Tag Archive for: physical therapy portsmouth nh

Why Those “Little Tweaks” After Shoveling Snow Matter More Than You Think

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If you live in New England, you already know — this winter has arrived with a vengeance.

After several mild seasons, we’re finally seeing the kind of snowstorms that turn everyday homeowners into part-time weightlifters overnight.

Shovels come out. Snowblowers get dragged from garages. Driveways, walkways, decks, cars, and mailboxes all need to be cleared — often quickly and in freezing temperatures.

In other words, snow removal involves a lot of lifting, twisting, pushing, and pulling, usually performed by people who haven’t done anything remotely similar in months.

So if your back feels tight, your neck is stiff, or your shoulders are aching after shoveling snow — you’re not alone. What matters most is what you do next.

Too often, people brush these symptoms off as “just soreness” or a minor tweak that will go away on its own. Maybe you take a few Advil and keep moving.

That might work short-term. But as I often remind patients at our Portsmouth, NH physical therapy clinic, the absence of pain does not mean the absence of a problem — especially when symptoms return every time you shovel, lift, or twist.

Minor stiffness or recurring tightness is often an early warning sign of a deeper mechanical issue. Over time, pain relievers stop working — or you find yourself needing them more often just to get through daily activities.

Why Clearing Snow Is a Perfect Storm for Injury

Snow shoveling injuries are incredibly common throughout New Hampshire, Maine, and Massachusetts, and for good reason.

Shoveling combines:

  • Repetitive bending and spinal rotation
  • Forward or overhead lifting
  • Sudden force production
  • Uneven, slippery footing

Snowblowers create their own challenges, including:

  • Sustained pushing through heavy snow
  • Resisting torque when the machine catches
  • Repeated twisting to adjust the chute
  • Forceful pulling to start or reposition the blower

Add cold temperatures, heavy wet snow, and muscles that aren’t warmed up, and you have a perfect setup for injury.

After every major storm here on the Seacoast, our phones start ringing. We see:

  • Low back strains and disc irritation
  • Neck stiffness and pain
  • Shoulder injuries — especially rotator cuff flare-ups
  • Knee and spine arthritis flare-ups triggered by sudden load

What makes these injuries tricky is that they don’t always show up immediately. Often it starts as:

  • A dull ache
  • A pinch when turning your head
  • A shoulder that feels “off” when reaching

These are exactly the signs people tend to ignore — until the problem escalates.

Why “Pushing Through It” Can Backfire

One of the biggest misconceptions about musculoskeletal pain is that it has to be severe to be serious.

In reality, many long-term injuries start as small mechanical problems that were never addressed.

When you irritate a joint, disc, tendon, or nerve while shoveling snow, your body compensates. Movement patterns subtly change. Muscles tighten to protect the area.

If that irritation doesn’t resolve properly, those compensations stick around — placing stress on tissues that weren’t designed to handle it. This is how a minor tweak turns into weeks or months of pain, even after winter ends.

The Problem With Masking Pain

When pain lingers, many people look for the fastest way to quiet it:

  • Anti-inflammatory medications
  • Muscle relaxers
  • Cortisone injections

While these options may temporarily reduce symptoms, they don’t promote healing.

Pain is information. It’s your body telling you something isn’t moving or loading properly. When you silence that message without addressing the cause, you’re more likely to repeat the same patterns — and delay true recovery.

Don’t Wait It Out — Why Early Action Matters

The good news? Most snow-related injuries respond extremely well to early, conservative care.

When addressed early:

  • Recovery is faster
  • Treatment is simpler
  • Long-term problems are often avoided

The key is identifying what’s actually driving the pain — not just where it hurts.

Is the pain coming from the spine or the shoulder joint? Is a nerve involved? Is inflammation primary, or secondary to poor movement and overload?

At our Portsmouth, NH physical therapy and regenerative medicine clinic, we rely on repeated movement testing and test-retest methods to determine what’s truly contributing to symptoms — not just imaging findings.

Once the root cause is clear, treatment can focus on restoring movement, improving load tolerance, and supporting the body’s natural healing process.

Non-invasive options like shockwave therapy, EMTT, targeted manual therapy, and prescriptive movement work together to reduce inflammation, improve blood flow, and promote tissue healing — without masking symptoms.

Listening to Your Body Pays Off

New England winters aren’t going anywhere. Neither is snow shoveling.

If your back, neck, or shoulders still hurt days after clearing snow, that’s worth paying attention to. Pain that lingers, worsens, or changes how you move is not something to ignore.

Seeking help early doesn’t mean you’re overreacting — it means you’re being proactive.

Your body is talking to you.
The smartest move is listening now — before it starts yelling.

