Tag Archive for: physical therapy portsmouth nh

Why Core Strengthening Isn’t Fixing Your Back Pain (And May Be Making It Worse)

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If you’ve ever Googled “how to fix back pain,” you’ve probably seen advice suggesting consistent movement, stretching, and core strengthening. And while that’s not wrong, it’s incomplete.

At our Portsmouth, NH physical therapy clinic, we see people every day who have been doing all the “right” core exercises—and still struggling with back pain.

Here’s why.

The Problem with Generic Core Strengthening for Back Pain

Yes, movement matters.
Yes, stretching can help.
Yes, core strengthening is important.

But only when applied at the right time and in the right way.

Jumping into generalized ab workouts—like planks, crunches, or stability exercises—too early can actually prolong your back pain or make it worse.

That’s because most back pain isn’t simply a strength issue.

Why Back Pain Is Usually a Movement Problem (Not a Weakness Problem)

One of the biggest misconceptions we hear from patients across the Seacoast NH area is:

“My back hurts because my core is weak.”

In reality, about 80% of back pain is mechanical, meaning it’s caused by the way your spine moves—not how strong it is.

While strengthening plays a role in long-term recovery, it’s not the first step.

If you’ve been focusing on core workouts and still dealing with recurring pain, this is likely why.

Why Your Ab Exercises Aren’t Working

Core exercises can:

  • Improve circulation
  • Create temporary support
  • Reduce discomfort short-term

But they don’t fix the root cause.

If your spine isn’t moving properly, adding strength on top of dysfunction can:

  • Reinforce poor movement patterns
  • Increase irritation
  • Lead to recurring flare-ups

This is why so many people in Portsmouth and surrounding areas feel stuck—doing everything right, but seeing no lasting results.

Mobility Before Stability: The Missing Link in Back Pain Treatment

At our Portsmouth physical therapy clinic, we follow a simple rule:

Mobility before stability

Before you strengthen your core, you need to:

  • Restore proper spinal movement
  • Identify the specific movement causing pain
  • Use targeted exercises based on your body

Not:

  • Random stretches
  • Generic workout plans
  • TikTok or YouTube routines

When you address the underlying mechanical issue first, your results improve dramatically—and actually last.

A Real-Life Example

One of our clients—a highly fit Marine veteran in his late 30s—had a strong core and consistent workout routine. But he still dealt with recurring back pain.

The issue wasn’t strength. It was mechanical dysfunction in his spine.

Once he focused on correcting movement patterns (instead of just strengthening), everything changed:

  • Faster recovery
  • Fewer flare-ups
  • Better day-to-day mobility (even after travel and long periods of sitting)

What This Means for You

If your core workouts aren’t fixing your back pain, you’re not alone.

And more importantly—you’re not broken.

You’re likely just missing a key step:

  • Fix movement first
  • Then build strength

When you do that, your progress doesn’t just feel temporary—it actually sticks.

Get Help for Back Pain in Portsmouth, NH

If you’re in Portsmouth, NH or the Seacoast area and tired of dealing with ongoing back pain, working with a specialist who understands mechanical back pain can make all the difference.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Back Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth.

To request your free guide to relieving back pain naturally, visit cjphysicaltherapy.com or call 603-380-7902.

Back Pain Isn’t a Rest Problem – It’s a Movement Problem

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If you’re dealing with back pain in Portsmouth, NH or the Seacoast area, your first instinct is probably to stop everything and rest. That feels logical — when something hurts, you avoid it.

But when it comes to back pain, that instinct may actually be keeping you stuck in a cycle of pain.

After more than 20 years of helping people overcome back pain at CJ Physical Therapy & Pilates in Portsmouth, NH, one of the biggest misconceptions I see is this:

Rest and passive treatments will fix the problem.

They might help temporarily — but they rarely solve the root cause.

Why Rest Feels Right — But Often Makes Back Pain Worse

When your back first “goes out,” taking a day or two to rest can help calm things down.

But after that, rest starts working against you.

Your body — especially your spine — is designed to move. Movement:

  • Keeps joints lubricated
  • Helps discs stay hydrated
  • Activates muscles
  • Regulates your nervous system

When you stop moving:

  • Muscles tighten
  • Joints stiffen
  • Pain sensitivity increases

This is why so many people in Portsmouth and surrounding Seacoast towns feel worse after prolonged rest, not better.

Research consistently shows that staying active (in the right way) leads to faster recovery and less chronic pain.

