Tag Archive for: Portsmouth

Physical therapy specialist treating frozen shoulder with non-invasive therapy in Portsmouth NH

Frozen Shoulder: Could Your Metabolism Be the Real Culprit?

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Frozen Shoulder: Could Your Metabolism Be the Real Culprit? (Portsmouth, NH Expert Explains)

If you’re dealing with a frozen shoulder, daily life can become difficult fast. Simple activities like putting on a jacket, reaching for a coffee mug, or sleeping comfortably can feel stiff, limited, or nearly impossible.

Traditionally, frozen shoulder has been viewed as a musculoskeletal issue caused by a tight shoulder capsule. Because of this, treatments often focused on aggressive stretching, cortisone injections, or even manipulation under anesthesia.

However, new research suggests frozen shoulder may actually be rooted in metabolic and immune system dysfunction— not just the shoulder itself.

New Research Shows Frozen Shoulder Is More Than a Shoulder Problem

A 2025 review published in the Journal of Clinical Medicine (Navarro-Ledesma et al.) proposes that frozen shoulder is influenced by:

  • chronic inflammation

  • metabolic dysregulation

  • hormonal changes

  • immune system imbalance

This supports something clinicians have observed for years:
frozen shoulder is a whole-body condition that shows up in the shoulder.

This also explains why standard treatments often don’t work long-term — because they fail to address the deeper biological factors influencing healing.

Why Frozen Shoulder Happens More in People Over 40

Frozen shoulder affects 2–5% of the population, especially women ages 40–60. What’s striking is how strongly it’s linked to metabolic issues:

  • Diabetes (10x higher risk)

  • Thyroid dysfunction

  • Obesity

  • Elevated inflammatory markers

These are no longer considered coincidences.

Another 2024 study (Healthcare, Hamed-Hamed et al.) found that individuals with elevated GGT (a liver enzyme linked to metabolic stress) or higher TSH (thyroid dysfunction) had worse stiffness and poorer outcomes.

This means your shoulder’s ability to heal is directly influenced by your whole-body biology, not just the joint itself.

Why Traditional Frozen Shoulder Treatments Often Fail

If frozen shoulder is driven by metabolic and immune changes, then forcing the shoulder to move aggressively can make symptoms worse.

Common treatments that fall short:

Cortisone injections
– Provide short-term relief
– Do not address systemic inflammation
– May weaken tissue with repeated use

Manipulation under anesthesia
– Can cause tearing or trauma
– May worsen inflammation
– Stiffness often returns

Aggressive stretching
– Overloads irritated tissue
– Increases inflammation
– Rarely works without addressing metabolic drivers

This is why many people go months or years without meaningful improvement.

A Smarter, More Effective Approach to Frozen Shoulder Treatment

At CJ Physical Therapy & Pilates in Portsmouth, NH, we use a whole-body, research-supported approach that calms inflammation, supports natural healing, and restores shoulder mobility safely.

Two of the most effective regenerative therapies include:

Shockwave Therapy (ESWT)

  • Stimulates blood flow

  • Softens tight, fibrotic tissue

  • Reduces chronic inflammation

  • Encourages natural mobility

EMTT (Electromagnetic Transduction Therapy)

  • Supports healthy cellular activity

  • Improves circulation

  • Reduces inflammatory signaling

  • Enhances tissue regeneration

These non-invasive therapies help your shoulder transition from the painful freezing phase into the healing thawing phase more effectively — without causing trauma.

Once inflammation calms, mobility exercises finally start to work as intended, allowing for faster and longer-lasting improvements.

Why This Matters for Seacoast Residents Over 40

Frozen shoulder rarely develops randomly. In your 40s, 50s, and 60s:

  • hormones shift

  • blood sugar regulation becomes more difficult

  • inflammation increases

  • connective tissue becomes more reactive

The right environment — not aggressive force — helps the shoulder heal.
Shockwave therapy, EMTT, and guided mobility exercises create the conditions your body needs to restore function naturally.

Final Thoughts

If you’ve been told to simply:

  • “wait it out,”

  • get another cortisone shot,

  • or undergo manipulation under anesthesia…

…it may be time to consider a more effective, biologically aligned solution.

Frozen shoulder may start in the shoulder, but the real drivers are systemic. Addressing these factors leads to quicker, safer, and more complete recovery.

Looking for Frozen Shoulder Treatment in Portsmouth, NH or the Seacoast?

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

If you want natural, research-backed solutions for frozen shoulder — without medication, injections, or aggressive procedures — we can help.

