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Daily rituals to boost immunity in colder weather

7 Daily Rituals to Strengthen Your Health This Season

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7 Daily Rituals to Strengthen Your Health This Season (Portsmouth, NH Wellness Guide)

As colder weather settles into Portsmouth and the Seacoast, it’s more important than ever to take care of your body and mind. Between busier schedules, fluctuating temperatures, holiday stress, and increased travel, your body works overtime this time of year. But staying healthy isn’t just about avoiding illness—it’s about supporting the systems that help you move well, think clearly, and feel balanced through the season.

After years of working with clients at CJ Physical Therapy & Pilates in Portsmouth, NH, I’ve seen how the simplest habits often have the greatest impact. These daily rituals support your immune system, keep your joints and muscles moving smoothly, and help you stay grounded—even during the busiest months of the year.

Here are seven easy wellness rituals you can start today to improve your immunity, mobility, and overall health this season.

1. Drink More Water Than You Think You Need

Hydration affects every aspect of your health. Water supports cellular function, helps fight infection, regulates inflammation, and stabilizes your energy. Even mild dehydration can leave you feeling tired, foggy, or more susceptible to illness.

Hydration doesn’t have to be boring—warm lemon water, herbal teas, or naturally flavored unsweetened beverages are great options. One of my favorites is hot water with lemon because it’s soothing and encourages slower, deeper breathing.

Keep a water bottle nearby throughout the day. When you’re busy, hydration is the first thing to slip—but also the fastest way to feel better.

2. Move Your Muscles Daily

Daily movement is one of the most powerful ways to support your immune system. Movement boosts circulation, helping immune cells travel efficiently while lowering stress hormones that weaken your immunity.

But here’s something you may not know:
Your muscles act like medicine.

When you activate them—especially through strength-based movement—they release anti-inflammatory proteins called myokines. These help regulate blood sugar, support metabolic health, reduce inflammation, and promote healthy aging.

Movement doesn’t need to be intense. On high-energy days, strength training or cardio works great. On low-energy days, try gentle Pilates, stretching, or a short walk around Portsmouth.

Consistency is key.

3. Protect Your Sleep Like Your Health Depends on It

Sleep is your body’s most powerful healing tool. During sleep, your tissues repair, your brain restores mental clarity, and your immune system releases proteins that help fight infection.

Poor sleep weakens immunity, increases stress, strains your metabolism, and affects your mood and focus.

Create a simple nighttime routine:

  • dim the lights

  • put your phone away

  • stretch gently

  • try herbal tea

  • read for a few minutes

When you sleep well, everything else feels easier—your movement, mindset, and overall health.

4. Eat Foods That Support Your Energy, Immunity, and Mood

Food is more than calories—it’s functional fuel.

Whole, colorful foods like vegetables, fruits, lean proteins, and healthy fats nourish your cells, balance blood sugar, and support your energy. Gut-friendly foods like yogurt, kefir, miso, and sauerkraut help strengthen your microbiome, which plays a direct role in immune health and emotional stability.

Start by adding one or two nutrient-dense foods each day. You’ll notice the shift quickly.

5. Stay Connected to Friends and Loved Ones

Human connection is one of the most overlooked wellness tools—especially during colder months when daylight is limited and holiday stress increases.

Loneliness and chronic stress weaken your immune system. Meaningful connection does the opposite—it boosts emotional resilience and lowers inflammation.

Connection doesn’t have to mean big events. A walk through downtown Portsmouth, a brief check-in call, or a quick coffee with a friend can shift your entire day.

Nurturing your relationships, even in small ways, supports your health all season long.

6. Spend Time Outside (Even When It’s Cold)

Fresh air and natural light are essential for healthy sleep cycles, vitamin D levels, mood balance, and immune function.

Even a five-minute walk outdoors can lower stress hormones and clear mental fog.

Yes, it’s tempting to stay cozy indoors during winter—but stepping outside helps break up stiffness, encourages gentle movement, and stabilizes your body’s natural rhythms.

If you enjoy walking, try building toward 10,000 steps per day, spread throughout your day.

7. Stretch and Breathe With Intention

Daily stretching increases circulation, reduces tension, and calms your nervous system—directly supporting your immune health.

Pair this with slow breathing and the benefits multiply. Deep breathing activates your deep core muscles, stabilizing your spine and preventing back pain. Since injury and pain add stress to your system, keeping your joints mobile and your core engaged becomes a key part of staying well.

Spend 5–10 minutes each day stretching your tightest areas:
hips • shoulders • chest • low back

These small daily rituals can dramatically shift your energy and posture.

Which Ritual Will You Start With?

You don’t need to master all seven rituals at once. Start with one or two that feel manageable. Small, consistent changes add up—especially when it comes to immunity, movement, and emotional balance.

If pain, stiffness, or injury is getting in the way, we’re here to help.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group.

To get in touch or request a Free Discovery Visit, visit our website or call 603-380-7902.

5 Things I Learned Walking in Italy

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When I travel, I love to walk. There’s no better way to experience a new country than on foot – and Italy was no different.

During my recent two-week trip, I averaged about 14,000 steps per day. Between the cobblestone streets, uneven stairs, and endless hills, my body got quite the workout.

Back home here in Portsmouth, New Hampshire, I realized how much those lessons from Italy apply right here on the Seacoast – from long walks downtown to exploring the trails along the waterfront.