Dr. Carrie Jose, Physical Therapy Specialist and Regenerative Therapy 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 with a physical therapy specialist visit cjphysicaltherapy.com or call 603-380-7902.

When Your Stretches Don’t Work – This Could Be Why

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If you’ve ever told someone you’re dealing with tight hips, tight hamstrings, tight calves, or a tight neck, chances are the next thought was: “I just need to stretch more.”

As a physical therapist, this is one of the most common assumptions I hear — and one of the biggest misconceptions when it comes to muscle tightness.

Stretching is not always the solution.
And in many cases, it’s not the problem either.

Tight does not automatically mean short, restricted, or in need of aggressive stretching. Understanding why a muscle feels tight is the key to creating real, lasting change.

Tightness Is Often a Sign of Compensation

Muscles don’t work in isolation. They rely on surrounding muscles, joints, and efficient movement patterns to share load and maintain stability.

When something in that system isn’t working well — such as weak stabilizers, limited joint motion, or poor movement mechanics — other muscles step in to compensate. Over time, those muscles become overworked, fatigued, and stressed, which often shows up as a persistent feeling of tightness.

Stretching a muscle that’s already overworking can:

  • Provide only temporary relief
  • Increase irritation
  • Remove tension the body is using for stability

This is why many people feel worse after stretching or massage — or why the tightness returns no matter how consistent they are.

The real solution begins by identifying what the muscle is compensating for and correcting the imbalance at its source through proper strength, movement, and load management.

Why Traditional Stretching Doesn’t Always Help

Static stretching — holding a stretch for 30–60 seconds — has long been considered the gold standard for flexibility. For many people, it works well.

But for others, it does the opposite.

When the nervous system is sensitive, sustained stretching can cause the muscle to guard instead of relax, making you feel tighter afterward. This is especially common in people with chronic pain, recurring injuries, or long-standing muscle tension.

A Better Option: Movement-Based Stretching

If static stretching hasn’t helped, a movement-based approach may be more effective.

Instead of holding a stretch at end range, you gently move into the stretch, ease off slightly, and repeat the motion. This tells the nervous system that the range is safe, allowing muscles to relax naturally instead of bracing.

For many patients, this approach:

  • Reduces guarding
  • Feels less aggressive
  • Leads to more lasting improvements

When Tightness Is Actually Dysfunction

If stretching and strengthening haven’t helped — and the tightness feels deep, stubborn, or unchanged — the issue may be tissue dysfunction, not flexibility.

Dysfunctional tissue occurs when the elastic components of muscle or tendon become disorganized and lose their ability to contract and release properly. This commonly happens after:

  • Surgery (especially with scar tissue)
  • Chronic tendon injuries
  • Old injuries that never fully rehabilitated
  • Trauma or repetitive overuse

In these cases, the tissue itself must be remodeled, not stretched.

This requires progressive, guided loading to restore collagen alignment, elasticity, and tolerance to stress — a process that takes time, consistency, and expert oversight.

Supporting Healing With Natural, Non-Invasive Therapies

At CJ Physical Therapy & Pilates in Portsmouth, NH, we often combine targeted rehabilitation with non-invasive therapies to help stubborn tissue respond better to treatment.

These may include:

  • Shockwave Therapy and EMTT, which stimulate blood flow, cellular activity, and healing in chronically tight or irritated tissue
  • Dry Needling, which helps reset excessive muscle tone, improve circulation, and reduce protective guarding

These tools don’t replace exercise — they help prepare the nervous system and tissue so movement and strengthening are more effective.

What to Do Next

If you feel tight all the time, the answer isn’t always more stretching.

Sometimes muscles are:

  • Overworked
  • Protecting another problem
  • Or dealing with tissue dysfunction that requires a different strategy

If your tightness keeps coming back, feels resistant to stretching, or worsens with aggressive release techniques, it may be time to stop guessing and get expert guidance.

When you treat the source instead of chasing the symptom, tightness becomes something you resolve — not something you constantly fight.

About the Author
Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Pain Expert and the owner of CJ Physical Therapy & Pilates in downtown Portsmouth, NH. She also writes for Seacoast Media Group.

To get in touch or request one of her free guides to back, knee, neck, or shoulder pain, visit cjphysicaltherapy.com or call 603-380-7902.

Back Surgery Is Rarely the Answer – Here’s What to Know First

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Back Surgery Is Rarely the Answer — Here’s What to Know First

The number of times this week I’ve heard people talk excitedly about their upcoming back surgery has genuinely left me disheartened. Not because surgery never has a place — but because it highlights just how misunderstood non-surgical healing for back pain still is.