CJ Physical Therapy & Pilates — Portsmouth, NH –  cjphysicaltherapy.com –  603-380-7902

Love to Hike? 7 Strategies for Healthy Knees

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Love to Hike? 7 Strategies for Healthy Knees

Hiking isn’t just good for the soul – it’s one of the best forms of exercise for longevity. Long, steady hikes typically put you in Zone 2 cardio, that sweet spot where your heart rate is elevated but you can still hold a conversation. Research shows Zone 2 training is one of the most powerful ways to build endurance, improve metabolic health, and protect your heart as you age. When you combine that with fresh air, nature, and the mental reset that hiking provides, you’ve got a recipe for living longer and healthier.

But here’s the catch…

If your knees hurt, you’re far less likely to get out on the trails and enjoy those benefits. For many adults in their 40s, 50s, and beyond, it’s knee pain – not lack of motivation – that sidelines them. Personally, I love to hike. My pup Bodie and I have already tackled 33 of the 48 White Mountain 4,000-footers together – and the last thing I want is for knee pain to derail that journey. Over the years, both in the clinic and on the trails, I’ve learned that protecting your knees isn’t just about avoiding injury – it’s about building mobility, balance, and strength so you can keep hiking and keep hitting that Zone 2 target for decades.

Here are 7 of my top strategies to keep your knees healthy on the trails:

1. Strengthen More Than Just Your Legs

Most hikers know strong legs matter. But what often gets overlooked is the role of your hips and core. Your glutes and hip muscles stabilize your pelvis, which in turn keeps your thigh bone – and your knee – aligned. If these areas are weak, your knee takes the brunt of every single step. On a typical 4K-footer, I rack up around 27,000 steps. Imagine your knee compensating on each one. Prioritize exercises that target glutes, hip stabilizers, and core muscles. Think bridges, planks, side steps, and single-leg work. The stronger your foundation, the better your knees will perform under pressure.

2. Keep Your Knees (and Hips) Mobile

Lack of mobility in your knees and hips – even a subtle loss – can impact the way your knees function. Your knees should fully straighten, bend deeply, and even hyperextend a little. Without this range, your knees can’t absorb the demands of steep inclines, rock scrambles, or uneven terrain. But don’t just focus on your knees – your hips and ankles need to move freely too. When one joint stiffens, another (often your knee) has to compensate. If your knees feel achy, check to make sure stiffness isn’t the reason.

3. Optimize Your Balance

Uneven trails, water crossings, and rocky descents demand excellent balance. Without it, your knees may end up working overtime to stabilize you. You can improve balance by practicing single-leg activities, such as standing on one foot while brushing your teeth, then progressing to single-leg squats and step-downs. Dynamic drills like walking heel-to-toe on a line or using a balance pad to mimic trail conditions can also be effective.

4. Train Eccentric Strength (Downhill Prep)

Most people’s knees flare up going downhill, not uphill. That’s because downhill hiking demands eccentric strength – the ability of your quads and even hips to control your descent while resisting gravity. Exercises like slow step-downs, controlled squats, and reverse lunges train your body for this exact stress, protecting your knees from strain when descending steep terrain.

5. Don’t Neglect Recovery

It’s easy to focus only on training for the hike, but recovery is just as important for keeping knees healthy long-term. Muscles and connective tissues adapt and get stronger when you give them time to repair. Simple recovery practices like foam rolling, stretching, and staying hydrated and prioritizing sleep all help reduce inflammation and improve resilience for the next hike. And if your knees are particularly sensitive after a hike – regenerative treatments like shockwave therapy and EMTT can help your joints recover quickly and naturally.

6. Choose Footwear That Supports Your Mechanics

Footwear can make or break your knees on the trails. Poor support or worn-out soles force your knees to work harder with every step. Good shoes aren’t just about cushioning – they should work with the way you move and give you stability when the trail gets rough. Keep in mind that your feet often widen and swell as you hike, which can change how your shoes fit and affect your mechanics. Choosing shoes with enough room in the toe box and proper support for your arches can prevent your knees from picking up the slack. Don’t forget the basics either – replacing trail shoes regularly (every 300–500 miles) is just as important as any strengthening exercise.

7. Get Checked Before It’s Too Late

One of the most overlooked strategies for preventing knee pain is early intervention. If you notice stiffness, swelling, or pain that doesn’t improve with movement, it’s better to get evaluated sooner rather than later. The longer you push through, the more compensations build up – and the harder it is to fix. In the same way you wouldn’t wait for your car to break before servicing it – you don’t want to wait for your knees to fail before seeking help.

Knee pain doesn’t have to stop you.

Hiking is one of the simplest and most enjoyable ways to support your health. It builds strength and endurance, keeps your heart and lungs working efficiently, and connects you to nature. But none of those benefits matter if knee pain keeps you on the sidelines. By strengthening your hips and core, improving mobility, training balance and eccentric control, choosing the right footwear, recovering properly, and seeking help early if pain persists – you’ll give your knees the best chance to keep carrying you up (and down) the trails for years to come.

