Tag Archive for: physical therapy

Vertigo and Fall Risk: 5 Ways to Safeguard Yourself Against Unexpected Falls

January 12, 2024/in Movement/by Carrie Jose

Vertigo is often described as a distressing sensation of spinning that makes you feel as if the world is moving around you – or that you are spinning yourself. It’s an unsettling experience – and can be dangerous – as it puts you at a greater risk for falling. Over 3 million older adults are treated in the emergency room every year due to fall-related injuries. One out of five of those falls causes serious injury – like a broken bone or head trauma.

If you are suffering from vertigo, it’s critical that you take time and due diligence to get to the bottom of what’s causing it so that you can safeguard yourself against unexpected falls. The good news is this is entirely possible. But first, it’s important for you to know that vertigo is a symptom, and not a diagnosis. Vertigo is the result of a disturbance in your inner ear (vestibular system). It can be caused by various things, namely, Meniere’s disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and cervicogenic dizziness… just to name a few. Once you’ve identified the root cause of your vertigo – the correct treatment approach is possible. I can’t tell you how many horror stories I’ve heard from people suffering from vertigo longer than they needed to – all because they didn’t get the right tests to diagnose the cause – or were prescribed medication they didn’t actually need. All the while, continuing to live with a constant fear of falling and never knowing when their next vertigo attack would occur.

The reason suffering from vertigo puts you at such risk for falling is because when it comes to balance, we rely on three bodily systems. One is your vestibular system, which vertigo disrupts. The other two systems are your vision and proprioception. All three systems are responsible for helping you orient and visualize yourself in space. When you have vertigo – you’re forced to rely on (and train) the other two.

The good news is there are strategies you can employ to compensate for a mal-functioning vestibular system.

If you suffer from vertigo – here are five simple and effective strategies that can help minimize your fall risk and enhance your safety:

Remove Hazards: Roll Up and Stow Away Rugs

In a home environment, even seemingly harmless elements like rugs can pose a significant risk. Rolling up and storing rugs minimizes the chance of tripping or slipping, providing a safer space to move around, especially during vertigo episodes. Smooth, obstacle-free floors reduce the likelihood of unexpected falls and help maintain stability.

Illuminate Pathways: Install Night Lights for Nighttime Mobility

Navigating through the house at night, especially when experiencing vertigo, can be daunting. Installing night lights along hallways, staircases, and near the bathroom provides essential visibility and helps prevent accidental falls. With well-lit pathways, you can confidently move around during the night, reducing the risk of missteps or collisions with objects.

Exercise Caution: Walk with a Companion and Use Hiking Poles

Engaging in physical activity is crucial for maintaining health, but doing so alone when experiencing vertigo can be risky. Pairing up with a friend for walks provides both companionship and an added layer of safety. Additionally, using hiking poles offers stability and support, especially when dizziness strikes unexpectedly, allowing for more secure movement during outdoor activities.

Focus and Reorient: Lock Your Gaze on a Steady Object during Dizziness

During vertigo episodes, it’s common to feel disoriented and unsteady. A practical technique to regain stability is to lock your gaze on a stable and fixed object. This method helps recenter your focus and gradually reduces the sensation of spinning or imbalance, allowing you to regain control of your body and surroundings.

Safe Driving Practices: Stabilize Focus and Minimize Distractions

When vertigo strikes while driving, it’s essential to prioritize safety. If feeling dizzy behind the wheel, fixate your gaze on a stationary object—such as the dashboard or the road ahead—to regain a sense of stability. Additionally, reduce all distractions by turning off the radio and refraining from engaging in conversations with passengers. Prioritizing focus and minimizing external stimuli can help mitigate the risks associated with vertigo while driving.

While these strategies can be helpful – please know that you don’t have to let vertigo keep running your life and stop you from doing what you love. With proper treatment, you can stay out of the hospital, stop taking medication and move out of the fall risk category with the support of a good vestibular specialist. Diagnosing vertigo is a step-by-step process that starts with a detailed medical history and extends to various physical examinations. Vestibular specialists will employ a range of tests, including specialized balance assessments for fall risk, to pinpoint your exact cause of vertigo. Navigating through these diagnostic tools is crucial for developing a treatment plan that works. Once the correct diagnosis is made, treatment can begin immediately to start retraining your brain. The key is to train your brain to stop relying on the damaged part of the inner ear (that leads to vertigo and dizziness) – and help it to rely on your other two balance systems instead so that you can stay safe and improve your balance.

Interested in learning more about Vertigo?

Join us for our Free Online Masterclass for Vertigo Sufferers! It’s happening January 23rd, from 6-7pm via zoom – click here to reserve your seat before they’re all 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, or seat in her upcoming Masterclass for Vertigo Sufferers – visit www.cjphysicaltherapy.com – or call 603-380-7902

6 Tips for Managing Debilitating Vertigo at Work

January 4, 2024/in Movement/by Carrie Jose

“Vertigo” is the sudden onset of dizziness, spinning and nausea that often stops you in your tracks without any visible signs or warning. If you’ve ever experienced vertigo, then you know the debilitating effects it can have on your daily life and ability to work. For those that haven’t experienced vertigo – it can be difficult to explain. Your co-worker will never understand why you missed that deadline. Your boss won’t understand why you had to miss work for the past three days. All because for 72 hours, the room has been spinning on and off, and you couldn’t spend more than five minutes reading on your computer before you felt the vertigo coming back on.

