Tag Archive for: physical therapy portsmouth nh

Is running bad for your knees?

Turns out – Running isn’t Bad for your Knees

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Is Running Bad For Your Knees?

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

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

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

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

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

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

Check your ankle mobility

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

Don’t just run – strength train too.

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

How’s your core?

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

Practice good running form

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

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

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

Back Surgery

Before Back Surgery – Try specialized physical therapy first

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Three Red Flags Your Hamstring Strain is Probably Something Else

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

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

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

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

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

1. You have chronic hamstring pain

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

2. Numbness and Tingling in your butt or leg

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

3. You feel pain below your knee

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

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

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

Are you local to Portsmouth, NH?

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

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

Is Exercising Hurting Your Back? 5 Reasons Why.

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Is Exercising Hurting Your Back? 5 Reasons Why.

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

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

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

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


1. It’s the wrong type of exercise

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

2. Stability training is introduced too soon

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

3. Your aren’t activating your core

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

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

4. You aren’t breathing properly

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

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

5. You’re using improper form

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

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

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

Are you local to Portsmouth, NH?

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

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

6 Essential Habits that Build your Immunity

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Flu season is upon us – and it’s that time of year where a healthy immune system is more important than ever. Whether it’s more shopping or extra Holiday gatherings, you’re bound to be around more people than usual, which is a recipe for spreading and catching germs.

Here are 6 essential habits that will help build your immunity:

1. Stay Hydrated

Staying hydrated is one of the best things you can do for your health all of the time, but it’s especially important when you’re trying to fight disease. Water helps flush everything out, and your cells (especially those that fight germs) work better when fully hydrated. But water isn’t the only thing that helps you stay hydrated. Broth, tea, or anything without a lot of sugar counts. Personally, when I’m not feeling well, I love making myself a big thermos of hot water with lemon and tea. Not only is it soothing but it’s packed with vitamin C. So how much water should you drink? The U.S. National Academies of Sciences, Engineering, and Medicine says that men should aim for about 15.5 cups per day, while women should aim for 11.5 cups. Now keep in mind, how much you exercise and sweat each day will vary these numbers, but as a general rule, keep your favorite water bottle by your side at all times and make staying hydrated easy.

2. Exercise Regularly

Exercising regularly is well-known for improving cardiovascular health, lowering blood pressure, keeping muscles and bones strong, and helping control your body weight. But did you know that regular exercise also helps you boost your immune system? There are a certain amount of immune cells naturally circulating through your body at all times. But when you exercise, and increase your blood flow, you help push more immune cells from your lymph nodes and spleen into your bloodstream. Now if you’re already sick or feeling low energy, it’s important to listen to your body and modify where you need to. You don’t want to risk getting an injury for the sake of your immune system. There has to be a balance. But going for an easy walk – even when you’re sick – can help. And when you’re not sick – get moving – it’s going to help build a healthy immune system not to mention a healthy musculoskeletal system.

3. Get some Sleep

Good, quality sleep is essential for your health, and it helps keep your immune system functioning well. When we sleep, our bodies produce special proteins designed to target infection and inflammation, and T-cells (white blood cells) that play a critical role in fighting infectious diseases. So what happens when we don’t sleep? Lack of sleep has been proven to increase the risk of illness. Sleep researchers at several universities tested this theory by exposing 164 volunteers to the cold virus through nasal drops while monitoring their sleep and evaluating their health habits. The participants who slept less than five hours were four-and-a-half times more likely to catch a cold than those who slept for seven hours a night. So prioritizing sleep is crucial all of the time – but especially when you’re fighting off a cold or illness.

4. Eat Well

Eating a healthy, whole-food and varied diet is one of the best ways to boost your immune system. Incorporating vibrant fruits and vegetables bursting with vitamins and antioxidants, such as citrus fruits, bell peppers, spinach, and berries, will bolster your body’s ability to fight off infections. Lean proteins like poultry and fish, along with probiotic-rich foods such as yogurt and kimchi, support a healthy gut, which happens to be where a significant portion of your immune system resides. And don’t forget about whole grains and healthy fats – like those found in nuts and olive oil. They help strengthen your immune system also. Eating well is good for you all the time – but especially when you’re sick and trying to fight off germs and infection.

5. Be Social

Having positive interactions with people and meaningful relationships is not only linked to improved immunity, but it also happens to top the list of things that help us to live longer. Now, if you’re already sick, then you may want to stay away from your friends and loved ones physically. That doesn’t mean you can’t pick up the phone or hop on Zoom. But when you’re feeling good and healthy – prioritize these relationships and connections. Make time for group activities, or walks with a friend. Being social and interacting with others contributes positively to your emotional well-being – and turns out – will help keep you from getting sick as well.