 

Why Your Back Pain Isn’t Going Away – Even After Rest, PT, and Chiro

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In my 23-year career, back pain is probably the one problem that frustrates people the most. It affects your sleep, your mood, your energy, and your ability to enjoy the things you love. Plus, it becomes even more frustrating after you’ve tried all the “right” things – like physical therapy, chiropractic treatment, and even good old-fashioned rest.

If this sounds like your story, you are not alone. I work with people every week who have done everything they were told to do – and they’re still in pain. And it’s not because they didn’t try hard enough. It’s because the true root cause of the problem was missed.

I always say… If your treatment plan isn’t working, you either have the wrong diagnosis or a poor treatment strategy.

Let’s take a closer look at why some of the most common treatments for back pain – rest, physical therapy, and chiropractic care – don’t always work.

Rest is Not a Cure

When your back hurts, resting feels like the safest and most natural thing to do. And for an acute injury, some rest is helpful. But debilitating back pain episodes aside, resting for more than a day or two can actually make things worse.

Your spine needs movement. Movement keeps your discs hydrated, your joints nourished, and your muscles coordinated and strong. Avoiding movement out of fear can lead to stiffness, weakness, and more pain – not less.

Your nervous system relies on movement – and your body’s response to it – to help it learn and recover after injury. If you shut everything down at the first sign of pain, your brain can start to associate movement with danger. That’s how chronic pain problems begin.

The reality is, if rest alone cured back pain, we wouldn’t have so many people still suffering from it.

Your Physical Therapy Isn’t Prescriptive

The research tells us that exercise is one of the most effective treatments for back pain – which is why physical therapy should be the gold standard. Physical therapists are trained to be movement experts. They should be prescribing exercises that are designed to take your back pain away – and keep it gone – while using hands-on work and modalities selectively to help you move with less pain and more efficiency.

But sadly, this doesn’t always happen. I often see clinics that rely heavily on passive modalities like ultrasound or electrical stimulation for short-term relief. Then the exercise “prescription” ends up being a generic list of stretches and core exercises you could find on YouTube.

If your physical therapy didn’t work, it’s possible the true root cause of your back pain wasn’t correctly identified. Many cases of back pain are due to “derangement syndrome” – when something in your spine (like a bulging disc) disrupts normal movement. Unless you correct the way your spine moves – and learn how to maintain that correction – the pain keeps coming back.

Physical therapy must be prescriptive in nature. If you just want general exercises, you can find them online or go to the gym. Your back might eventually feel better – but you’ll never know what fixed it, and you’ll have no way to fix it again when the pain returns.

Chiropractic Adjustments Aren’t Always Enough

Chiropractic care can sometimes be the difference between being unable to move and finally being able to straighten yourself out – especially during an acute episode of back pain. But most chiropractic care is passive. It has its place, but problems arise when people rely solely on adjustments to stay out of trouble. Chiropractic care should be paired with prescriptive, active movement that retrains your nervous system and gives you tools to manage your pain.

Another issue I see is people who have relied on adjustments for years. Eventually, they realize the pain keeps coming back. That’s often because the joint being mobilized provides only temporary relief, while the root cause isn’t being addressed. Chiropractic adjustments also aren’t very specific. Your spine often needs precise movements, in a specific direction, repeated over time. When it comes to disc or nerve problems, it can take thousands of reps of the right movement to resolve the irritation and get the pain to stop. A chiropractic adjustment can sometimes disrupt that carefully prescribed movement plan – and then you’re back at square one.

This all might sound a bit “technical” to you, and that’s because it is. It’s also why so many people still suffer from back pain despite trying everything.

But don’t overthink it. Ask yourself: Is chiropractic care still helping? Are you relying on the adjustments less and less? If yes, you’re on the right track. If not, it may be time for a new approach.

What to Do Instead

There’s no one-size-fits-all solution for back pain. But successful treatment usually starts by asking better questions and taking the time to uncover the real root cause.

Is it your muscles? Your joints? A disc? A nerve? Or the way your brain and nervous system have adapted over time?

A thorough, mechanically based assessment often reveals things that X-rays and MRIs miss. In fact, imaging can sometimes lead to too much information – and send you down a path of unnecessary treatments that should be reserved as a last resort.

Once the true source of your problem is found, a plan that emphasizes active movement, education, and progressive activity is far more effective than passive treatments or rest alone. Passive treatments can help reduce symptoms quickly, but long-term success depends on learning how to care for your back with the right tools, the right guidance, and the right movements.