Here are five of the biggest lessons I learned walking through Italy – and what they can teach you about keeping your body active and pain-free, no matter where life takes you.

1. Comfortable Footwear is Non-Negotiable

Let’s start with the obvious – shoes. Your feet are your foundation, especially when you’re walking all day. The wrong footwear can ruin your trip. Most people don’t realize how much their feet influence the rest of their body. Poor support, tight toe boxes, or too-flat soles can change how your hips and spine move – and not in a good way.

I brought one good pair of supportive sneakers that went with everything (including my dresses) and a pair of flexible, cushioned sandals for the occasional, fancier nights out. This allowed my feet to move naturally while still absorbing shock from all those ancient stone streets. Investing in proper footwear isn’t vanity – it’s injury prevention.

When your feet move well, your hips and back have a fighting chance at doing the same.

2. Mobile Hips Make Your Steps Easier

Italy is full of hills, uneven terrain, and stairs – lots of stairs. Without good hip mobility, that’s a recipe for soreness and fatigue. One of the biggest things I noticed while walking was how much easier it was to climb, descend, and cover long distances because my hips moved freely.

When your hip joints are mobile, your glutes can actually do their job. They engage more easily, which means your legs and back don’t have to work as hard. Most people with “tight hips” don’t have a flexibility problem – they have a mechanical one. If your hip joint doesn’t move fully, your muscles are forced to compensate and structures within your hip can become aggravated.

Simple corrective movements that restore hip motion can make a world of difference – not just for walking in Italy, but for walking pain-free through everyday life.

3. Breathing Activates Your Core

The more I traveled, the more I realized how important my breath was – especially on steep climbs or long walking days. Most people think “core stability” means planks and crunches, but your diaphragm – your breathing muscle – is at the center of it all.

When you breathe properly, your deep core and pelvic floor activate and stabilize your spine without effort. That stability supports your hips and pelvis, keeps your posture tall, and prevents strain on your back.

The way you breathe sets the tone for your entire body. When you’re breathing well, everything else – from your stride to your balance – improves.

4. The Right Stretch – at the Right Time

Just before my trip, I had a mild flare-up of back pain. The last thing I wanted was for it to follow me to Italy. What helped me most wasn’t stretching constantly just to “feel good,” but using corrective, targeted movements that actually did good – and helped fix the problem.

After long flights or train rides, I’d take a few minutes to gently extend my back and open my hips – small, specific movements designed to restore joint motion after sitting too long. During long walking days, I focused on keeping my hips and ankles mobile instead.

Overstretching the wrong things, in the wrong way, and at the wrong time can make matters worse by putting extra strain on already tired muscles and joints. The key is to stretch with intention. Don’t just chase the tightness. Understand what’s causing it – and address the source instead.

5. Recovery Is Just as Important as Movement

After walking all day, it was tempting to collapse into bed. But the best thing I did for my body was take a few minutes each evening to move gently – especially through my spine and hips. I’d lie on the floor, breathe deeply, and let my body unwind from the day.

Walking loads your body just like exercise does – and your tissues need time and movement to recover. Restoring motion and blood flow at the end of the day helps prevent stiffness the next morning and keeps your joints healthy in the long run.

And now that I’m home, I’ve been putting these lessons into practice at my clinic in Downtown Portsmouth.

Whether it’s walking around Prescott Park, heading up the local trails, or just keeping up with daily life, recovery is key. My go-to? A quick session of shockwave therapy to help heal sore, overworked muscles, plus EMTT (high pulsed magnetic therapy) to boost recovery and cellular repair — all available right here at CJ Physical Therapy & Pilates in Portsmouth, NH.

My Takeaway

Italy reminded me of something I teach my Seacoast patients every day: when your body moves well, life feels better. Whether you’re walking downtown, hiking Mount Agamenticus, or strolling along the coast, your mobility determines how much you enjoy it.

The right shoes, mobile hips and spine, a strong core, and a little recovery time can be the difference between loving every step and counting down the minutes until you can sit down.

 

 

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If you’re local to Portsmouth, NH or the Seacoast area and want to stay active, healthy, and pain-free as you age — request a FREE Discovery Visit with one of our specialists at CJ Physical Therapy & Pilates.

Why Most Meniscus Tears don’t need Surgery

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A meniscus tear is one of the most commonly diagnosed knee injuries – and also one of the most misunderstood.

If you’ve recently been told you have a torn meniscus and that surgery is your only option – I want you to take a deep breath and pause for a moment… Because in most cases – especially if you’re over 40 – there’s a very good chance you can avoid the operating room altogether.

Let me explain.

The meniscus is a rubbery, C-shaped piece of cartilage that acts like a shock absorber between your thigh bone and shin bone. You have two in each knee – one on the inside (medial) and one on the outside (lateral). Their job? To help your knee glide, bend, twist, and bear weight with more ease and efficiency.

Meniscus tears typically occur in two major ways. The first is sudden trauma – often from twisting or pivoting during sports or a misstep. The second is more subtle and due to age-related degeneration. As we get older, wear and tear can gradually weaken the meniscus – making it more prone to tears – even when there is no obvious incident.

But here’s something most people don’t realize… It’s entirely possible to have a meniscus tear but not experience any symptoms.