Perhaps the most challenging aspect of suffering from vertigo is the unknown. By definition, vertigo is a symptom that occurs due to a miscommunication between your vestibular system (responsible for balance and spatial orientation) and your brain’s interpretation of those signals. When the signals are mismatched – the result is vertigo – that awful, uncontrollable sensation of spinning or dizziness.

What does this look like in real life?

You could turn your head slightly too far or slightly too fast and bam – here comes the dizziness. You could get up from a chair or out of bed too quickly and suddenly the room is spinning. Vertigo has the ability to quickly and without notice turn the ordinary, mundane parts of your day into the scariest parts of your day… Suddenly everything from driving, working at a computer, walking to lunch, or getting up to go to the bathroom become debilitating and unreliable. Every single one of these tasks not only becomes difficult – but often the scariest parts of your day as well. becomes the scariest part of your day. Why? Because every single one of these tasks requires balance and coordination – and when your vestibular system and brain don’t cooperate – these things become extraordinarily difficult.

While there are many underlying causes to vertigo, and only a vertigo specialist can determine this, there are some things you can do to mitigate the onset of vertigo so that it doesn’t continue to impact your work day.

Here are tips for managing debilitation vertigo at work:

1. Utilize Blue Light Filter Glasses

Prolonged screen time can exacerbate vertigo symptoms, and these glasses work to block harmful blue light emitted by digital devices. By alleviating the eye strain associated with screen time, these specialized glasses create a more comfortable visual experience, potentially lessening the likelihood of triggering or worsening vertigo episodes during your work day – especially if your work involves extended use of the computer.

2. Wear Noise-Canceling Headphones

Noise sensitivity often accompanies vertigo. Using noise-canceling headphones can create a quieter work environment for you, minimizing any overstimulation that might trigger or worsen your vertigo episodes. When you reduce auditory input, you’ll find it easier to focus, and it will be a calmer sensory experience for you at work.

3. Opt for a Swiveling Computer Chair

A swiveling chair offers the flexibility to rotate your body when shifting between screens or tasks. This minimizes abrupt head movements, which can trigger vertigo. The ability to turn your body rather than constantly turning your head can significantly reduce the risk of a debilitating vertigo episode happening during your work hours.

4. Find a Stable Focus Point During Physical Activities

Engaging in physical tasks that might induce dizziness can be challenging. If you experience vertigo during physical movements, find a stable object or point in your surroundings and focus on it. This fixed reference point can help recalibrate your balance and reduce the sensation of dizziness.

5. Be Mindful or your Movement and Pace

Sudden and quick movements are known to trigger episodes of dizziness and spinning from those suffering from vertigo. When you mindfully and purposefully slow down – you alleviate the stress on your vestibular system. This can go a long way in helping to minimize triggers that may exacerbate your vertigo symptoms.

6. Ensure Adequate Lighting

Aside from your vestibular system, your vision also helps significantly with balance. By ensuring ample lighting in the workspace – you can help compensate for the disruptions caused by vertigo. Well-lit environments provide clearer visual cues, assisting in maintaining balance and reducing the risk of falls during a vertigo episode.

If you’re currently suffering from vertigo – or have been dealing with vertigo on and off for years – perhaps it’s time to consult with a physical therapy vertigo specialist. The right practitioner will perform specialized tests to identify if your root cause is movement based – and can determine if you need to see a neurologist or eye specialist instead or in conjunction. By going this route first, you can determine if the cause of vertigo can be successfully treated naturally , and avoid treatment approaches that involve medications or procedures that you might not need. But in the meantime, hopefully some of these strategies help you create a more manageable work environment if you suffer from vertigo on a regular basis.

4 Spine-saving tips for less pain during Holiday Travel

December 21, 2023/in Movement/by Carrie Jose

For many, Holidays mean traveling to visit family and friends. Or perhaps you’re a New England resident and just want to get away from the cold for a few days. Either way, hours in the car, hours on a plane, and sleeping on mattresses you’re not used to can wreak havoc on your spine.

The good news is there are some simple and easy things you can do to help prevent this. Here are 5 of my top tips to save your spine during holiday travel:

Tip #1: Interrupt your sitting

The biggest strain on your body while traveling is undoubtedly the prolonged periods of sitting. Our bodies are made to move continuously throughout the day. Too much sitting puts extra load and compression on your spine, and can trigger an underlying problem you weren’t even aware of. On road trips or long plane rides, getting out of your seat is critical for keeping your neck and back healthy. In a car, plan extra time in your trip to pull over at rest stops and walk around. On a plane, choose an aisle seat so it’s easy to get up and stretch. I recommend interrupting your sitting every 30 min for good neck and back health whenever you’re able. Keeping up with that frequency while traveling can be difficult, but something is better than nothing.