6. Get Outside

Getting a regular dose of fresh air not only reduces stress, but it gives you vitamin D. You can get vitamin D from food and supplements – but the best place to get it is from the sun. The effectiveness of vitamin D on fighting colds and flus is still unclear and being studied, but vitamin D is believed to help facilitate a healthy and normal immune system. But regardless of the research, getting outside feels good and gets you away from all that circulated air indoors. I don’t think it’s a coincidence that we get more colds in the winter, so when you can, bundle up and get outside. Your immune system will actually thank you.

Having a strong immune system keeps us healthy. And when we’re healthy, we can take that opportunity to work on and optimize other aspects of our health – such as strength, mobility, and cardiovascular health – that keep us feeling good and reduce our risk of injury. Getting sick puts a stop to life’s momentum, and can prevent you from getting into a routine altogether if you’re getting sick often. So don’t take your health for granted. If you haven’t already, start incorporating one or more of these habits into your life today.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

How Regenerative Shockwave Therapy is Helping Injured People Stay Active and Mobile

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Regenerative Shockwave Therapy

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

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

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

Here are just some of the ways regenerative shockwave therapy is helping injured people (especially those aged fifty-plus) stay active, mobile, and doing the activities they love.

Pain Management:

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

Improved Mobility:

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

Blood Flow Stimulation:

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

Reduces Scar Tissue:

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

Accelerated Recovery:

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

If you’re currently injured and avoiding exercise – consider adding regenerative shockwave therapy into the mix to help reduce your pain, improve your mobility, and get you back to your favorite activities faster. Who knows, it could be the missing link to your healing that you didn’t even know existed.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

Sciatica

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

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

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

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

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

What to Avoid:

1. Soft beds and couches 

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

2. Child’s pose and stretching forward.

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

3. Letting your MRI dictate treatment.

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

What to Do:

1. Go for Walks. 

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

2. Pay attention to your Posture.

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

3. Talk to a Mechanical Pain Specialist.

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

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

How Back MRI’s Lead to more Invasive Treatments and Surgery

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If you’ve ever suffered from acute or long-standing back pain, you’ve likely wanted to “see inside” and know what’s going on. If this is you – you’re not alone in your thinking – and many medical doctors agree with this approach. However, evidence suggests that unwarranted MRI’s on your back can lead to unnecessary invasive treatments and surgeries, which often result in more harm than good in the long-term.

Let’s take a look at the research.

As part of their International Choose Wisely Campaign, the BMJ (British Journal of Medicine) published findings of a 2020 study that investigated what happens when back pain sufferers get MRI’s done too early (defined as less than 6 weeks into an episode and absent of any red flags). In more than 400,000 patients, those who received early MRI’s on their back were more likely to undergo back surgery and be prescribed opioids. And worse – they had higher pain scores at 1-year follow-up than those that didn’t get an MRI. This is not an isolated study. There is mounting evidence that indicates when MRI’s are done too early or unnecessarily – it leads to more surgery, more invasive treatments, more negative perceptions and catastrophization of spinal conditions, and overall – poorer outcomes.

So when is a back MRI needed? 

When you’ve got any alarming symptoms (known as “red flags”) you should absolutely get an MRI. These include signs of cancer, infection, inflammatory disease, possibility of fracture, or severe neurological deficit. Qualified health care practitioners are trained to identify these red flags. However, they are seen in only about 5-10% of all back pain cases. For context, in my two decades of treating patients with back pain, only three had these serious symptoms. This isn’t to downplay severe back pain cases, but to emphasize that most back pain patients don’t need an MRI for a proper diagnosis and treatment plan. And if you get an MRI when you don’t need one – you might end up with unnecessary treatments or surgeries, be prescribed opioids, and are likely to feel generally worse about your back pain.

The problem with relying on back MRI’s

When you get an MRI of your back – the problem is it shows you everything.

You’ll see a comprehensive view of bulging discs, arthritis, stenosis, and degenerative discs – which are all common findings – but also a normal part of aging. Everybody gets them whether you have back pain or not. But because we haven’t done a good enough job of normalizing these findings – they often get blamed for your back pain when seen on an MRI. But the research shows you can’t reliably correlate your MRI findings to the true cause of your back pain. In fact, they’ve compared MRI’s of people with and without back pain and found they can share almost identical results. In a set of publications known as the Lancet series, Martin Underwood, MD, co-author and professor at Warwick Medical School, said: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Confused? I don’t blame you.