A study published in the New England Journal of Medicine found that 35% of adults over 50 had meniscus tears on MRI – yet no knee pain. Another study from JAMA reported that 60% of people over 65 had torn menisci on imaging, but again, no symptoms. What does that tell us? That just because a tear shows up on your MRI doesn’t mean it’s the source of your pain – or that it needs to be surgically fixed.

OK – I know what your next question is… Why do some tears cause pain while others go unnoticed? It all comes down to knee mechanics.

A meniscus tear by itself doesn’t always cause symptoms. But if your knee isn’t moving well – or if the tear disrupts how your bones, joints, and muscles interact – it can lead to irritation in the meniscus or the surrounding structures. When your knee mechanics are off, your body starts to compensate. These compensations put extra stress on nearby tissues, trigger inflammation, and ultimately result in pain. The tear may start the problem – but it’s the mechanical dysfunction that keeps it going.

This is why so many people who undergo arthroscopic surgery to “clean up” their meniscus continue to struggle with pain months – or even years – later. If the underlying joint dysfunction isn’t addressed, the surgery won’t fix the root problem. I’ve seen countless people feel better temporarily after meniscus surgery, only to have the pain return because the same dysfunctional movement patterns were never corrected.

So what should you do instead? Focus on restoring proper mobility first and then strength.

Mobility refers to your joint’s ability to move freely and fully. Strength refers to the muscles around your knee providing the right amount of stability. When a tear disrupts either of these, it puts strain on the knee and surrounding structures. That’s when swelling, irritation, and instability begin to show up.

The first step to healing a meniscus tear naturally is not jumping into strength exercises, as many people do. It’s actually restoring mobility first – making sure the knee can bend, extend, and rotate the way it’s supposed to. Only then should you begin a strategic strengthening program that supports proper movement and joint alignment.

And no, you can’t just go on YouTube and pick random exercises. You need guidance from a specialist who understands mechanical knee pain – someone who knows how to assess your knee joint function and prescribe movement in a way that supports true recovery.

In my 23 years of practice, I’m happy to report that I’ve worked with hundreds of people who were told they needed surgery – but never got it. The secret was helping them restore natural knee function and resolve their pain without invasive procedures, which often lead to complications like scarring or infection. In fact, those who chose the natural route typically return to walking, running, and enjoying life without limitation faster than their surgical counterparts.

Still not convinced? Let’s look at the numbers. 

Research shows that 70–80% of people over 40 with meniscus-related knee pain get full relief with conservative, specialized treatment. That means no cortisone, no surgery. Yet arthroscopic meniscus surgery remains one of the most common orthopedic procedures in the country.

Why? Because MRIs are persuasive, and the belief that “a tear must be fixed” is deeply ingrained in most people’s thinking. But imaging doesn’t tell the full story. Pain is more complex than what you see on a scan – and knowing that research has shown your knee can function well despite a tear is something you should pay close attention to.

Let me re-iterate something for you one more time… The key to healing a meniscus tear naturally lies in restoring proper knee function (sometimes even hip and back function). That means mobility first, then strength – prescribed strategically and adapted as you progress.

So what should you do if you’ve been diagnosed with a meniscus tear?

  1. Don’t panic. Not all tears need to be fixed.
  2. Get a second opinion from someone who specializes in mechanical knee pain – not just someone who reads MRIs.
  3. Avoid quick fixes like cortisone injections or surgery unless truly necessary.
  4. Start working with a specialist who understands how to address mobility and strength in a way that’s specific to your knee – and your life.

You owe yourself the chance to explore natural recovery first. For most people, it’s not only possible – it’s the better long-term solution.

If you’re struggling with knee pain and unsure what path to take, feel free to reach out. Whether you want to avoid surgery, get a second opinion, or simply better understand your options – I’d love to help.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists for free by booking 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 Tips for Wrapping Gifts Without Aggravating Neck or Back Pain

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If you’re anything like me – you’ve left your Holiday wrapping to the absolute last minute. And if that’s the case – there’s a very good chance you’re going to overdo it – and aggravate any existing neck or back pain you might have.

The good news?

There are things you can do to significantly mitigate the chances of your neck and back pain flaring up – and perhaps avoid it altogether.

Here are five great tips – and even a bonus recovery tip – to help you get through your last minute gift wrapping without aggravating your neck or back:

1. Create an Ergonomic Wrapping Station

The way you set up your wrapping station matters. Sitting on the floor or crouching over a low coffee table forces your spine into unnatural positions, creating stress on both your neck and back. Instead, wrap your gifts on a surface that allows you to sit or stand comfortably at waist height.

If you’re sitting, use a supportive chair along with a lumbar roll to keep your back and neck in their most natural position. For those who prefer standing, consider using an anti-fatigue mat to reduce strain on your back. Elevating your workspace ensures you’re not constantly hunching over, which is a common culprit for neck and back pain.

2. Don’t Sit or Stand Too Long – Move!

Sitting or standing in one position for extended periods can lead to stiffness and pain in your neck, shoulders, and back. Set a timer to remind yourself to take movement breaks every 20-30 minutes.

During these breaks, perform a few gentle stretches for your neck and back. Try rolling your shoulders backward, gently tilting your head side to side, or doing a seated spinal twist. Movement encourages blood flow, which helps reduce stiffness and tension. Plus, breaking up the task gives you a mental refresh so you can focus on getting your wrapping done instead of neck or back pain.