Tip #2: Use a lumbar pillow

While sitting, a proper lumbar pillow is not only essential for good lower back alignment, but also for proper neck alignment. We have natural curves in our spine that are designed to absorb shock and disperse load. Ever heard of the dreaded “forward head”? That’s the posture your neck assumes when it needs to compensate for lower back slouching. When your spinal curves are not maintained, such as when sitting or slouching for prolonged periods, you get abnormal and unwanted forces throughout your spine, resulting in pain and stiffness that can occur in both your neck and lower back. When purchasing or making your own lumbar pillow – you want to make sure the roll is thick enough to maintain the natural curve (lordosis) in your lower back without much effort while you sit. The built-in lumbar supports that you can adjust in your car are typically not adequate enough – so don’t rely on those. Have a small pillow or roll handy to compensate.

Tip #3: Maintain a neutral spine while you sleep

When traveling and facing various mattresses that might not align with your typical sleeping setup, there are ways to compensate to prevent neck and back pain. Start by packing a portable travel pillow that offers adequate support for your neck’s natural curve. If the mattress is too firm, consider using extra blankets or folded clothes strategically placed under specific body parts, like your hips or shoulders, to create a more cushioned surface. If the mattress is too soft, try placing a firm object, like a folded towel or a small pillow, beneath your lower back for added support. Sleeping on mattresses you’re not accustomed to while traveling can be challenging – and you’re never quite sure what you’ll be getting into. The name of the game is to position yourself in a way so that you’re sleeping in a neutral position – where your head, neck, and spine all align.. It might take a bit of trial and error, but adapting your sleeping setup while traveling can significantly reduce discomfort and ensure less pain and strain in your neck and back.

Tip #4: Stay Hydrated

Staying hydrated during holiday travel plays a crucial role in preventing neck and back pain due to its impact on overall bodily function. Adequate hydration supports the elasticity of spinal discs, which act as cushions between vertebrae, preventing them from becoming stiff and compressed. Dehydration can exacerbate muscle tension and reduce flexibility, increasing the likelihood of discomfort and stiffness in the neck and back. By drinking enough water, you help maintain proper circulation, delivering essential nutrients to muscles and tissues, promoting their relaxation, and reducing the risk of cramping or spasms that often contribute to neck and back pain during long journeys. Plus – hydration supports your body’s ability to recover and repair – so when you’ve got those travel-related strains on your spine that are ultimately inevitable no matter how careful you are – you’ll simply feel better faster.

Traveling any time of year, especially during the Holidays, comes with its own set of challenges and problems. There is no need to add unwanted neck and back pain to that list. Implementing even just one of these spine-saving tips next time you travel can make a real difference in alleviating neck and back pain – and allow you to focus on your destination instead.

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

Request a free discovery visit by clicking here. We will ask you all about what’s been going on and see if we would be the best 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 request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected]

Before you get a Cortisone Injection – Ask these questions

October 5, 2023/in Movement/by Carrie Jose

Cortisone (or steroid) injections have become increasingly popular over the years for people looking to address chronic joint pain and inflammation.

Why have they become so popular? Well, for starters, they have a reputation for getting rid of pain quickly, and they are generally considered a better alternative to something like surgery. But there can be consequences when you choose the “quick-fix” route. Before you decide on whether or not a cortisone injection is right for you – let’s look at some important considerations.

First… the benefits…

Quick Relief:

This is the main reason folks don’t think twice about getting a cortisone injection. And when you’ve been suffering for a while with something like back or knee pain – or it keeps coming back at the most inopportune times – cortisone injections are an attractive option.

Targeted Treatment:

In contrast to a pain pill – or even an oral steroid – people like the idea of a cortisone injection because you can choose exactly where it’s going to go. This makes your treatment more targeted and theoretically, more effective. Plus, a localized injection compared to an oral medication could mean smaller amounts of the drug going into your body, thus, potentially minimizing any potential side effects.

Alternative to Surgery:

I’m a huge advocate of avoiding surgery unless absolutely necessary. So if all other conservative and natural treatments have truly failed, then a cortisone injection could be a good option for you. It’s certainly better than a surgical procedure.

Now – let’s look at the risks and side effects…

Cartilage Damage and Weakening of Tendons:

Based on research and evidence, we know that repeated cortisone injections cause damage to cartilage (the cushioning material inside your joints) and weakening of tendons. This might not be an issue for you if you know you’re getting a joint replacement surgery and using cortisone to pass the time and help control pain. But otherwise, repeatedly getting cortisone injections in your joints or tendons will increase your likelihood of needing surgery down the road – so it’s an important consideration – especially if your first cortisone injection doesn’t work or doesn’t last.

Risk of Infection:

This is an important risk to consider – especially when it comes to cortisone injections in your spine. With any type of injection – you run the risk of inadvertently introducing bacteria, which could lead to serious complications. While an infection is not ideal in any area of your body, it can be especially dangerous in your spine because it could lead to things like meningitis and epidural abscesses.

Short-term Relief:

While the quick pain relief you can get from a cortisone injection seems attractive, there are unintended consequences. First, even though joint inflammation is what’s causing you pain, it’s rarely the root cause of your problem. That’s why the relief you get from cortisone injections rarely lasts and the pain returns. The problem with this is that you’re more likely to get repeat cortisone injections which we know causes damage. Plus, once the pain is gone, you think your problem is gone, and you’re less likely to address it.

If after all this you’re still considering a cortisone injection – at least ask these important questions first…

Are you absolutely sure the root cause of your issue is inflammation? Or is it a symptom of an underlying problem?