If your back pain isn’t going away – even after rest, PT, or chiropractic – it’s not a sign that you’re broken or destined for surgery. It could just mean the true cause of your pain hasn’t been found yet.

If you’re tired of chasing quick fixes and want real answers, we can help. Schedule a free Discovery Visit to uncover the root cause of your back pain and find out if we’re the right fit to help you get lasting relief.

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.

7 Fun and Healthy Ways to Celebrate Mother’s Day on the Seacoast

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Mother’s Day is a time to honor the incredible women in our lives. While flowers and brunch are timeless, sometimes the most meaningful gift is simply quality time spent together. This year, why not swap the restaurant waitlists and crowded gift shops for something a little more memorable?

Here on the Seacoast of New Hampshire, we’re lucky to have access to some of the most beautiful coastline, trails, and natural parks in New England. Whether your mom loves to move, relax outdoors, or try something new – there’s no shortage of ways to celebrate with her in a fun, active, and healthy way.

Here are 7 fun and healthy ways to celebrate Mother’s Day on the Seacoast:

 

Take a Scenic Coastal Bike Ride

Treat Mom to a leisurely bike ride along the Seacoast’s stunning shoreline. Begin in downtown Portsmouth and pedal out toward Rye via Route 1A. This route winds through the historic charm of New Castle, offers sweeping ocean views, quaint seaside cottages, and scenic beaches along the way. It’s the perfect mix of fresh air, gentle movement, and quality time – made even sweeter with a stop for coffee or ice cream along the way.

Explore the Rockingham Rail Trail

If Mom prefers a quiet ride or walk away from busy roads, the Rockingham Rail Trail is a fantastic option. This converted rail corridor stretches for miles through peaceful woodlands, wetlands, and charming rural areas. The wide, flat trail is perfect for casual biking or a long walk, and it’s ideal for chatting as you move at your own pace. Access points in Newfields allow for convenient parking to explore as much or as little of this trail as you desire.

Kayak or Paddle at Odiorne or Rye Harbor

If your mom loves being on the water, an afternoon of paddleboarding or kayaking could be the perfect outing. Paddleboarding challenges your balance and engages the core, while kayaking offers a more relaxed rhythm with a great upper-body workout. No gear? No problem. Local favorites like Portsmouth Paddle Co. and Portsmouth Kayak Adventures offer rentals, lessons, and even guided tours – making it easy for beginners to join in the fun.

Hike Mount Agamenticus or the Urban Forestry Center

If your mom enjoys hiking, there are plenty of local trails that offer both beauty and tranquility. Mount Agamenticus in York, Maine provides several loop trails and beautiful summit views. For something a little less strenuous, check out the Urban Forestry Center in Portsmouth. It offers peaceful, wooded trails that are perfect for an afternoon stroll. The forest and mountains are great places to unplug, breathe deeply, and enjoy each other’s company away from the hustle of everyday life.

Visit Nubble Lighthouse and Stroll the Marginal Way

Make a scenic drive to York, Maine and surprise Mom with a visit to the iconic Nubble Lighthouse. It’s one of the most photographed lighthouses in the country—and for good reason. After taking in the views, consider walking a portion of the Marginal Way in nearby Ogunquit, a picturesque oceanside path with sweeping vistas and benches for a rest or a nice chat.

Celebrate Mom’s Green Thumb

If your mom has a love for gardening, flowers, or nature’s beauty, spend part of the day visiting your favorite local nursery or garden center – and then help her get her hands dirty by planting something together. Whether it’s herbs, flowers, or even a raised veggie bed – she’ll appreciate the help and time spent together.

Stroll Through Prescott Park and the Portsmouth Waterfront

Put your best walking shoes on and take a walk through Prescott Park and along the Portsmouth waterfront. By mid-May, the gardens are beginning to bloom, and the salty air and river breeze make for a perfect spring stroll. Grab a treat from a local café, browse the shops, or simply sit and take in the view together.

Is Pain or Injury Keeping you from Enjoying these Activities?

Mother’s Day lands at a great time of year to get outside and do something active with your loved ones. But if nagging pain or injury is holding you back – or has you hesitant to try something new this season – it may be time to seek help from a mechanical pain specialist. They will help you figure out the source of your problem and provide you with natural treatment methods designed to get you out of pain and back to doing everything you love quickly.

Local to the Seacoast? CLICK HERE to speak with a specialist now.

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.

6 Tips to Protect Your Back When Shoveling Snow

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6 Tips to Protect Your Back When Shoveling Snow

We’re finally getting some winter weather here on the seacoast. And although it’s beautiful – and the skiers are rejoicing – someone still has to shovel that snow and clear it out of the way. If that someone is you – then you’ll want to keep reading. Because repetitive bending and twisting of your back (the primary movement in shoveling) is the perfect recipe for unwanted back pain.