3. Use the Right Tools

The tools you use can make a big difference in minimizing strain. Opt for ergonomic scissors with padded handles to reduce stress on your hands and wrists. Tape dispensers are also a must-have to prevent repetitive wrist motions that can lead to discomfort.

If you’re wrapping on the floor, use a cushion to support your hips and lower back. For added neck relief, consider placing a rolled-up towel under your neck during floor session breaks to give it some relief and maintain its natural curve. These simple adjustments can help you avoid unnecessary strain while you focus on creating perfectly wrapped packages.

4. Check Your Posture

Poor posture is one of the biggest contributors to both neck and back pain. While wrapping, make a conscious effort to:

  • Relax Your Shoulders: Keep them down and away from your ears to avoid tension in your neck and upper back.
  • Maintain a Neutral Spine: Whether sitting or standing, ensure your lower back keeps its natural curve.
  • Align Your Head: Avoid craning your neck forward. Bring the gift closer to you instead of leaning toward it.

These small posture corrections can go a long way in keeping discomfort at bay and ensuring your body feels great long after the wrapping is done.

5. Spread Out Your Wrapping Tasks

Rather than saving all your wrapping for Christmas Eve, try wrapping a few gifts at a time over several days. This approach prevents prolonged periods of repetitive motion and reduces the overall strain on your neck and back.

Now – if you HAVE waited till Christmas Eve to wrap your gifts – then ignore this tip and move on to your bonus recovery tip 🙂 

Bonus Recovery Tip: Treat Yourself to a Little TLC

Even with the best precautions, some muscle soreness and tension might still sneak in. Combat this by treating yourself to recovery techniques like foam rolling, deep breathing, a good stretching session, or one of our Regenerative Therapy Sessions! 

And if your pain persists or worsens – don’t ignore it. Seeking advice from one of our mechanical pain specialists can help you address the root cause or your neck and back pain and prevent it from becoming a much bigger issue that impacts more than just wrapping gifts.

Live near Portsmouth, NH? Connect with one of our mechanical pain specialists by clicking HERE!

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

Is running bad for your knees?

Turns out – Running isn’t Bad for your Knees

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Is Running Bad For Your Knees?

I love to play family-feud style trivia. And if there was ever a question – “Name an activity that is bad for your knees” – I know that running would be the number one answer. 

But this is simply not true – and there is research to prove it.

There is a common myth that continued running will eventually cause, or accelerate arthritis in your joints. But in a 2013 study published in Medicine & Science in Sports & Exercise (the American College of Sports Medicine’s flagship journal) this theory was debunked. The results of the study concluded that runners were statistically less likely to develop knee and hip arthritis compared to other types of exercise. In a more recent study from 2020, published in PeerJ, it was found that although running does indeed create a lot more “pounding” in your knees compared to something like walking – this process actually helps to “build-up” your cartilage and make it stronger – which is a huge factor in helping to slow down arthritis.

But what about those that do get knee pain when they run? What’s the explanation?

Healthy running comes down to having optimized running form and body mechanics – otherwise it could become problematic for your knees.

So if you’re having knee pain when you run – instead of blaming the sport – consider one or more of the following:

Check your ankle mobility

Ankle mobility is going to influence the way force from the ground hits your foot, which can in turn impact how force (load) impacts your knee. According to Trail Runner Magazine, “if your ankle can’t move adequately, then excess forces are shifted up to the knee. The knee may be forced to flex, and/or rotate, and/or tilt more than it should. This may result in loads that the tissues of the knee can’t handle.” Everything from the types of shoes you were to old ankle sprains can all have an impact on how well your ankle moves. A specialist in movement and joint mechanics can help you test and improve your ankle mobility – and let you know if it’s impacting your knees when running.

Don’t just run – strength train too.

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing strong lower limb muscles is critical. The hamstrings and quadriceps play a crucial role in stabilizing the patella, otherwise known as the kneecap. Running is an extremely repetitive action and consequently requires durability and endurance from your joints — something that is lost quickly when you neglect strength training.

How’s your core?

It may seem like running is all in the legs, but in reality, so many of our physical actions stem from the core. You derive all your power, speed, and stamina from your core muscles, and if they are weak, all your joints suffer — including your knees. A stable core is key for maintaining balance and rhythm while running. It also keeps your weight distributed between your legs and prevents undue stress from resting on your knees. My favorite way to improve core strength is Pilates, especially for runners, because this exercise system gives your joints a nice break. But any core strengthening routine that focuses on using your body weight and minimizing stress on your joints is going to be beneficial for you if you’re a runner.

Practice good running form

It doesn’t matter if you’re a marathon runner or an occasional jogger — good running form is essential. It determines where and how the impact of every step is distributed throughout your body. But here’s the thing… Good running form is dependent on optimized joint mobility and strength – so simply changing your form might not be enough – and could even cause you more problems. You want to figure out why you’re running with a “bad” or inefficient form – correct what’s causing it – and then work to train your body to run in a more efficient way. This will not only help your knees – but all your other joints as well.

If you’re someone who loves to run and wants to keep running – I have good news for you – it’s not bad for your knees. But if you’re currently having knee pain while running – you’ll want to look at and consider one more of these strategies to figure out why. The best thing to do is enlist the help of an expert – such as a specialist physical therapist or movement expert – who can help you diagnose where your knee pain is coming from and get you on a path to fix it.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].