I can’t tell you how many people (even healthcare providers) get this wrong. Since 70-80% of all joint pain is mechanical in nature – meaning something in the joint isn’t moving right, and thus, irritating the surrounding structures which can lead to inflammation – it’s critical you rule this out first. Cortisone injections won’t fix an underlying mechanical problem.

What are the long-term side effects of repeated cortisone injections?

This can be a bit of a trick question – because we already know the answer to this. Repeated cortisone injections cause joint and tendon damage. If your doctor is not already aware of the current research, or dismisses it, they are less likely to caution you away from the procedure when there could be better, more natural alternatives. It’s always important to be well-informed and advocate for yourself when you’re working with any type of healthcare practitioner and being recommended an injection or procedure of any kind.

What are the alternatives?

Have you already tried quality physical therapy treatment that is designed to address your underlying problem and help you get rid of your joint inflammation naturally? Pain relief is slower with this option, and can sometimes be worse before it gets better, but it’s more likely to result in long-term relief instead of short-term. Movement and exercise are considered the best medicine when it comes to joint pain, inflammation, and arthritis. You may need some guidance so as not to overdo it, but exercises such as Pilates and Yoga are gentle on your joints, allowing you for safe movement without exacerbating your pain in most cases.

When prescribed properly, cortisone injections do work. But sadly, for most people, steroid injections are oversubscribed, not always necessary, and disappointing when they don’t work or last.

I’ve seen too many cases over the course of my career where cortisone injections provide a false sense of hope, or worse, irreversible joint damage. For all of these reasons, I highly recommend you educate yourself, and consider all the risks and possible alternatives before you get a cortisone injection. I’m a huge fan of avoiding pills, procedures, and surgery and using natural movement and exercise to get rid of most musculoskeletal problems. If you’re looking to do the same – consider talking to a mechanical pain expert who can 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].

The Top Four Benefits of Orthopedic Dry Needling and Why You Should Consider it.

September 29, 2023/in Movement/by Carrie Jose

Orthopedic dry needling is a modern therapeutic treatment technique that has been adopted by physical therapists and medical professionals to alleviate pain and improve muscle function. But despite its escalating popularity, I’m still surprised at how many people are unaware it even exists.

What exactly is orthopedic dry needling?

Orthopedic dry needling involves the insertion of fine, sterile acupuncture needles into myofascial trigger points (“knots”), tendons, or muscles that are typically painful, stiff, or causing discomfort. Unlike acupuncture, which aims to balance and restore the flow of energy (“chi”) in your body, dry needling focuses on restoring your muscles and soft tissue back to their optimal state. During a dry needling treatment, a needle is inserted into specific areas to encourage blood flow and homeostasis, sometimes eliciting a ‘twitch’ response in the muscles. The needles may remain in place for a short duration, or may be removed quickly, depending on the condition being treated. Dry needling is backed by scientific research and has been shown to work effectively. It’s thought to turn off trigger points, ease muscle tension, reduce inflammation, and relieve pain – all to help improve how your muscles perform and work.

Here are the top 4 benefits of orthopedic dry needling and why you should consider this treatment technique if you haven’t already:

1. Pain Relief

Dry needling can quickly alleviate pain, which means you can get back to your regular activities sooner. While the treatment itself can sometimes be painful, and lead to residual soreness 24-48 hours after your treatment, you’ll find that the positives far outweigh the negatives. Most of my clients find that a little bit of soreness right after the treatment is well worth the pain relief they experience afterwards. Dry needling works best for pain relief when it’s performed alongside functional and integrative therapies such as corrective movement strategies – which will result in long-lasting pain relief instead of more short-term.

2. Better Mobility

Dry needling does more than just relieve pain – it helps to enhance how you move. When muscles are tight, they can restrict movement and create a lot of discomfort. By releasing tension in tight muscles, increasing blood flow, and reducing inflammation – dry needling facilitates more comfortable and more extensive range motion in your joints. This allows you to move more freely and perform your favorite activities with less pain and restriction. In conjunction with corrective exercises and stretches, dry needling can be an extremely valuable tool for enhancing and maintaining good mobility.

3. Enhanced Muscle Function

Good mobility is just one aspect required for optimal muscle function. Your muscles also need to know how to activate properly and together. Sometimes – when you’ve been suffering from pain for a while – the muscles surrounding the problem area can “fall asleep at the wheel”. While you may be able to successfully get rid of your pain in a particular area, getting rid of and correcting the problem is a different story. I often say: “just because your pain is gone – does not mean your problem is gone”. If you don’t address underlying muscular compensations, your pain will eventually come back and sometimes it’s worse. The stimulation provided by orthopedic dry needling can help get your brain to pay more attention to the affected area, thus, helping “sleepy” muscles come back to the party and work like they’re supposed to.

4. Faster Recovery

When you’re injured, your body needs all the help it can get to heal. Dry needling not only enhances blood flow to the targeted area, but helps to create an environment for muscle regeneration as well – thus – helping to speed up the recovery process of injured or damaged soft tissue. Additionally, the improved blood flow aids in the removal of metabolic waste products and the delivery of nutrients to the tissues, fostering faster healing of the injured areas and less inflammation. This accelerated recovery is particularly valuable for athletes or weekend warriors aiming to return to their sport faster, as well as anyone looking to get back to their favorite activities as quickly as possible.