The truth is, about 70-80% of all back problems, even sciatica, are considered what we call “mechanical” in nature. Your pain will come and go, you’ll have good days and bad days, and you’ll often feel better with movement. Mechanical back pain cannot be diagnosed by an MRI – it’s diagnosed via repeated movement testing to see what triggers and relieves your back pain. And it’s treated with corrective movement strategies designed to get rid of your pain and keep it gone. If you undergo an MRI for what’s essentially mechanical pain, you risk receiving treatments that are not only unnecessary, but can exacerbate the problem. Remember, you can’t reverse a back surgery. And complications related to back surgery are complicated to treat. You owe it to yourself to exhaust all possible conservative treatments.

If you’ve been suffering with back pain for years, I know it’s frustrating.

Consider speaking to a mechanical back pain expert who can help you accurately determine the root cause of your back pain with corrective movement strategies instead of a back MRI.

Give yourself a chance to resolve your back pain naturally instead of resorting to invasive treatments or procedures.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request a seat in her upcoming Masterclass for Back Pain & Sciatica – visit her website www.cjphysicaltherapy.com or call 603-605-0402

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5 Ways Working Out Can Aggravate Your Back

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The research continues to show that the best “treatment” for back pain is exercise. But for some, a work out is what actually aggravates their back. This is a common frustration I hear from clients. They know that strengthening their core and working out is good for their back. But when they do – they suffer. 

Here are five ways your work out is aggravating your back:

1. Misguided Exercise Choice

While the research isn’t wrong about exercising and back pain – not all exercises are appropriate depending on the type and severity of back pain you’re experiencing. For example, walking is considered one of the best activities for back pain sufferers, but for some, it’s excruciating. Strength training and lifting weights should be an essential part of back pain rehabilitation (and prevention). But if it’s done haphazardly, you’re going to have problems and likely aggravate your back. “Exercise” is not what causes problems for most people – it’s exercise choice. And when you make the wrong choice and aggravate your back, you tend to do the worst thing possible – rest and avoid exercise altogether. There is a middle ground when it comes to exercise and back pain. Working with an expert who understands this is essential.

2. Premature Stability Training

Stability training is an important part of back pain recovery – but I often see it introduced too soon. “Mobility before stability” is my mantra. If you don’t have full mobility in your spine, there is a reason, and it must be explored. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You don’t want to stabilize this scenario. You want to restore proper mobility first and then stabilize your spine. I can’t tell you how often I see people making this mistake. When it comes to back pain and working out, mobility-first is a must. If you’ve got a stiff back but have been trying to stabilize it – this could be why your back is getting aggravated when you work out. Stability work has been introduced too soon.

3. Poor Core Activation

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your “6-pack abs” are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or when performing complicated, coordinated movements such as tennis or golf – you’re setting yourself up for injury. The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. If you’re constantly having back pain every time you work-out or exercise, it could be that you lack the ability to activate your core properly – and/or when you need it.

4. Poor (or non-existent) breathing technique

Not breathing properly – or not breathing at all – can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, deep back muscles, pelvic floor musculature, and your diaphragm. Your diaphragm is what controls your breathing. Let’s say you hold your breath when you exercise. This means your diaphragm isn’t expanding or contracting, which impacts the other four muscle groups in your deep core. All four muscle groups must work together in order for your core to be functional and strong. Plus – when your diaphragm – or any other muscle group in your deep core can’t work like it should – you get unnecessary pressure and strain on your back muscles. If you’re constantly aggravating your back every time you work out – make sure you’re breathing properly. Or at the very least, not holding your breath.

5. Improper form

Perhaps the most common reason working out aggravates your back is because you’re not using proper form. There’s a lot of people out there who think posture and form don’t really matter. But they do. When you lift weights, for example, you’re adding load to your spine. It’s essential you have good form and technique when your spine is under load or stress. The tricky thing about form, however, is that you can get away with poor form for a time. It might not hurt the first time you lift with improper form – or the fourth – but by your 100th rep – your back will start talking to you. Same goes for body weight exercises. Just because you aren’t adding load to your spine in the form of an external weight, doesn’t mean you can’t still aggravate it by doing the same movement over and over poorly. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture. Otherwise – if you haven’t aggravated your back yet – it’s only a matter of time.

If you’re always hurting your back when you work out – it’s likely due to one of these five reasons.