Back Surgery

Before Back Surgery – Try specialized physical therapy first

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Approximately 500,000 Americans undergo back surgery to relieve their pain every year.

But the American Society of Anesthesiologists estimates that 20 – 40% of those surgeries fail – leaving folks worse off than before they were considering back surgery in the first place. And what happens when your first back surgery fails? You get a second surgery – and maybe even a third – to try and repair the failure. Once you go down that rabbit hole – your chances of success after back surgery drop significantly – down to a mere 5-15% success rate.

Knowing this, why do so many doctors and medical specialists continue to recommend back surgery without first exhausting all possible non-invasive solutions?

Well, when back surgery works, it can be a highly effective form of pain relief. So it’s attractive. But it’s important to note that within 3-5 years, according to research, many patients find themselves feeling worse than before surgery, and reverting back to relying on daily pain medication. People assume back surgery is going to be a pain-removing procedure, when in actuality it’s only a pain-reducing procedure. This was concluded by a 2003 study in the European Spine Journal that investigated the long-term success of posterolateral spinal fusion. They found only 20% of the subjects continued to be pain free after 5 years, and warned against patients relying on surgery as a long-term fix.

Given the list of potential complications from back surgery – including infection, blood clots, nerve damage, adverse reactions to anesthesia, and incomplete pain relief – it’s imperative you consider all other non-invasive treatment options first. It may take longer for you to experience pain-relief, but the results will be longer-lasting and you can avoid putting yourself at risk for irreversible complications.

Examples of non-invasive treatment options include chiropractic treatment, acupuncture, massage, shockwave therapy, therapeutic exercise, and of course, physical therapy. But the biggest objection I hear from folks against trying some of these non-invasive solutions – often for a second or third round – is that they’ve “tried it all” and it didn’t work. But more often than not, after diving in further, I find that patients have “cherry-picked” their treatment choices over the years without any real strategy – or they’re trying way too many things and all at once.

Not only does this get exhausting, but it’s ineffective. 

Passive modalities (acupuncture, massage, chiropractic treatment, etc) are great at reducing pain but you need to match them up with specialized and corrective movement strategies to make the effects last. Traditional physical therapy, Pilates, and personal trainers can all help you to feel better as well, but if the exercises aren’t specialized enough, they won’t have any effect or could even make you feel worse. Without a strategic plan, and putting all of these things together and in the right order, you’ll have  a hard time getting rid of your back pain naturally. 

Over my 22 years of working with patients suffering from back pain and sciatica, I say all of this from experience. For the first 10 years of my career I was what I call a “generalist”. I worked in traditional physical therapy settings where I followed doctor’s orders, relied on insurance to dictate what I could and couldn’t do, and I used many of the passive modalities already mentioned above along with (what I thought at the time) were the best core training and back stabilizing exercises.

It wasn’t until I went on to learn specialist techniques and truly understand how back pain actually manifested, that I was finally able to help people not only get rid of back pain – but keep it gone for good and avoid surgery. It is entirely possible to treat back pain on your own and get rid of it naturally – and then maintain and prevent it with the right types of exercise – but you really need to work with a specialist who can guide you through this process.

So what’s the difference between a physical therapy specialist who treats back pain versus a generalist?

They’ll do their own examination and come up with their own diagnosis, they won’t rely on just passive modalities to help you, and you’ll have an extremely precise and customized exercise prescription instead of a bunch of general exercises (that you could honestly learn from YouTube). If you’re suffering from a back problem and want to avoid procedures and surgery at all costs – it’s really important that you don’t just stop with general physical therapy or chiropractic treatment and assume you’ve exhausted all of your options.  Look for someone who specializes in back pain in the way I’ve just described, and has a proven track record for coming up with strategic treatment plans that last. 

Eighty percent of all back problems are mechanical in nature and come on slowly over time from repeatedly moving poorly or from your lifestyle (even when your back pain seems to have come on suddenly and out of nowhere). Because of this, all of the passive modalities, including back surgery, and general exercises in the world will not correct these problems – and your back pain and associated symptoms will continue to return until you have a full understanding of what’s going on and can correct them. When you find a specialist who can do this for you – it’s life changing. Before you consider back surgery, consider working with a specialized physical therapist, especially if you’re already tried regular physical therapy and it failed. They do exist – and if you need help finding one – please reach out. I’m happy to help you locate one in your area.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Three Red Flags Your Hamstring Strain is Probably Something Else

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A hamstring strain is a common injury I see in active patients aged 40 and above. But sadly – it’s also one of the most common mis-diagnoses I see as well. 

First, what does a true hamstring strain or injury look like?

A true hamstring strain typically presents with a sudden, sharp pain in the back of your thigh. Usually during activities such as sprinting, jumping, or sudden changes in direction. The injury often occurs due to overstretching or overloading the muscles beyond their capacity. Thus, leading to microscopic tears within the muscle fibers. Symptoms typically include tenderness, swelling, and bruising in the affected area, along with difficulty walking or bending the knee. To recover from a hamstring strain, you first need to heal the injured muscle/tissue. Then properly strengthen it so it can handle all the activities you want to do. This involves some combination of rest and therapeutic movement at first, followed by carefully prescribed strengthening and loading of the damaged tissue so that it heals back strong and resilient. When a hamstring injury is accurately diagnosed, and properly rehabbed, you can return to all the activities you love and it shouldn’t bother you again.