Should you consider orthopedic dry needling?

When I think of orthopedic dry needling, I think of it like a helping hand to feel better, move more freely, and enhance just about any other treatment you’re using alongside it. For example, a corrective exercise is only going to work if you can execute it properly. If you’ve got stiff, painful muscles that prevent you from performing your exercise or stretch that you know you need to do to help a particular problem – dry needling can be the magic in between.

It’s important to note that dry needling is not necessary or right for everyone. So it’s important that you know what it is and when it can be used to improve your health. If after reading this article you think orthopedic dry needling could be something that you’re missing – talk to a qualified physical therapist or health care practitioner who practices dry needling – and ask if you’re a good fit for this treatment technique.

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].

6 Reasons Your Back Surgery Failed

September 8, 2023/in Movement/by Carrie Jose

Back surgery, often viewed as a last resort for those suffering from debilitating back pain, has become increasingly common in the last 15 years.

A quick Google search reveals that an estimated 1.5 million spinal fusions are performed annually in the United States alone. When you consider that 70-80% of all back pain is considered “non-specific” and does not require surgery – that number is staggering. Additionally, it’s been well documented that 20-40% of all back surgeries fail, resulting in what we call “Failed Back Surgery Syndrome”. So why then – do we continue to operate?

If you or a loved one is considering back surgery – I highly recommend you do your due diligence and research first.

To give you a head start – here are 6 reasons why back surgery often fails:

1. Incorrect Diagnosis

If the wrong diagnosis leads you to an unnecessary surgery – then your back surgery is going to fail. How does this happen? All too often we blame aging structures in the spine as the main source of our pain. But what many fail to understand is that arthritis and degenerating discs (for example) are a normal part of aging. Everyone has it – but not everyone has back pain. An aging spine is not a reason to get back surgery – so be cautious anytime someone blames arthritis or disc degeneration for your pain. It’s typically not the full story.

2. Surgical Complications

Surgical complications are a risk when you undergo any type of surgery – even when it’s coined “minimally invasive”. From anesthesia reactions, to accidentally nicking a nerve, to the possibility of infection – complications can occur – and some of them irreversible. Conservative therapy and natural treatments involving movement and exercise come with virtually no risk – and have better outcomes than surgery according to research. You want to make absolutely certain that a back surgery is warranted before you put yourself at risk for complications.

3. Scar Tissue

Scar tissue is an unavoidable consequence of any surgery and a necessary part of the healing process – but its impact is significantly underestimated. For some, scarring can get out of control and be excessive, manifesting itself similar to an auto-immune condition. For others, they simply have no clue that scars need to be managed and mobilized. Unmanaged scar tissue will become adhesive and may cause problems with your nerves, fascia, and general mobility. While there are treatments such as Shockwave therapy that can help regenerate damaged soft tissue from scarring – unmanaged scar tissue can be one reason your pain doesn’t resolve after back surgery.

4. False Expectations

A lot of folks go into back surgery with false expectations. They think they’ll be out of pain and back to their activities in no time. But proper healing from back surgery is deceivingly long. While most incisions will technically heal in about 2 weeks – your body has a different timeline. Most people grossly underestimate the impact their condition prior to surgery will have on their recovery. Your pain may be gone after surgery, but all of the underlying, compensatory problems that developed leading up to your surgery have not magically disappeared.

For example, it takes a minimum of 6-8 weeks to build and retrain muscle. If you had nerve impingement that was inhibiting a muscle from performing properly, it’s going to take several months to get that strength back. When this is not considered, and you jump back into activities too soon, you’re asking for trouble.

False or mismanaged expectations about recovery after back surgery is a big reason for poor outcomes.

5. Images are Misleading

X-rays and MRI’s do not tell the full story when it comes to back pain. And in most cases, they are misleading and can result in an incorrect diagnosis. For example, I already mentioned to you that most things you see in your images – such as arthritis, degenerative disc disease, and even bulging discs – occur naturally as you age.

But they don’t always lead to back pain.

Studies have shown that 60% of folks in their 50’s will have bulging discs on X-ray and 80% will have disc degeneration – regardless of whether back pain is present or not. These statistics only increase with age. If you allow your imaging alone to dictate your decision to get back surgery – you’re increasing your risk of it failing because it may not have been necessary in the first place.

6. Back Surgery Makes Money

At the end of the day, healthcare is a business. And back surgeries are among the most lucrative procedures in the medical industry. According to studies and statistical data, common back surgeries like lumbar fusion cost anywhere from $50,000 to $90,000. But it only costs hospitals a fraction of that amount to actually administer. Plus, despite its unethical nature, some surgeons have been reported to receive kickbacks for using certain medical devices and performing more surgeries. While this is an indirect reason for your back surgery failing, it’s not something you can ignore. The profitability of back surgery naturally lends itself to being overutilized when there could be better, natural solutions instead.

After all this, I hope you can see that back surgery isn’t a decision you should take lightly, and a good outcome should not be assumed.

Consider the statistics. Anywhere from 20-40% of all back surgeries fail and it could be due to any of the reasons we just looked at. Most back pain (70-80% to be exact) is considered non-specific and mechanical in nature, and can be resolved naturally with prescriptive exercises, lifestyle changes, and corrective movement strategies. It’s worth exhausting all of these options first before jumping into a surgical procedure that has a good chance of failing you.