The Real Cause of Most Back Pain

Here’s what most people aren’t told:

About 80% of back pain is mechanical.

That means it’s caused by how your spine is moving (or not moving) — not necessarily damage or injury.

Your spine is made up of multiple joints that need to work together. When even one segment isn’t moving properly:

  • Discs can become irritated
  • Nerves may get compressed
  • Surrounding muscles tighten up

Many people in Portsmouth, NH assume they need something to be “put back into place.”

But the real issue is usually poor movement patterns, not alignment.

Why Passive Treatments Don’t Last

By the time most patients come into our Portsmouth physical therapy clinic, they’ve tried:

  • Massage therapy
  • Chiropractic adjustments
  • Injections
  • General physical therapy

And they all say the same thing:

“It helped… until it didn’t.”

That’s because these treatments are often:

  • Too passive
  • Not specific enough

They may relieve symptoms temporarily, but they don’t:

  • Retrain your body
  • Correct movement dysfunction
  • Prevent the pain from coming back

Even traditional physical therapy can fall short if it relies on generic exercise programs instead of a precise diagnosis.

Movement Is Medicine — When It’s Done Right

The most effective treatment for back pain — supported by research — is:

Targeted, specific movement.

But not just any movement.

At our Portsmouth clinic, we use what we call “first-aid movements” — simple, specific exercises that:

  • Reduce pain quickly
  • Relieve pressure on discs and nerves
  • Restore normal joint motion

From there, we build a plan that includes:

  • Strength training
  • Mobility work
  • Movement retraining

This is what allows you to:

  • Get out of pain
  • Stay out of pain
  • Return to normal life without fear

Back Pain in Portsmouth, NH: It’s Not a Rest Problem

Most back pain isn’t caused by doing too much.

It’s caused by not moving well enough.

If you keep treating it with rest alone, you’ll likely stay stuck in this cycle:

Pain → Rest → Temporary Relief → Repeat

But when you start addressing the movement problem, everything changes.

You stop guessing.
You stop fearing movement.
And you finally get long-term relief.

Get Help for Back Pain in Portsmouth, NH

If you’re struggling with persistent or recurring back pain in the Portsmouth, NH or Seacoast area, the right plan can make all the difference.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Back Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth.

To request a free back pain guide or get help:
Visit: cjphysicaltherapy.com
Call: 603-380-7902

herniated disc

Herniated Discs and Cortisone Shots – What Most People Get Wrong

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Herniated Discs and Cortisone Shots: What Most People Get Wrong About Back Pain Treatment in Portsmouth, NH

If you’ve been told you have a herniated disc and that your next step might be a cortisone shot, you’re not alone. This is one of the most common treatment paths recommended for people dealing with back pain after an MRI reveals a disc bulge or herniation.

Many people assume that if their MRI shows a herniated disc and they’re experiencing pain, the logical next step is a cortisone injection. But that assumption often sends people down a path of procedures that don’t actually address the root cause of their back pain.

At our Portsmouth, NH physical therapy clinic, we frequently see patients who were advised to get injections before anyone fully explained why their pain was happening in the first place.

The truth is that cortisone shots—most commonly delivered in the spine as an epidural steroid injection (ESI)—can help in certain situations. The problem is that they are often recommended without first understanding the type of back pain someone is experiencing. When that happens, people may undergo injections that do little to solve the real problem.

Understanding when injections help begins with recognizing that not all back pain behaves the same way.

Not All Herniated Disc Pain Is the Same

When people hear the words “herniated disc,” they often imagine a serious structural injury that needs to be treated with medication or a procedure.

But the presence of a herniated disc on an MRI does not automatically mean injections are necessary. In fact, research has shown that many people have herniated discs on imaging and experience no symptoms at all.

What matters far more is how the body is responding to the disc and the type of pain it creates.

Broadly speaking, most back pain falls into two categories:

  • Inflammatory pain
  • Mechanical back pain

Both can occur with a herniated disc, but they behave very differently and respond to different treatments. Unfortunately, this distinction is rarely explained to patients, which is one reason cortisone injections are often misunderstood and overused.

When Cortisone Shots Can Help

While cortisone injections are rarely my first recommendation, they can be helpful when pain is primarily driven by inflammation.

Inflammation is a normal part of the body’s healing process. When tissue becomes irritated or injured, the body releases chemicals that increase blood flow and begin repair.