If you’ve recently suffered an injury to your hamstring – and it doesn’t sound like what I’ve just described – then you’ll want to keep reading – because there’s a good chance it was mis-diagnosed and your treatment is all wrong.

Here are 3 red flags that indicate your hamstring strain is probably something else – and usually a back problem instead:

1. You have chronic hamstring pain

A true hamstring strain is simply an injury to your soft tissue (muscle) and it should heal with time. Now, sometimes you don’t rehab it properly, and it can result in chronic problems, but it shouldn’t be chronic pain. There’s a difference – let me explain. A poorly rehabbed hamstring is likely to cause problems elsewhere in your body (namely your hip and knee), but the hamstring itself won’t remain chronically painful. You might trigger a poorly rehabbed hamstring when you do activities that bother it, but at rest, it will be for the most part “healed”. If you experience chronic achiness, especially at rest or when you’ve been sitting for a long time, this is likely something else. Signs like this often point to an undiagnosed back problem. This is especially true if when you first hurt your hamstring it seemed to have come out of nowhere – for example – you just woke up with it one day or it came on gradually. True hamstring injuries are painful where you hurt it, and go away with time and certainly with proper rehab. A chronic pain in your hamstring that lingers for months or years, especially when you’re at rest, is probably something else.

2. Numbness and Tingling in your butt or leg

This symptom is almost always a red flag that the problem is stemming for your lower back or sacrum (tail bone area of your spine). This is because the nerves responsible for sensation in both your butt and leg originate from your spine. Your hamstring, on the other hand, is a muscle. Anatomically speaking – it can’t directly refer numbness to anywhere in your leg. With a true hamstring strain, you’ll experience localized pain, tenderness, and even swelling – but not numbness. So if you’ve suddenly started experiencing pain in the area of your hamstring, and are also having numbness and tingling in your leg, then your hamstring strain is probably due to something else – most likely a problem in your spine.

3. You feel pain below your knee

Your hamstring is the big group of muscles in the back of your thigh (you have three of them). They are responsible for flexing your knee and extending your hip. They originate from a bone at the bottom of your pelvis, deep inside your butt, and attach into various areas behind your knee. Because of where your hamstring is located, it’s impossible to feel true hamstring pain below your knee. This is a big red flag to me that the problem is likely coming from your spine. Now, it’s possible that your lower leg has begun to compensate for a poorly rehabbed hamstring strain and it’s hurting due to that. However, if you feel pain radiating from the back of your thigh, past your knee, and into your lower leg – it’s likely a back problem. Fun fact: 38% of all lower leg pain comes from a source within your spine even if you don’t have any back pain at all. So it’s very possible that pain in the back of your thigh and lower leg could be originating from your lower back.

Keep an eye out for these three red flags next time you feel pain or strain in your hamstring.

Remember that in most cases, you’ll know when you’ve strained your hamstring. With a true hamstring strain, the pain occurs at the time of injury and it’s fairly obvious. But if your hamstring pain comes out of nowhere, becomes chronic, starts feeling numb and tingly, or you’re experiencing pain below your knee – then you must consider that it could be something else – and that it’s likely a back problem. Talk to a physical therapy specialist who understands how to diagnose this properly. If you don’t get the root cause right, you won’t get the treatment right, and it will only delay the time it takes to get back to doing all the activities you love.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists by booking a free discovery visit HERE. They’ll ask you what’s been going on and see if we would be a good fit to help you 🙂

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, email her at [email protected].

Is Exercising Hurting Your Back? 5 Reasons Why.

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Is Exercising Hurting Your Back? 5 Reasons Why.

The research continues to show that the best “treatment” for back pain is exercise. But what do you do when exercising hurts your back instead of helps? 

This is one of the most common frustrations I hear from my clients. The doctor looks at their back and takes an X-ray. He or she only sees something like arthritis or degenerative disc disease. Surgery doesn’t make sense – so the advice is to go exercise – and specifically to strengthen their core. But when it doesn’t work they are at a loss.

So why would exercise hurt your back – when the research overwhelmingly shows that it’s supposed to help?  

Here are 5 reasons why your exercise routine might be causing your back pain instead of helping it:


1. It’s the wrong type of exercise

While the research isn’t wrong about exercising and back pain – it doesn’t always reveal the specifics on the type of exercise that’s being done. For example, walking is considered one of the best activities for back pain sufferers, and for the majority it will help significantly. But I also have clients who get worse just walking to their mailbox at the end of the driveway. What the research is really saying is that movement – not necessarily “exercise” – is what’s really good for back pain – even acute back pain. But you need to make sure it’s the right type of movement for your specific type of back pain. If you get the type of exercise or movement wrong – you’ll feel worse – and it’s one reason why exercise will sometimes hurt your back instead of help.

2. Stability training is introduced too soon

Stability training is an important part of back pain recovery – but I often see it introduced too soon. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. You want to make sure you explore that fully and get the spine moving the way it should be before you begin stabilizing or strengthening it. Every now and then I stabilize first, but it’s rare. More often than not I see that people with long standing back pain are suffering from a mobility problem that was missed. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You want to figure that out first before jumping ahead to stability training of your core and spine.