No matter how much education I share, or how much research exists showing that back surgery is not the guaranteed fix people think it is, many individuals still give up far too quickly and default to surgery.

So here I am again — speaking from clinical experience, personal experience, published research, and thousands of patient stories — to say this clearly: back surgery is rarely the only option, and it is almost never the best first option.

Why Back Surgery Often Fails to Deliver Long-Term Relief

Each year in the United States, tens of thousands of adults undergo back surgery in an effort to relieve pain. Yet even with modern surgical techniques, long-term success is far from guaranteed.

A 2023 systematic review published in the Journal of Pain Research found that approximately 15% of patients experience ongoing or recurring pain after spine surgery, commonly referred to as failed back surgery syndrome. Other peer-reviewed spine and pain studies show persistent pain rates ranging from 5–30%, depending on the procedure and patient population.

Re-operation rates are also concerning. A 2022 nationwide cohort study published in Scientific Reports found that 14–18% of patients required another back surgery within five years. For individuals who had already undergone spinal surgery, the likelihood of needing additional surgery was even higher.

Once someone enters the surgical pathway, it often becomes increasingly difficult to step off it.

The Real Risks of Back Surgery People Don’t Talk About

While these percentages may not seem overwhelming at first glance, they matter — especially when you consider the very real risks of back surgery, including:

  • Infection
  • Blood clots
  • Nerve damage
  • Adverse reactions to anesthesia
  • Incomplete or temporary pain relief

And something research doesn’t always capture: surgery cannot be undone. This reality is rarely emphasized enough during decision-making.

Why “Trying Everything” Often Isn’t Really Trying Everything

This is why exploring conservative, non-surgical back pain treatment is so important — but not in a random or unstructured way.

Many people tell me they’ve already tried physical therapy, chiropractic care, massage, acupuncture, injections, or exercise and that nothing worked. When we look closer, most have spent years cherry-picking treatments without a clear strategy.

They often repeat the same generalized approaches, layer too many treatments at once, or rely entirely on passive care to fix what is actually an active, mechanical back problem.

Passive Care Can Help — But It Isn’t Enough

Passive treatments like massage, acupuncture, and chiropractic care can be incredibly effective for calming pain and reducing inflammation. But pain relief is not the same as healing.

Without pairing passive care with precise corrective movement and tissue-specific loading strategies, relief is usually temporary — and confusing.

The Role of Modern, Non-Surgical Regenerative Therapies

In recent years, I’ve seen remarkable results using non-invasive regenerative shockwave and electromagnetic therapies to stimulate blood flow, cellular repair, and tissue regeneration in damaged muscles, tendons, ligaments, and irritated nerves.

These treatments don’t simply mask pain. They support the body’s natural healing response, improving tissue quality and reducing inflammation so meaningful recovery can occur.

When used strategically — and combined with the right movement-based care — these therapies have been a game-changer in my Portsmouth practice, helping many people avoid injections, delay or prevent surgery, and finally heal for the long term.

Most Back Pain Is Mechanical — Not Surgical

Approximately 80% of back pain is mechanical in nature. It develops gradually from how we move, sit, train, work, and recover.

Even when pain appears suddenly, the underlying problem has usually been building for years. No surgery, injection, or generic exercise program can correct poor movement patterns or faulty spinal mechanics.

Until those issues are addressed, pain tends to return — even after surgery.

Why Seeing a Back Pain Specialist Matters

After more than 23 years working with people suffering from back pain and sciatica, I can confidently say this: the difference between a generalist and a specialist is profound.

For the first decade of my career, I worked in traditional, insurance-driven physical therapy settings. I followed prescriptions, used common passive treatments, and truly believed I was doing everything right.

Everything changed when I pursued advanced specialty training and learned how to properly assess, classify, and treat mechanical back pain. That shift allowed me to help people not only get out of pain — but keep it gone and avoid surgery altogether.

Before You Say Yes to Back Surgery — Pause

If you’re dealing with persistent back pain and feel surgery is being presented as your only option — especially if you’ve already tried traditional physical therapy — please pause.

Our back pain specialists in the Seacoast focus exclusively on these problems and understand how to combine movement science with modern regenerative therapies.

Before you say yes to back surgery, make sure you’ve truly exhausted every conservative option available. Natural healing is not only possible — it is often the most effective and longest-lasting solution when done correctly.

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

To get in touch — or request a free discovery visit with one of our specialists — visit our website or call 603-380-7902.

Healthy couple exercising outdoors, promoting back-friendly fitness and injury prevention in Portsmouth, NH.