Here are 6 tips to protect your back when shoveling snow:

1. Warm Up First

Most people wouldn’t start a heavy workout without warming up first, yet when it comes to shoveling, we tend to just grab the shovel and go. That’s a mistake. Shoveling is a full-body activity that engages your legs, core, and upper body. If you don’t prepare your muscles, you’re more likely to strain something – especially your back.

Take five to ten minutes to warm up with light movements. Marching in place or jumping jacks help get blood flowing, while torso twists and squats loosen up your spine and legs. And don’t forget your upper body. Arm circles are a great way to warm up your shoulders  – which can also get quite achy when shoveling. Taking just 10-15 min to warm up your body and lubricate your joints before shoveling can go a long way toward protecting your back.

2. Use Your Legs

Our spines weren’t designed to lift heavy things – that’s what our legs are for. Your spine’s main job is to provide structural support and stability so you can stand upright and move freely. When lifting or shoveling, your legs should be doing the work – not your back.

To ensure your legs are driving the power – it’s essential that you use proper lifting mechanics. Instead of bending or curving at your waist – hinge at your hips and bend your knees. From there, engage your hamstrings and glutes to lift the snow and use your core muscles to throw it away. Even with perfect form – your back might still get sore. That’s totally normal. But it’s far less likely to get injured – and that is what we’re trying to avoid.

3. Pivot Instead of Twist

One of the most vulnerable movements for your lower back is repetitive bending and twisting. The stress this puts on your spine makes it easy to “throw your back out.” Now let’s be clear – that doesn’t mean you should never bend or twist – your spine is designed to safely perform these motions. The problem occurs when you add load to this motion (like heavy snow) or do it repeatedly.

To protect your back – lead with your pelvis and hips instead of your torso. When turning to throw or push snow, keep your shovel and hips (use your belly button as a guide) pointing in the same direction. If they’re out of sync, it means you’re twisting from your torso instead of pivoting – and that’s a surefire way to hurt your back when shoveling.

4. Breathe to Engage Your Core

Holding your breath during exertion is common, but it can be a big problem – especially when it comes to core activation. When you hold your breath, your diaphragm can’t expand and contract properly, which is essential for engaging your deep core muscles. If your deep core isn’t firing, your larger abdominal and back muscles will struggle too.

Strengthening your core is beneficial for all activities – not just shoveling—but none of it matters if you forget to breathe. Without proper breathing, even the strongest core won’t do its job effectively, and this can set you up for a back injury over time.

5. Stay Hydrated

Even in cold weather, physical exertion can lead to dehydration. Just because you’re not sweating or feeling thirsty doesn’t mean you don’t need water. In colder temperatures, your thirst signals aren’t as strong, making it easy to overlook hydration. And even if you’re not sweating, you’re still losing fluids. Dehydration can lead to muscle fatigue, cramping, and stiffness – all of which increase your risk of a back injury while shoveling. Plus, when your muscles aren’t properly hydrated, they become less flexible and more prone to strains, making bending and lifting feel even harder.

To stay ahead of dehydration, drink water before, during, and after shoveling – even if you don’t feel thirsty. Sip small amounts frequently rather than chugging large amounts at once. Warm fluids like herbal tea or broth can help keep you hydrated while maintaining body temperature. Be mindful of caffeine and alcohol, as they contribute to dehydration. Staying hydrated keeps your muscles and joints working efficiently, making shoveling safer and easier for your whole body, not just your back.

6. Use Ergonomic Tools

Investing in an ergonomic shovel can reduce strain on your back and joints. These shovels promote better posture by minimizing bending. Many have curved handles or adjustable lengths, allowing you to maintain a more upright position. This distributes the workload more evenly, reducing stress on your back.

Now, you might be thinking, “I have a snow blower – my back will be fine.” Think again. It’s easy to push with your upper body instead of your legs, which puts strain on your spine. Poor technique makes your back more vulnerable to injury – even if you don’t feel pain in the moment. The real trouble comes later when you grab a shovel for a quick cleanup or simply sit down to relax. You may be in for a rude awakening when you stand up and realize your back is stiff and locked up. Ergonomic shovels and equipment like snow blowers go a long way in protecting you back – but they don’t replace the need for good posture and proper body mechanics.

Bonus tip: See a Specialist

If you’re already prone to back injuries and dread the thought of shoveling another snowstorm – it’s time to seek help. These tips are great for protecting a healthy back and preventing future injuries, but they won’t solve an ongoing back problem. You need expert care for that. Look for a back pain specialist who prioritizes natural solutions over pills and injections (such as a mechanical back pain specialist) so you can get back to doing all the activities you love. Oh—and shoveling too.