3. Your aren’t activating your core

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your 6-pack abs are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or performing complicated movements that require good coordination, you’re setting yourself up for injury.

The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. Pilates (when done properly and with a well-trained instructor) is a type of exercise that can accomplish this quite well. If you’re constantly having back pain every time you exercise or try to strengthen your core, it could be that you lack the ability to activate it when it counts.

4. You aren’t breathing properly

Not breathing properly, or not breathing at all, can significantly impact the effectiveness of your exercise routine. This directly impedes your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise. In order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, your deep back muscles, your pelvic floor, and your diaphragm. Your diaphragm is what controls your breathing.

Let’s say you hold your breath when you exercise. When this happens it means your diaphragm isn’t expanding or contracting in the way it needs to for your deep core to be fully functional. Additionally, when your diaphragm doesn’t work like it should, it adds unnecessary strain and work to your back muscles. This is one reason why you might not be able to activate your core properly – and why exercise might be hurting your back.

5. You’re using improper form

The last and most common reason why exercising might be hurting your back is because you aren’t doing it right. There’s a lot of people out there who think posture and form don’t really matter. But they do. If you’re lifting weights – especially when frequently and repetitively – you want your spine to be in good alignment. It might not hurt the first time you lift with improper form, but it will hurt when you get to your 100th rep.

Same goes for body weight exercises. Just because you aren’t adding load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. That’s really where people get in trouble. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture or it’s going to catch up to you and cause you unnecessary back pain.

If exercising is currently hurting your back – it could be due to one of these five reasons. Get expert help to figure out which one it might be – because at the end of the day – exercise really is good for your back. You just might need some expert guidance from a back pain specialist who “gets” this stuff to get there.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists. We will ask you all about what’s been going on and see if we would be a good fit to help you. Book your free Discovery Visit here.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

5 Ways Regenerative Shockwave Therapy Speeds Healing and Boosts Mobility for people aged 50+

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Regenerative Shockwave Therapy

Arthritis, degenerative joint disease, and general wear and tear of our bodies are all a normal part of aging – and these things tend to become more problematic once we get into our 50’s and beyond.

A lot of people falsely believe that as these ailments start to rear their ugly heads, it means you need to slow down, or even cease, some of your favorite activities. This couldn’t be farther from the truth. But as you get older, what is true is that you’re probably going to need some aid and assistance to keep doing all the activities you love – especially if you’ve had an injury.

Aside from mastering the basics… drink plenty of water, get adequate sleep, fuel your body with wholesome nutritious food, and exercise/move daily… There is something else I’ve found that can really make a difference in how active and mobile you’re able to get (and stay) once you’ve hit your fifties. It’s called regenerative shockwave therapy – a treatment that utilizes high-energy “shock waves” (or soundwaves) to trigger a biological response that helps to aid and accelerate the healing process of your soft tissue (anything that isn’t bone). I only came across this revolutionary technology a few months ago. And while I was initially skeptical – I’ve since become a huge fan. Why? It’s safe and non-invasive, it aids the body’s natural healing process, it’s backed by research, and I’ve seen it work remarkably well to help with pain relief and soft tissue healing. 

Here are 5 ways that regenerative shockwave therapy is helping injured people (especially those aged 50+) heal faster and boost their mobility:

1. Pain Management:

One of the main reasons people reduce their physical activity is due to pain. But movement and exercise are actually an essential component (in most cases) for pain relief. But let’s face it, when you hurt, you’re just not as motivated to move. This is where regenerative shockwave therapy comes in. It quickly penetrates deep into your soft tissue to help bring blood flow and healing properties to a targeted area to reduce pain. And it keeps working even after the treatment is over. As your pain reduces, you feel more confident to move and resume your favorite physical activities faster.

2. Improved Mobility:

As you approach age 50 and beyond – you may notice your joints naturally becoming stiffer. Stiffness on its own might not seem like a big deal – but it becomes a problem when it leads to compensatory movement patterns – which can eventually lead to pain. Shockwave therapy helps to promote collagen production, the protein responsible for maintaining the suppleness and flexibility of your soft tissue. Good mobility helps you move better and feel better – and shockwave therapy can be a valuable companion in this process.

3. Blood Flow Stimulation:

Good blood flow and circulation are essential components to quick healing of any soft tissue injury. Shockwave therapy aids in this process with vasodilation – ensuring that the injured or degenerated tissue receives a higher influx of nutrients – which speeds up the recovery process. As we get older, the integrity of our soft tissue can suffer, so anything that can stimulate blood flow is going to help you heal – and get you back to your favorite activities faster.

4. Reduces Scar Tissue:

It’s not uncommon to meet folks in their 50’s (and beyond) with at least one or two orthopedic surgeries under their belt. While I consistently advocate against resorting to surgery, there are times when it’s necessary and beneficial. But a mismanaged scar can ruin everything. Scars don’t act like your original tissue and if they aren’t managed properly – will cause mobility restrictions that worsen over time. Shockwave therapy can help to break down scar tissue and stimulate the production of new, healthy tissue – which can restore any discomfort or dysfunction that the scar was causing – getting you back to your activities faster.