Why New Year’s Fitness Goals Backfire — And How to Protect Your Back

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Why New Year’s Fitness Goals Backfire — And How to Protect Your Back

Every January, it happens like clockwork.

Gyms fill up. Fitness challenges kick off. People recommit to moving more, getting stronger, and finally prioritizing their health. And honestly — that motivation is a great thing.

But then February and March arrive… and we start seeing a different pattern here at our physical therapy clinic in Portsmouth, NH.

Back pain flares up. Old injuries resurface. New aches suddenly derail workout routines. And many people quietly decide they’re “too old,” or that certain exercises “just aren’t for them.”

In reality, the issue usually isn’t motivation or effort. More often, unresolved or low-grade back pain quietly follows people into their New Year’s fitness routines — and when increased intensity, load, or frequency is layered on top of poor movement patterns, even the best intentions can backfire.

If your goal this year is to stay active and pain-free, the solution may not be doing more — but doing things smarter.

Why January Is a High-Risk Month for Back Injuries

January is one of the highest-risk months of the year for back injuries — and that’s no coincidence.

Back pain rarely appears out of nowhere, even when it feels sudden. In most cases, it develops gradually over months or even years due to prolonged sitting, repetitive bending or twisting, and subtle compensations the body makes without you realizing it.

The holiday season often magnifies these stressors:

  • Long car rides and travel
  • More time sitting on soft couches
  • Disrupted routines and less daily movement

By the time January arrives, many people are already showing early warning signs of a brewing back pain episode — stiffness, mild aches, or irritation.

Then comes the abrupt shift:
New workouts. Heavier lifting. High-intensity classes. Aggressive stretching. Movements the body hasn’t been prepared to tolerate.

This combination is why so many people start the year strong — only to find themselves sidelined weeks later with back pain or sciatica.

Exercise Is Medicine — But Only When the Dose Is Right

Exercise is one of the most powerful tools we have for preventing and resolving back pain — when the dose is appropriate.

When your back is healthy, general exercise and strength training can be excellent preventive tools. But when back pain is already present, a more specific and individualized approach is often needed.

Roughly 80% of back pain is mechanical in nature, meaning it comes from how your body moves, sits, bends, lifts, and responds to load — not simply from structural issues like arthritis or disc degeneration. In fact, research consistently shows that many people with disc bulges or degeneration have no pain at all.

When faulty movement patterns and underlying spine mechanics aren’t addressed first, working harder in the gym can unintentionally amplify the habits that caused the problem in the first place. This is a major reason New Year’s fitness routines fail — despite great intentions.

How to Pursue Fitness Goals in a Back-Friendly Way

The good news? You don’t have to choose between staying active and protecting your back.

A few simple strategies can dramatically reduce injury risk while supporting long-term fitness.

1. Reduce Prolonged Sitting

Sitting increases compressive forces on the spine by up to 40%. Spending most of the day seated and then jumping into intense workouts puts your back at a disadvantage before exercise even begins.

Breaking up sitting time every 30 minutes with brief movement or posture changes gives your spine a break and creates a healthier foundation for exercise.

2. Don’t Underestimate Walking

Walking restores natural spinal movement, improves circulation, and reduces hip stiffness — a common contributor to back pain.

Aiming for 6,000–7,000 steps per day (about 45–60 minutes spread throughout the day) supports spinal health, joint mobility, and cardiovascular fitness without overwhelming your system. If walking consistently worsens your back pain, that’s a sign to seek expert guidance — not to stop moving altogether.

3. Focus on Postural Variety, Not “Perfect Posture”

No posture is healthy if it’s held too long. The spine thrives on movement and variability.

Rather than chasing perfect posture, focus on changing positions often while maintaining general postural awareness.

4. Strengthen Your Core — Intelligently

Core strength is important, but it’s not always the fix for back pain people expect. Because back pain is often sensitive to position and load, generalized core exercises can sometimes make symptoms worse.

Targeted, well-coached strength training and functional movements — guided by a back-aware professional — help build stability at the right time and in the right way.

5. Don’t Wait for Back Pain to “Go Away”

Mechanical back pain rarely resolves with time alone. It adapts, compensates, and quietly becomes limiting.

The absence of pain doesn’t always mean the absence of a problem. Understanding why your back hurts — and which movements help or worsen symptoms — is far more effective than relying on short-term fixes.

Work Smarter, Not Harder This Year

A successful New Year’s fitness plan isn’t defined by how hard you push in January.

It’s defined by how consistently you can move throughout the year — and whether you can keep doing the activities you love without setbacks.

With the right approach, movement becomes the solution — not the reason you’re sidelined.

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

To get in touch — or request a free discovery visit with one of our specialists — visit our website or call 603-380-7902.

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].