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

5 Ways Pilates can help Manage Osteoporosis

August 18, 2023/in Movement/by Carrie Jose

Osteoporosis is a “silent” disease of the bones that makes them weaker and far more susceptible to breaking.

The Bone Health & Osteoporosis Foundation estimates that approximately 10 million Americans suffer from this disease, and another 44 million have low bone density. Osteoporosis affects one in two women and one in four men. A woman’s risk of breaking a bone when she has osteoporosis is equal to her combined risk of breast, uterine and ovarian cancer. For men, they are more likely to break a bone than get prostate cancer. Hip fractures are common with osteoporosis, and of the nearly 300,000 folks who fall and break their hips, 25% end up in nursing homes and never get back to their previous function.

If these statistics don’t scare you, they should. But the good news is there are plenty of things you can do – starting right now – to help protect yourself from this condition. When you research osteoporosis, diet and exercise consistently come up as key prevention strategies. When it comes to exercise, you want to make sure it focuses on healthy resistance exercises, mobility, flexibility, and balance.

Well… there happens to be one exercise system that accomplished all of this. It’s called Pilates.

Here are 5 Ways Pilates can help manage your Osteoporosis:

1. It’s a weight bearing exercise

One of the primary recommendations for preventing and managing osteoporosis is to engage in weight-bearing exercises. Well here’s the amazing thing about Pilates – the entire exercise system is based on bearing your own weight through various movements. Pilates gradually progresses you through postures of lying, kneeling, and standing – on both hands and feet – allowing you to bear weight through multiple planes and postures. This makes Pilates an excellent choice for those wanting to better manage their osteoporosis.

2. It improves muscle strength

You might be wondering… how does improving muscle strength help with bone strength? As your muscles become stronger, they pull harder on your bones, which helps improve the inherent strength of your bone. Plus, stronger muscles provide more support to your skeletal system as a whole, putting you at less risk of a fracture. Pilates in particular focuses on core strength – which is key for providing support to all your other muscles. And when you use the Pilates equipment to enhance your practice, you’ve got the resistance of springs putting special focus on all your tiny muscles, which helps strengthen areas of your body that might be inaccessible via traditional strength training methods.

3. It enhances flexibility and range of motion

It’s quite common for your joints to get stiffer and your flexibility to be impacted when you’ve got osteoporosis. You may think this is inconsequential – but stiffness and immobility can actually create more stress on your bones – which is what we’re trying to avoid. Pilates exercises emphasize the stretching and elongation of muscles, which inherently improves your range of motion. This will not only make you feel better – but makes doing everyday tasks a lot easier and they’ll feel less stressful on your body – which is important when you’re dealing with osteoporosis.

4. It encourages proper alignment and posture

Over time, osteoporosis can lead to unwanted changes in your spine, such as a stooped or kyphotic posture. Not only will these changes make it more difficult and uncomfortable to sit upright and move around, but they can make the bones (vertebrae) in these deformed areas of your spine more susceptible to damage. Pilates can help prevent and reverse these changes. Pilates emphasizes lengthened and proper spinal alignment and helps you to become more aware of your posture during the day. If you want to avoid (or even reverse) a slumped and kyphotic posture – with or without osteoporosis – Pilates can help.

5. It helps improve your balance and stability

Fall prevention is critical for those living with osteoporosis. And one of the best ways to prevent falls is to work on your balance. One might not think of Pilates as playing a key factor in this, however, Pilates is an exercise system that not only focuses on your core, but your feet as well. Everyone knows that a stronger core is going to make your whole body feel more stable. But when you’ve got feet that are more mobile and more in-tune with the ground – it dramatically improves your balance – making Pilates a safe and healthy way to not only improve your balance but decrease your risk of falling.

The best management of osteoporosis requires a multifaceted approach – and factors such as diet, nutrition, and exercise modifications must all be considered. Pilates is just one factor in the mix. But I like it because it hits on so many areas that are critical for the successful management of osteoporosis. If you’ve never tried Pilates before, I’d highly recommend giving it a whirl.

But be sure to get approval from your doctor first, and enlist the help of a movement specialist who understands how to work with someone suffering with osteoporosis.

Local to Portsmouth, NH? Consider speaking with one of my specialists by clicking HERE.

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 enroll in her upcoming OsteoCore Strong Bones Program – visit her website www.cjphysicaltherapy.com or call 603-605-0402

Your Pains Location May Not be it’s Source

July 28, 2023/in Movement/by Carrie Jose

Pain is both a confusing and scary topic.

There’s lots of advice out there on what to do when you experience pain and it’s hard to know who to listen to. Should you rest – exercise – apply heat – apply ice – see a doctor – get an MRI – or just wait it out to see if it goes away on its own? Any or all of this advice could be right – but it’s irrelevant until you accurately determine where your pain is coming from.

For example, if you have pain in your knee, and it’s coming from your back, the best knee treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the most common reasons why so many people suffer longer than they need to, and it’s one of the biggest contributors to unnecessary procedures and surgery. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain, alone, is not a reliable way to figure that out.

Let me explain.