5. Accelerated Recovery:

At the end of the day, and for all the reasons already stated, shockwave therapy helps to speed up your body’s own natural healing process and thus – recovery. Consider it a companion and “best friend” to any rehabilitation protocol. With increased blood flow, reduction of scar tissue, and improved pain and mobility – you tolerate things with more ease and can progress more quickly. When you’re younger – you have a lot of this naturally on your side already. But as we age, everything slows down, including our body’s natural recovery processes. Shockwave therapy steps in to fill this gap so you don’t have to miss out for too long on your favorite physical activities.

If you’re currently injured and avoiding exercise – consider adding regenerative shockwave therapy into the mix to help reduce your pain, improve your mobility, and get you back to your favorite activities faster.

To learn more about Regenerative Shockwave Therapy and other benefits, CLICK HERE. Who knows, it could be the missing link to your healing that you didn’t even know existed.

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, email her at [email protected] or CLICK HERE to talk to one of our specialists.

Sciatica

Battling Sciatica? Here’s what to Avoid and what you should do Instead

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Did you know that nearly four out of five people will suffer from a debilitating back pain episode at some point in their lives and that it can result in sciatica?

“Sciatica” is a term used to describe searing pain, burning, or numbness that runs from your back and down your leg, often below your knee and into your foot. It occurs because something in your lower back is irritating the nerve that sends signals to your leg. It can be caused by anything that puts pressure on and/or irritates your sciatic nerve –  such as herniated or bulging discs. 

What a lot of people don’t know is that you can have sciatic symptoms without actually having any back pain. Sciatic symptoms can occur just in one place in your leg – like your knee and/or foot – or run down the whole leg as described above. Regardless of how your sciatica is behaving – there are some general “best practices” that almost all versions of sciatica will respond to. 

Here’s what you should avoid when you’re battling sciatica – as well as what to do instead:

What to Avoid:

1. Soft beds and couches 

While it may feel better in the moment – lying in soft beds or couches will ultimately aggravate your sciatica. When you lie in soft beds or couches – it forces you into a slouched posture – which puts unwanted pressure on your already irritated nerves. What’s tricky is that you often won’t notice the aggravation while you’re in the slouched position. It won’t be until later, perhaps when you get up to walk or move around, that you’ll feel worse. Because of this, people mistakenly attribute the aggravation of their sciatica to the activity they just did instead of the prolonged, slouched position they were assuming perhaps just minutes or hours before.

2. Child’s pose and stretching forward.

Just because a stretch feels good, doesn’t mean it is good – another big misconception when it comes to sciatica. Since sciatica is often caused by a bulging or herniated disc that is putting pressure on your nerve – you want to avoid anything that is going to increase that pressure. When you stretch forward – like in child’s pose – you’re opening up the space in between your vertebrae (intervertebral space). In between each vertebrae lies your discs. Although it feels good “in the moment” when you’re stretching forward – and may even temporarily relieve your sciatica – this relief won’t last. By opening up your intervertebral space – you’re making it easier for your discs to protrude out and irritate your nerves – unknowingly prolonging or worsening your sciatica.

3. Letting your MRI dictate treatment.

As already mentioned, sciatica often involves bulging discs – and an MRI will typically confirm this. But here’s what you might not know… Research has shown us that lots of folks (more than 60%) have bulging discs showing up on their MRI’s, but they don’t all have back pain or sciatic symptoms. What that means is that while sciatica is often caused by a bulging disc, a bulging disc doesn’t always guarantee you’ll have sciatica. Why is this important? Because when you allow your MRI findings to dictate your treatment plan, you’re more likely to undergo a procedure or surgery that might not be necessary. Removing the bulging disc material or fusing your spine together might take the pressure off the nerve temporarily, but if the underlying issue is a movement or mechanical problem, and it’s not addressed, it’s only a matter of time before your problem comes back and/or shows up in a different area of your spine.

What to Do:

1. Go for Walks. 

Walking is one of the best things you can do for back pain – even though it may seem counterintuitive to do so when you’ve got pain running down your leg. Walking is an upright activity that is generally good for sciatica versus the slouched, curved posture you have when sitting. When you walk, pay close attention to what happens in your leg. Do your symptoms worsen or start to get better? If they worsen, certainly stop and seek professional guidance. But if your leg starts feeling better – then the walking is likely good for your sciatica.

2. Pay attention to your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. When your sciatic nerve is irritated, it becomes highly sensitive to postural changes in your lower back (especially slouched postures). Whether you’re sitting or standing – you want to maintain the natural S-curve of your spine as best as you can. I recommend to my clients they use a lumbar roll whenever they are sitting to make maintaining this posture easier. Correcting your posture alone is often not enough to get rid of your sciatica, but it can keep you from getting worse, and prevent it from coming back if you’ve successfully eliminated your sciatic symptoms.

3. Talk to a Mechanical Pain Specialist.

Did you know that 70-80% of all musculoskeletal pain is mechanical in nature? Both back pain and sciatica can fall into this “mechanical pain” category – which is caused by slowly developing movement problems or habits that eventually result in stiffness and mobility restrictions in your spine. These restrictions can lead to irritated structures, such as nerves. So if your sciatica is due to a mechanical problem – it’s not going to permanently improve with pills, procedures or surgery. You’ll need to find a mechanical pain specialist who can help correct and restore your movement patterns for a long-term solution you can maintain on your own.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].