Are you local to Portsmouth, NH?

If so, consider speaking to one of my back pain specialists by clicking HERE.

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

5 Reasons to Ditch the Pills and Embrace Exercise as Medicine

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Our bodies are built for movement, yet modern life has us sitting far more than we should.

Compared to our ancestors, we’re moving less and sitting more – sometimes for over half the day. While fitness trackers and smartwatches encourage us to stand and get more steps in, it still doesn’t seem to be enough to counteract the effects of a sedentary lifestyle.

Physical inactivity has now become a major health issue, and the consequences are clear: less movement leads to more musculoskeletal issues and chronic pain (among other things). And the unfortunate reality is that most folks turn to pain medication for relief, despite research increasingly pointing to regular exercise being just as effective and far healthier.

Here are 5 reasons to ditch the pills – and embrace exercise instead – as a powerful form of medicine to manage musculoskeletal pain naturally.

1. Exercise Mediates Pain

The way we perceive pain is complex. Many assume it’s a direct response to physical damage or injury – but it’s not that simple. The perception of pain involves numerous physiological and psychological factors that the brain must interpret. Depending on your general health, past experiences, and mental health condition, this can vary quite drastically from person to person. In other words – it’s your brain that decides how much or how little pain you experience.

Because of this complexity, external factors like exercise (and also pain medication) can alter how we perceive these signals. When we exercise, our bodies exhibit an increased tolerance towards pain, and a lower perception of pain intensity. This phenomenon is called “exercise-induced hypoalgesia” – and it works by closing down the gateways that allow pain signals to enter the brain. Certain medications can do this too, but when you exercise, you’re doing it naturally. 

2. Exercise Helps Inflammation

Inflammation is a normal part of your body’s healing process, and it occurs when inflammatory cells travel to a place of injury. However, if inflammatory cells stick around too long, it can result in chronic pain and irritation. This is where exercise can really help. 

When you exercise, your body experiences minor physiological stress, which triggers your body’s natural inflammatory reaction. During the inflammatory process, certain proteins called anti-inflammatory cytokines are produced. These protein chemicals help to modulate the body’s inflammatory response – ultimately reducing the level of inflammation associated with your pain. Inflammation can be both good and bad. When you exercise, you are creating “good” inflammation, which will naturally help to ease your pain.

3. Exercise Stimulates Endorphins

Ever wonder why a quick walk outside or a strenuous gym workout magically makes you feel better? It’s not your imagination. It’s something called endorphins – neurotransmitters released by your brain to alleviate pain and promote pleasure.

Endorphins are considered your body’s natural “opioids” because they interact with the same pain-inhibiting receptors in your brain that drugs like morphine do. But unlike morphine, endorphins are triggered naturally and don’t come with harmful side effects like addiction, drowsiness, or mental fog. Exercise stimulates the production of endorphins, boosting your mood, reducing stress, and giving you access to your very own stash of natural, healthy painkillers.

4. Exercise Improves your Mental Health 

Exercise and mental health share a powerful connection. It’s virtually impossible to influence one without the other.

Regular exercise stimulates the production of various mood-boosting chemicals, including endorphins (that we just spoke about) along with serotonin and norepinephrine. Aside from helping to control pain, endorphins are also considered a “feel-good hormone”. They trigger feelings of positivity that, once again, are similar to morphine. Serotonin and norepinephrine are instrumental in alleviating symptoms of depression and anxiety. Therefore – when you exercise – it’s virtually impossible not to feel better. And since we know that pain is controlled by your brain – anything that improves mental health is going to contribute positively to your relationship with pain.

5. Exercise as a Prescription

OK – so we’ve discussed the multitude of positive effects that exercise has on pain perception, inflammation, and mental health. But what if you’re currently suffering from an injury? Is it possible to still use exercise as a pain reliever? The short answer is yes. But it’s challenging to do on your own. You can’t just google “best exercises for back pain” and expect good results.

When it comes to using movement or exercise to rehab an already existing injury – it needs to be carefully prescribed. 

For all the reasons already discussed, physical activity will still help you modulate pain – but you must consider the role exercise is going to have on any potential tissue damage. With weakened or damaged tissue, exercise is still an effective pain reliever, but it has to be prescribed or you risk worsening your injury.

For these reasons, I always recommend working with a movement expert who truly understands the nature of musculoskeletal pain and tissue healing. If you start a general exercise routine because you want to feel better  – I applaud you – just make sure you’re getting your desired result. But if you start exercising to help with pain and don’t experience any noticeable improvement – or you catch yourself modifying to work around your pain – then it’s time to enlist the help of an expert. Otherwise, you risk ending up on pain pills, which is exactly what we want to avoid.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE.

