don’t address the underlying cause of the knee pain. Instead, they mask the symptoms, allowing the root problem – whether it’s osteoarthritis, tendonitis, or a mechanical imbalance in the knee joint – to worsen over time. By numbing the pain, cortisone shots may allow you to continue harmful activities that could exacerbate your condition, leading to long-term damage.

2.  Potential for Joint Damage

Since the relief from cortisone shots is temporary – they are often repeated. And repeated cortisone injections can lead to cartilage degeneration and weaken the tendons and ligaments in your knee. Studies have shown that frequent cortisone use can accelerate the wear-and-tear process, potentially hastening the need for knee replacement surgery down the line. This is particularly alarming for active individuals who are hoping to preserve their knees for as long as possible so they can keep doing all the activities they love and enjoy.

3. Delayed Healing

Cortisone’s anti-inflammatory effects can actually interfere with the body’s natural healing processes. Inflammation, while uncomfortable, is an essential part of how the body repairs itself. Reducing inflammation with steroids (like cortisone) can disrupt tissue repair, meaning that any existing damage to your knee could take longer to heal. And when you mask your symptoms with cortisone – it makes this even harder to detect.

4. Risks of Infection and Other Side Effects

Like any injection, cortisone shots come with the risk of infection. Additionally, they may cause side effects such as increased blood sugar levels, skin thinning, or changes in pigmentation around the injection site. While these risks may seem minimal to some, they should be weighed carefully against the short-term benefits of temporary pain relief.

So… What Should You Do Instead?

I’m a huge fan of natural treatments whenever possible. And when it comes to knee pain, there are plenty of natural alternatives that not only promote healing , but address the root cause of your knee pain – allowing for more long-term relief instead of short-term.

1. Shockwave Therapy

Shockwave therapy is a non-invasive treatment that uses acoustic sound waves to stimulate the body’s natural healing processes. The waves create micro-traumas in the tissues surrounding your knee joint, which triggers increased blood flow and promotes tissue regeneration. Shockwave therapy has been shown to reduce pain, improve mobility, and even help with conditions like calcific tendonitis and knee osteoarthritis.

What’s especially beneficial about shockwave therapy is that it not only reduces pain but also works to heal the damaged tissues. Unlike cortisone shots, which only offer symptom relief and can even damage tissue, shockwave therapy targets the underlying problem, making it a great option for those looking to fix their knee pain for the long term.

2. Dry Needling

Dry needling is another natural treatment that can help alleviate knee pain by targeting trigger points in the muscles around the joint. This technique involves inserting thin needles in and around your knee joint to release tension and improve blood flow. By relieving muscle tightness, dry needling helps restore proper alignment and function in your knee joint, reducing pain and preventing further injury.

This approach works particularly well for those with knee pain caused by muscle imbalances, tendonitis, or chronic stiffness. Since dry needling promotes muscle relaxation and better circulation, it helps the knee heal from within, supporting long-term recovery.

3. Work with a Mechanical Knee Pain Specialist

A mechanical knee pain specialist is a healthcare professional trained to assess and diagnose the root cause of your knee pain through specialized movement analysis. Unlike traditional healthcare providers who may prescribe pain relief or general exercises without fully understanding the mechanics of your knee, mechanical pain specialists take a deep dive into how your body moves. By pinpointing issues such as improper joint alignment, muscle imbalances, or overuse patterns, they can design a customized treatment plan to address the root cause of your pain, versus just chasing symptoms.

The key benefit of working with a mechanical knee pain specialist is that they focus on the underlying biomechanics of your knee as well as surrounding joints/muscle groups that may be contributing to your pain. It’s a more holistic approach designed to restore normal function in your knee joint, alleviate pain, and teach you how to prevent future injuries as well.

While a cortisone shot is routinely recommended by medical doctors, and may offer quick relief, they don’t contribute to the healing process and can, in fact, cause long-term harm.

Opting for natural treatments like shockwave therapy, dry needling, or working with a mechanical knee pain specialist who can often integrate these treatments in with corrective, targeted exercises – has several advantages – and it’s much healthier for your knees. Most importantly, these natural approaches address the root cause of your knee pain rather than just masking it. 

If you’re suffering from knee pain, and need help finding reputable healthcare providers in your area who can offer these natural treatment alternatives with success and expertise – reach out – we can help direct you toward what to look for – and what to watch out for.

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

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Knee Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or request a seat in her upcoming Masterclass to end Knee Pain naturally – without pills, procedures, or surgery – CLICK HERE.