I’ve met people who’ve suffered from unrelenting tennis elbow for years – despite treatment protocol after treatment protocol – only to find out it was coming from their neck. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, they found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms, even when there wasn’t any spine pain. In other words, the pain they were feeling in their knee, elbow, or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you.

But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 40% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear. But what most people don’t realize is that these findings are quite normal and happen naturally as you age.

Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite the science proving this over and over – doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery – they let images and an inaccurate diagnosis lead the way.

Whenever I meet someone with isolated extremity pain, especially if it came on suddenly and out of nowhere, I always consider that it could be coming from their spine.

How can you figure this out?

Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time if it’s not addressed.

Moral of this story… If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source, and that where your pain is may not be where your problem is. And if you’re considering some kind of surgery or procedure, you definitely want to rule out that the problem could be elsewhere.

Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your elbow, knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

Looking for help and local to Portsmouth, NH? 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 get one of her free guides to knee and back pain, visit www.cjphysicaltherapy.com or email [email protected].

Running Over 50: Top 3 Injuries and What you can Do

July 21, 2023/in Movement/by Carrie Jose

If you love to run, then you’re probably no stranger to running injuries.

But if you love to run and you’re over 50, not only are you more likely to suffer a running-related injury compared to runners half your age, but you’ll tend to suffer from different categories of injuries as well. In older runners, we tend to see more soft-tissue related injuries versus problems with joints and stress fractures. Part of this is due to the fact that older runners may have been running longer. This predisposes them to more long-term wear and tear that is typically associated with soft tissue injuries like tendinopathy and plantar fasciitis. Older runners also are more likely to have altered their running mechanics over time, another factor that leads to injury. Either way, the good news is that once you know what to look for, you can take proactive measures to prevent these common running injuries as well as treat them naturally.

Here are the top 3 running injuries I see in people over 50 and what you can do:

1. Plantar Fasciitis

Plantar fasciitis is a condition characterized by a sharp, stabbing pain in your heel or bottom of your foot. It often worsens with the first steps in the morning or after long periods of rest. This discomfort comes from inflammation in your plantar fascia, a thick band of tissue running across the bottom of your foot from your heel to your toes. Factors such as overuse, improper footwear, high arches, flat feet, and tight calf muscles can all contribute to the development of plantar fasciitis, whether you’re a runner or not.

Prevention measures for plantar fasciitis include incorporating regular stretching and self-massaging of your plantar fascia and calf muscles before and after running. Balance exercises that focus on strengthening the intrinsic muscles of your foot, along with maintaining a healthy weight can also help – as it will allow you to better control and manage the load that gets transmitted through your plantar fascia. But what if you’re already suffering from pain due to plantar fasciitis? Don’t just resort to rest and ice, which has been known to impede healing. Plantar fasciitis requires prescriptive loading of your muscles in order to remodel the damaged tissue. This, along with non-invasive treatments such as Shockwave Therapy designed to enhance blood flow to the tissue, can aid in accelerating your healing.

2. Runner’s Knee (Patellofemoral Pain Syndrome)

Runner’s knee is a term used to describe a variety of conditions that cause pain around the kneecap (patella) – and is often synonymous with patellar tendonitis. You’ll notice your runner’s knee most during activities that require knee bending, walking downhill, or descending stairs. Overuse of your quadriceps muscles, poor tracking of your patella, and any other muscle or joint imbalance that results in increased load to the front of your knee can all result in runner’s knee.

Regular and balanced strength training of the muscles around your knee – particularly of the quadriceps, hamstrings, and hip muscles – is a key prevention strategy. Making sure you have good ankle and foot mobility is also important. Because if your foot doesn’t move well when you run, unwanted forces move up the chain into your knee, eventually leading to runner’s knee. If you’re already suffering from runner’s knee, then you’ll want to first mitigate your pain. Similar to plantar fasciitis – rest and ice won’t do much for you. Getting blood flow to the area – followed by carefully prescribed exercises designed to restore your mechanics and properly load your patella tendon – is what’s going to heal the irritated tissue in and around your knee and make it stronger.

3. Achilles Tendinitis

Achilles tendinitis presents as pain and swelling in the back of your heel or lower calf. Right where your Achilles tendon connects your calf muscles to your heel bone. Your Achilles pain will typically be most prominent during or after running. It may be accompanied by stiffness when flexing your foot. While the causes of Achilles tendinitis are very similar to that of plantar fasciitis, we see this occur most often with sudden increases in intensity or duration of training. Particularly, this happens when your body is not adequately prepared.

A gradual increase in training load, regular calf strengthening and stretching exercises, and proper warm-up and cool-down regimens can go a long way in preventing Achilles tendinitis. Be cautious of your footwear as well. Minimalist running shoes have become extremely popular. But, if you move into them too quickly, your Achilles tendon could become irritated due to the sudden change in load and force. If you’re already suffering from Achilles tendinitis, the treatment is quite similar to that of plantar fasciitis. The exception is that when it comes to tissue loading, you’ll want to focus more on your lower calf and Achilles tendon, versus the plantar fascia.

With all of these conditions, keeping yourself healthy and in good shape is crucial for prevention.