Get expert help to figure out which one it might be – because at the end of the day – exercise is good for your back – and you don’t want to avoid it or dismiss it when there could be a perfectly reasonable explanation

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

Consider speaking with one of my specialists – we will ask you all about what’s been going on with you and see if we would be a good fit to help! CLICK HERE to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request one of her free guides for getting rid of back pain – visit her website www.cjphysicaltherapy.com or call 603-605-0402

5 Signs Your Core is Weak – And What You Should Do About It!

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A strong, healthy core is important for our health and posture. When your core is strong and working properly, you will have less back pain, better posture, and will move with more ease and endurance.  But how do you know if your core strength is where it needs to be? 

Here are five signs that might indicate your core is weak and what you can do about it:

1. Your Back Hurts

The most common side effect of a weak core is back pain. Your core’s job is to support your spine and act as the center from which all movement stems. If those muscles are not properly conditioned – meaning, if they aren’t conditioned to engage when they are supposed to – your spine is at risk for being overworked and muscular strain and tension is inevitable. 

What can you do? When it comes to back pain, it’s really important that you talk to an expert about how to properly strengthen your core. Don’t go at it haphazardly. A lot of people jump to core strengthening to fix their back pain when there are other things that need to be addressed first. Without proper guidance, you could make your back worse doing the very thing that is meant to help you.

2. You Have Poor Balance

Believe it or not, it’s not just your feet and ankles that help you balance. Your core strength plays a huge role in this as well. Your core muscles surround your pelvis and help to stabilize it – if those muscles are weak – particularly your hips and glutes – your balance will undoubtedly be affected. 

What can you do? Work your core in a functional manner. If you’re already practicing balance exercises, don’t just hope for sheer luck. Actively focus on the connection between your foot and your deep core. You’ll be surprised at what this visualization will do for both your balance and core activation. If you struggle with this – then it’s a good idea to work with an expert who can help you.

3. You slouch all the time

If you’re struggling to maintain good posture – you might have a weak core. Observe your posture right now. Are your shoulders rolled forward? Is your low back missing its natural curve? Is your head poked forward? When you go to correct your posture – does it feel difficult or tiresome to maintain? If so, your core might need some endurance-training.  

What can you do? This is a situation where consistent core training will carry over into your sitting posture. Your postural stabilizers are what allow you to sustain prolonged sitting and standing postures. The more accustomed they are to being activated and working – the more likely they will naturally kick in when you’re standing and sitting. Over time, it will become easier to maintain good posture and with a lot less effort.

4. Your feet and wrists hurt

When you have a weak core – and lack the proper central support and stability you need – your outer muscles and joints will eventually suffer. We already talked about balance. If your core isn’t working to help you stay more stable, your feet will have to work harder, resulting in overtaxing of the tissue on the bottom of your foot. If your middle back can’t support you when you’re pushing or pulling, your wrists will take the brunt and this can result in stiffness or pain over time. If you’ve got any chronic problem that isn’t getting resolved over time, something is missing. In the case of your wrists and feet – it could be a weak or underfunctioning core.

What can you do? If you’ve been trying to resolve your foot or wrist pain for a while and aren’t getting the results you hoped for – consider shifting your focus to deep core training. I’m not talking sit-ups and crunches, I’m talking about deep stability training that is going to result in a better balanced body – where your wrists, core, and feet are all connected and working together. Something like Pilates can help you achieve this – provided you’re working with a highly skilled instructor. Pilates is specifically designed to strengthen your core in a way that emphasizes full body strength.

5. You’re always holding your breath 

If you’re always being reminded to breathe when you move or exercise, it’s a sign your core might not be working properly. Your deep core is made up in part by your diaphragm, which is your main breathing muscle.  When your core lacks stability, or in most cases, doesn’t know how to engage in the right way, your diaphragm will contract to compensate.  One of the most tell-tale signs that this is happening is that you always hold your breath during exercise. 

What can you do? I always say – when in doubt – just breathe. If you’re breathing through every movement then your diaphragm can’t stay contracted. Start here. If you notice that other things start to get tight and uncomfortable as a result – namely your hips and your neck – then it means you’re now using those muscles instead of your diaphragm to compensate for your weak core. In that case – consider getting expert help because these movement patterns are hard to break on your own. 

If any of these signs sound familiar to you, then you might want to start paying more attention to your core strength!

There’s so much more to a strong core than 6-pack abs and the ability to hold a plank for days. Pay attention to the more subtle signs I’ve just outlined for you. If you’re noticing one or more – it could be a sign that your core needs some extra love and attention – and the you need to learn how to strengthen it properly. 

Are you local to Portsmouth, NH? 

Check out our Pilates offerings and other services here. We have specialists who may be able to help you strengthen your core properly – from the inside out.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].