Occasionally, however, this inflammatory response doesn’t shut off properly. When those inflammatory chemicals linger longer than necessary, they can irritate nearby tissues and create persistent “chemical” pain.

This type of pain tends to:

  • Feel constant
  • Change very little with movement or posture
  • Be described as hot, inflamed, or deeply irritated

When inflammation behaves this way, cortisone injections can help by suppressing those inflammatory chemicals and calming irritated tissue. Once inflammation settles, movement and exercise can become effective again.

However, this type of inflammatory pain is not the most common cause of back pain.

Most Herniated Disc Pain Is Mechanical

Most back pain—even when a herniated disc is involved—is mechanical in nature.

Mechanical back pain is related to how the joints, muscles, and spine move together. It often develops when certain areas of the body become stiff while others compensate, creating inefficient movement patterns and excess stress on the spine.

Many people with herniated discs notice patterns like:

  • Pain worsening when sitting too long
  • Relief when standing or walking
  • Improvement with stretching or changing positions

These patterns are important clues.

When back pain improves with movement, the most effective treatment is usually restoring proper movement patternsthrough physical therapy.

This includes:

  • Identifying mobility restrictions
  • Correcting faulty movement habits
  • Strengthening the muscles that support the spine

Herniated discs can sometimes become irritated by everyday activities like lifting awkwardly, twisting suddenly, or even coughing or sneezing. When this happens, nearby muscles and nerves may become temporarily inflamed, making the pain feel intense and alarming.

But in many cases, this irritation is temporary and part of the body’s normal response—not something that requires injections or surgery.

The bigger issue is often the mechanical stress that caused the disc irritation in the first place.

Unless that underlying problem is addressed, the disc may continue to flare up repeatedly. Once movement patterns improve and mobility restrictions are corrected, the disc bulge or herniation often becomes far less significant.

The Problem With Treating Symptoms Instead of Causes

One of the biggest limitations of cortisone injections is that they treat symptoms rather than causes.

By reducing inflammation, the injection may temporarily decrease pain. But it does not correct the movement problems or mechanical stress that contributed to the disc irritation.

In some cases, this temporary relief can even backfire. When pain is masked, people may return to activities that continue irritating the spine without realizing it.

Over time, this can reinforce the same patterns that caused the injury and increase the likelihood of repeated back pain flare-ups.

New Non-Invasive Treatment Options for Back Pain

Fortunately, newer regenerative therapies are offering alternatives to cortisone injections for calming inflammation and promoting healing.

One example is Extracorporeal Magnetotransduction Therapy (EMTT). This technology uses high-frequency magnetic energy that penetrates deep into tissue and stimulates healing at the cellular level.

It is often combined with shockwave therapy, which helps stimulate circulation and tissue repair in irritated areas.

These therapies are non-invasive treatments for back pain that work with the body’s natural healing systems rather than suppressing them.

How to Tell What Type of Back Pain You Have

If you are considering a cortisone shot or epidural steroid injection for a herniated disc, the most important step is understanding how your pain behaves.

The way your symptoms respond to movement can provide valuable clues.

If your symptoms:

Improve when you walk, stretch, or change positions
Your pain is likely mechanical in nature. In these cases, treatment focused on restoring proper movement—often through physical therapy—can be the most effective solution.

Feel constant, inflamed, and largely unaffected by movement
Inflammation may be playing a larger role, and treatments designed to calm inflammation could potentially help.

Either way, cortisone injections do not fix structural disc problems or movement dysfunction. They simply reduce inflammation.

Long-term recovery from back pain almost always requires addressing how the body moves. When those underlying issues are corrected, many people find their back pain improves without ever needing injections.

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

To learn more about natural treatment options for back pain in Portsmouth, NH, or to request a free copy of her guide to relieving back pain naturally, visit www.cjphysicaltherapy.com or call 603-380-7902.

skiing

Ski Season Isn’t Over Yet: How to Keep Your Knees Strong and Stable on the Slopes

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Ski Season in New Hampshire Isn’t Over: How to Prevent Knee Pain on the Slopes

Ski season in New Hampshire isn’t over yet – and if your knees are already starting to “talk” to you after a day on the mountain, it’s time to pay attention.

Whether you’re skiing in the White Mountains or making weekend trips north from Portsmouth, NH, your knees take on significant stress with every turn, carve, and correction on uneven terrain.

Skiing is one of the most knee-intensive recreational sports. Add speed, rotation, moguls, and the occasional fall – and your knee joint works overtime.