Why Walking is Essential for Your Health After 50

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Walking is one of the most underestimated, yet accessible and beneficial forms of exercise for folks over 50.

As we age – the saying “use it or lose it” gets closer to home – and maintaining an active lifestyle becomes even more crucial. 

The good news is that a regular routine of walking offers a simple and low-impact way to not only maintain an active lifestyle – but combat the “use it or lose it” syndrome. A regular walking routine not only supports cardiovascular health, strengthens muscles and bones, and aids in weight management – but also boosts mental well-being and enhances balance and coordination. It’s not a surprise to me that more and more adults over 50 are lacing up their walking shoes and hitting the pavement… yet so many are still skeptical and/or disregard this great form of exercise.

Regardless of where you stand on walking for health… Here are 7 reasons to do it (especially if you’re over 50):

1. Enhances Cardiovascular Health

Cardiovascular disease remains the leading cause of death among older adults. A regular walking routine can significantly improve heart health by boosting blood circulation, reducing bad cholesterol levels, and increasing good cholesterol levels. The rhythmic nature of walking ensures that your heart pumps at a steady rate, which is beneficial for overall cardiovascular health.

2. Strengthens Muscles and Bones

Aging naturally leads to the loss of bone density and muscle mass. However, regular walking can counteract this process. As a weight-bearing activity, walking strengthens bones and reduces the risk of osteoporosis and fractures. It also engages multiple muscle groups simultaneously, helping them stay active and strong.

3. Boosts Mental Health

Walking isn’t just a physical activity – it’s also great for mental health. Walking has been shown to reduce symptoms of depression and anxiety significantly. It provides an opportunity to clear your mind, reflect, and even meditate. Walking with friends or loved ones adds a social aspect, which can be incredibly beneficial for your mood and mental well-being. For an extra mental boost, try walking in nature—the fresh air and tranquil environment can be rejuvenating for both mind and soul.

4. Aids in Weight Management

As you age, your metabolism naturally slows down, making weight management more challenging. Regular walking helps burn calories, maintain a healthy weight, and prevent chronic diseases like diabetes and heart disease. Being at a healthy weight also means increased energy levels, easier mobility, and less stress on your joints.

5. Improves Joint Health

Many people fear arthritis and avoid activities that might exacerbate it. However – despite some medical opinions – movement is one of the best remedies for arthritis. And walking is particularly beneficial for arthritis. It helps lubricate the joints, especially the knees and hips, and keeps the surrounding muscles and soft tissues loose and flexible. Regular walking is super beneficial for managing arthritis effectively.

6. Enhances Balance and Coordination

Falls are a significant concern as we age due to decreased bone density and the subsequent naturally occurring increased risk of fractures. Maintaining balance and coordination is easier than trying to regain them after they’ve diminished. Walking requires the coordination of several muscle groups – plus enhances the body’s ability to stabilize itself quickly – thereby reducing the risk of falls.

7. Low-Impact and Adaptable

One of the greatest advantages of walking for those over 50 is its low-impact nature. Unlike high-impact exercises such as jogging – walking is gentle on the joints and can be easily adapted to fit your fitness level. Whether you prefer a leisurely stroll around the neighborhood or a brisk hike in the park – walking can be tailored to meet your individual needs and goals.

If you’re over 50… and you haven’t yet incorporated a regular walking routine into your lifestyle…

What are you waiting for? It’s one of the most simple yet effective ways to stay active, healthy, and mobile after the age of 50. But if an injury or pain is holding you back from starting or continuing a regular walking routine – it’s time to consult a movement expert. 

Eighty percent of all musculoskeletal pain and injury is related to a movement problem that can be resolved naturally, and without procedures or surgery. But you can’t truly figure this out without consulting a movement expert, or physical therapy specialist who specializes in mechanical pain. Reach out if you need help finding one in your area.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a free Discovery Visit to explore a solution for your pain or injury with a mechanical pain expert – CLICK HERE.

Pain when gardening

Pain-Free Gardening: How to Protect Your Back and Love Your Garden

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Gardening season is finally here – and with all of gardening’s positive benefits – it’s no surprise that gardening is such a huge passion for so many. 

Tending to plants and watching them flourish offers a profound sense of accomplishment. The connection to nature is therapy for your soul. And the meditative practice of gardening reduces stress, gives you a break from the hustle, bustle and stress of daily life, and enhances your mental well being. Plus – let’s not forget all the physical benefits of gardening. Anything that gets you moving, active and mobile I’m a fan of.