Enlisting the help of a running coach is also a good idea. They can address any potential issues with your running mechanics that may have occurred over the years. If you’re picking up running for the first time, or returning to it later in life, take it slow and easy. Consider talking to a movement expert who can detect and analyze any imbalances in your body. They can ensure that you’re moving and exercising correctly. Imbalances will cause you to compensate. This is not something that will be immediately obvious to you – until it’s too late.

Three Science-backed Reasons not to Rely on Imaging for Orthopedic Surgery

June 23, 2023/in Movement/by Carrie Jose

Approximately 7 million people undergo an orthopedic surgery each year in the United States. Topping this list are elective procedures (meaning they are not life threatening or urgent) such as ACL reconstruction, total hip and knee replacements, arthroscopic surgery (meniscus repairs, shoulder decompression, etc), and spinal fusions.

Now, what if I told you that of the top 10 elective orthopedic surgeries performed, only one (carpal tunnel syndrome) has real evidence to support that surgery will have a better outcome than conservative care. A recent study published by scientists in the UK hospital system and National Health service reviewed thousands of published studies in an effort to find out if orthopedic surgery was truly better than conservative care or placebo procedures. They found that sadly, thousands of patients are undergoing invasive procedures every year with known associated risks and complications. All while there was an equal or better alternative.

One of the biggest reasons this happens is because people rely on imaging (X-rays, MRI’s, CT scans) to determine whether or not they need surgery. Don’t get me wrong, this incredible technology has revolutionized the field of medicine and orthopedics. The problems occur when we fail to look at the full picture (no pun intended) and rely on images alone to make important decisions about our musculoskeletal health.

Here are three science-backed reasons not to rely on imaging alone when considering orthopedic surgery:

1. Imaging does not always correlate with symptoms

One of the most fundamental reasons why imaging alone should not dictate your decision to get orthopedic surgery is the well-documented lack of correlation between image findings and actual symptoms.

Studies have shown that 20-25% of all people will show a bulging disc in their spine on MRI. This happens even when they don’t have any back pain. At least 50% of adults over the age of 50 will show torn meniscus or cartilage in their knees and feel completely fine. In 2013, The New England Journal of Medicine published a study that found one-third of participants with no knee pain had “abnormal” results in their imaging. This was while one-half of the participants who actually experienced knee pain had completely clear scans.

We have to start normalizing what aging actually looks like on a scan. Just because you’ve got a bulging disc, torn cartilage, or even “bone on bone” arthritis – it doesn’t mean you need to rush into the operating room.

2. Risk of Over-diagnosis and Overtreatment

Overdiagnosis refers to the identification of conditions that aren’t actually causing symptoms or harming a patient. The biggest culprits here include spinal stenosis, joint arthritis, and degenerative joint conditions. One notable study from 2017 published in PLUS ONE, a peer-reviewed mega journal, found that at least 20% of arthroscopic knee surgeries were overdiagnosed and subsequently overtreated. How did they now? Because even though their scans showed things like “wear and tear” and torn cartilage, they had no relevant dysfunction or clinical findings. The only thing indicating they needed surgery was the overdiagnosis of normal aging in their knee.

A particularly sad story comes to mind as I write about this. I recall treating a man with spinal stenosis who was told by his doctor he needed steroid injections to calm the inflammation in his back. He had 6 weeks until his injections, and during that time, we were able to decrease his pain by about 80%. Since it’s impossible to reverse or stop spinal stenosis without surgery (because it’s related to wear and tear as you age), I knew that his pain was being caused by other unrelated factors. But following doctor’s orders, he still went through with the injections. Unfortunately, he had a bad reaction to the injections that left him worse off than when he started with me. His over-diagnosis of spinal stenosis led to a cascade of over-treatment and worse pain than when he started.

3. Non-surgical treatments can be equally effective (if not better)

Orthopedic surgery should really only be considered as a last resort. No matter how routine or “non-invasive” the surgery is, there are still risks of infection and complication, and you want to avoid those at all costs. The problem with conservative treatment is that it takes longer to get to the same (or better) result. And let’s face it, we live in a quick fix world and rarely have patience for this, especially when you’ve got a scan that seems to say otherwise.

Study after study shows that arthroscopic knee surgery (in particular) has the same or better results when treated conservatively (physical therapy and exercise). In fact, when you get arthroscopic surgery on your knee, it increases the likelihood you’ll need a total knee replacement. With back surgery, we know that in the first year or two, your pain will be better or gone. But by year 2-3, if your symptoms haven’t crept back in yet, you’ll feel just as good as your peers who forewent surgery. But after year three, your back pain symptoms tend to return, and you’ll often feel worse than your friends who decided to take the conservative approach from the get-go.

The research continues to support that 70-80% of all musculoskeletal pain is mechanical in nature. Mechanical problems have to do with movement dysfunction and lifestyle/postural habits. They don’t show up in a scan, and they are best treated conservatively. When you see something on an image, it’s better to assume it’s irrelevant and that you fall into the 70-80%. This will protect you from being overdiagnosed and help you avoid potentially unnecessary procedures and surgery. Pay attention to your pain, symptoms, and overall function – they tell a much better story than your images.

Are you local to Portsmouth, NH?

Consider seeing one of my Specialists – they’re experts in mechanical pain. In a free Discovery Visit you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health. Whether that’s working with us or not!

CLICK HERE to request a Free Discovery Visit.

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].