Sciatica

Why Cortisone Shots Don’t Work for Sciatica

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If you’ve ever suffered from sciatica – then you don’t need me to tell you how debilitating the condition can be.

From shooting and searing pain into your buttocks that can run all the way down to your foot – to numbness, tingling and loss of strength… sciatica has the ability to significantly impact your quality of life. What’s worse? It typically comes out of nowhere – making this condition even more frustrating to deal with.

It’s no wonder that a majority of people resort to “quick fixes” like cortisone shots – in hopes it will put an end to their back pain and sciatica suffering. According to the American Academy of Family Physicians (AAFP), epidural steroid injections (a type of cortisone shot) are among the most common interventions for chronic low back pain and sciatica. In a study published in The Spine Journal in 2015 – it was reported that approximately 50% of patients with sciatica opted for cortisone shots for pain relief as part of their treatment plan. 

But just because cortisone shots for sciatica are popular and considered “standard” – it doesn’t mean they are best practice.

First of all – even if a cortisone shot “works” (almost 50% of the time they don’t) – the results are typically temporary.  Only 20-30% of patients have been able to report sustained relief past a few month’s time. Everyone else reports anywhere from a few weeks to 3 months relief. The problem with the majority of people only experiencing temporary relief from cortisone shots in their spine – is that  you risk “chasing the pain” with more cortisone shots (or prescription meds), acceptance of your condition and continued suffering (I call it “bad back syndrome”), or opting for spine surgery, that in most cases, is totally preventable.

OK – statistics aside – why exactly don’t cortisone shots work for sciatica?

The reason cortisone shots don’t work is because they are attacking symptoms instead of the root cause of your sciatica. Cortisone shots are great when you have an out of control inflammatory reaction to an injury. This presentation is distinct and rare. We call it “chemical  pain” and it’s essentially the result of your body’s natural inflammatory process going a bit haywire.

What makes chemical pain distinct from mechanical pain (which accounts for 80% of all sciatica/low back pain) is that most “mechanical” sciatica will come and go throughout the day – and will be better or worse during certain activities and positions. For a simple example – your sciatica may “scream” at you if you’ve been sitting for too long – but will ease up and feel better if you stand up and stretch. This is a classic presentation of mechanical sciatica.

Chemical pain does not behave like that. It literally hurts all the time and the only thing to relieve it is drugs.

And even that is temporary – thus – justifying the more invasive cortisone shot when accurately diagnosed. The tricky thing about mechanical sciatica/low back pain is that it occurs slowly over time and is the result of abnormal stress and strain on your discs and spinal nerves. It’s a “lifestyle” and movement condition at its root – not an inflammatory condition. While the cortisone shot may succeed in temporarily getting rid of the inflammation – it won’t ever get rid of the mechanical cause – which means you’re more likely to prolong the true problem over time. A cortisone shot, at its best, puts a bandaid on your sciatica. And this is the number one reason why so many people end up in a vicious cycle of treatments, and end up getting both unnecessary and preventable spine surgery.

So what should you do for your sciatica instead of a cortisone shot?

First, trust the research and evidence – which says there’s an 80% chance your sciatica has a mechanical root cause – and that the inflammation you’re experiencing is instead – a symptom. Research aside, I can vouch for this over the 22 years I’ve been helping people get rid of sciatica naturally. 

Second, medical doctors (unfortunately) are not trained in recognizing, diagnosing, or even treating mechanical pain. You need a mechanical pain specialist to help diagnose and get rid of mechanical sciatica – if you want it done the right way and for the long term. Plus – the best thing about working with a properly trained mechanical pain expert first – is that it’s fool-proof. If it’s not a mechanical cause – and it indeed is an inflammatory process “gone wrong” inside your spine – they will rule it out quickly – and refer you for a cortisone shot (appropriately).

So here’s the good news…

There’s an 80% chance your back pain or sciatica is a mechanical problem at its source. Which means that when working with the right medical professional(s) – you can successfully get rid of it naturally – and avoid cortisone shots altogether. I’m a huge advocate of natural, DIY treatment approaches whenever possible – because although small – there are real risks associated with invasive procedures like cortisone/epidural injections. And when those adverse reactions occur – they are often irreversible. 

Why not give yourself the shot at a natural approach to your sciatica before diving into an invasive one?

I’m not talking YouTube exercises and Google – I’m talking actually mechanical pain specialists. I know a lot of them. So if you’re struggling to find one in your area – please reach out. I’d love to help.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media group. To get in touch, or grab a seat in her upcoming Masterclass: “Put an end to back pain naturally – without surgery, procedures, or pills – CLICK HERE.