The good news?

Most ski-related knee pain is mechanical. And mechanical knee pain is often predictable – and preventable.

At our Portsmouth, NH physical therapy clinic, we help active adults stay strong on the slopes by focusing on two essentials: mobility and stability.

Why Knee Pain Happens While Skiing

Your knees need two key things to stay healthy during ski season:

Mobility – the ability to fully bend and straighten to absorb force
Stability – the ability to control rotation and handle load without collapsing inward

When one (or both) is missing, your knee becomes vulnerable to irritation, swelling, or injury.

If you’re experiencing knee pain after skiing in New Hampshire, one of these factors is likely contributing.

1. Don’t Skip Your Warm-Up Before Hitting the Slopes

If you’ve driven an hour or more from Portsmouth to the mountains, your knees have likely been compressed in a bent position the entire time.

Prolonged sitting increases stiffness and pressure in the front of the knee – especially for adults over 40.

Then what happens?

You step out of the car, click into your skis, and immediately head downhill.

That’s a massive transition for your joints.

Instead, spend 5-10 minutes warming up your knees, hips, and ankles before your first run:

  • Bodyweight squats
  • Controlled lunges
  • Gentle hip mobility drills
  • Ankle mobility work

Your first run should never be your warm-up. Preparing your joints ahead of time improves blood flow, activation, and control – all of which help your knees better tolerate the demands of the day.

2. Build Strength Where Your Knee Needs Support

Your knee does not function in isolation. It relies heavily on the muscles above and below it for protection and control.

Strong quadriceps and hamstrings provide balanced stability to the joint, while strong glutes and a stable core help maintain proper alignment, manage rotation, and prevent the knee from collapsing inward.

When these muscles are weak or not functioning well – your knees are forced to absorb stress they were never meant to handle on their own.

If you want to ski confidently into your 50s, 60s, and beyond, lower body and core strength training are not optional – they are foundational.

Strong, well-coordinated muscles reduce unnecessary strain on your joints and improve both performance and longevity on the slopes.

3. Maintain Full Knee Mobility

Mobility is just as important as strength.

Your knees must be able to fully bend and fully straighten in order to function properly. Any loss of extension or flexion – even minor – compromises the surrounding ligaments and joint structures, forcing them to work harder than they were designed to.

These subtle mobility restrictions become even more apparent under the higher demands of skiing.

If your knee already feels stiff during everyday activities – it will not magically improve once you are on the mountain. In fact, the added stress often exposes underlying limitations.

A consistent mobility routine – particularly one that restores full knee extension – can significantly reduce strain and allow your knee to adapt more effectively to the dynamic demands of skiing.

4. Address Mechanical Knee Pain Early

Approximately 80 percent of knee pain is mechanical in nature, meaning it is driven by how the joint is moving – or not moving – rather than simply wear and tear.

The good news is that mechanical pain responds extremely well to specific corrective movements designed to address the root cause of the problem.

Once the correct movement is identified – it can act like medicine for your knee. Completely natural and highly effective.

The right prescriptive movement will reduce pain quickly, improve motion, and restore confidence in your knee again. It also gives you a tool you can use on your own – so you don’t have to rely on anti-inflammatory medications just to get through the rest of ski season.

If your knee swells after skiing, catches with certain movements, or flares up after a long day on the mountain – it may very well be the result of a mechanical dysfunction.

Small mechanical issues rarely remain small when repetitive stress – like skiing – continues. Addressing them early can prevent more significant problems down the line.

For this, it is important to consult with a specialist trained in mechanical knee pain. Identifying the correct prescriptive movement is key. When done properly – it is the difference between managing symptoms and truly correcting the underlying issue.

Finish Ski Season Strong in Portsmouth, NH

Skiing should feel powerful and controlled – not unstable or uncertain.

Most injuries do not occur because people are too active. They occur because the joint was underprepared for the demand placed upon it.

If you are experiencing knee pain after skiing and live in Portsmouth, NH or the Seacoast area, the specialists at CJ Physical Therapy & Pilates can help.

Led by Dr. Carrie Jose, our team specializes in mechanical knee pain treatment and helping active adults return to skiing with confidence – without relying on injections or surgery.

To request a Free Discovery Visit or receive a free copy of our guide to managing knee pain, visit cjphysicaltherapy.com or call 603-380-7902.

Ski season isn’t over yet. There is still time to protect your knees, ski strong, and finish the season with confidence.

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.