But how do you continue to pursue your gardening passion when your back hurts? It’s been a very common concern as of late. The good news is that it’s entirely possible to spend more time loving your garden than tending to your back.

Here are 5 of my top tips to protect your back when gardening:

1. Avoid bending from the waist

A common gardening posture I see is folks standing with straight or slightly bent knees and bending over from their waist – creating an “L-shape” with their body. While this posture is acceptable to do from time to time – it’s not a good idea to do this over and over again while gardening. This particular posture puts a lot of strain on your lower back as well as the backs of your knees. Over time, your lower back muscles will become very sore and tight, which can make them susceptible to injury when you least expect it. What to do instead? Get in the habit of squatting and bending from your knees. If you must do a particular gardening activity for a sustained period – try being on all-fours – and switch your hands periodically. These positions are much better for your back and you’ll be able to sustain the activity for much longer.

2. Take frequent breaks

It’s easy to get lost in the activity of planting and weeding. But even if you’re choosing good postures like I mentioned above – your back still needs a break. Our spines do not enjoy being bent forward for prolonged periods and when you do this for too long without taking a break – it puts a lot of stress on the vertebral discs in your spine and makes them more likely to bulge. I recommend setting a timer and giving yourself a break every 30 min. Simply stand up and get out of the bent over posture. Your back will thank you and you’ll be able to garden for much longer without risk of injuring your spine.

3. Pivot instead of twist

One of the most vulnerable positions for your back is the combination of bending and rotating. And when done repetitively, you’re almost guaranteed an injury to your spine. When you’re doing things like digging or planting – activities that have you bending and twisting – you want to pivot instead. Keep your body in line with the activity you’re doing. Don’t rotate or twist from your waist. How do you do this? Make sure your hips are always in line with the object you are moving and maneuvering. Keep your ribs in line with your pelvis and always move them as a unit. While it’s ok to bend and twist from your waist on occasion – you’ll find yourself in some trouble when you do this over and over again – especially if you have a history of back pain episodes happening to you in the past.

4. Use gardening tools wisely

Gardening tools can be of significant help when it comes to maintaining good posture and avoiding overuse of your muscles and joints. When you have to lift something heavy – especially repeatedly – use a wheelbarrow. This valuable gardening tool will allow you to lift and move heavy things with significantly less strain on your back. If you’ve got to be on your knees or squatting a lot – consider using a gardening bench. This will make it easier to sustain activities that require prolonged bending or kneeling. Lastly, use tools with longer handles to help avoid crouched over postures. If you can maintain a more upright posture while gardening, you’ll be able to tolerate it longer and with less back pain. 

5. Raise your gardens

Let’s face it, gardening involves bending over and lots of it. Activities like this are just not good for your back when done over and over. Consider modifying your garden to include more raised boxes and beds. This is going to make it so much easier to tend to your plants without having to bend over so much. And when you need to create a work surface – make sure that is raised too. Bending forward isn’t “bad” for your spine – but when you bend all the time without giving your back a break – you’re asking for trouble. Modifying your garden to make it more ergonomic can make a huge difference in the health of your spine.

Gardening has so many positive benefits and it’s a true passion for so many folks I speak with. The last thing I want is for back pain to be the thing that stops you from doing something you love. Hopefully these tips give you some important things to consider – and more importantly – help you protect your back so you can focus on loving your garden.

Are you local to Portsmouth, NH?

CLICK HERE to speak with a specialist for free.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or get a free copy of her guide to back pain – click here or call 603-380-7902

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Do Cortisone Shots Work on Herniated Discs?

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Do Cortisone Shots Work on Herniated Discs?

A recent conversation with someone regarding whether or not they should get a cortisone shot in their back to help a herniated disc inspired me to write this article. Why? Because in speaking with her, I realized how misinformed she was about when you should and shouldn’t get a cortisone shot, and what they are and aren’t good for. And I hate to see people getting procedures or injections when they don’t actually need one.

So when is a cortisone shot a good idea?

Cortisone shots work really well when the primary source of your pain in a targeted area is inflammatory or “chemical”. When you’ve got pain that is of chemical origin – then chemical drugs (like a cortisone shot) will work well to get rid of it. So what is “chemical pain” and how is it different? Chemical pain is the result of your body’s natural inflammatory response in response to injury – which produces an influx of chemicals and other nutrients in your blood to heal the injured area. Since this process creates inflammation and swelling – you feel pain. When the inflammatory process is working correctly, these chemicals naturally dissipate as the tissue heals. But on occasion, the process can get out of hand and get dysfunctional. The painful chemicals linger and create an almost constant state of pain that really doesn’t respond to any kind of movement or even rest.  In the case of back pain due to a herniated disc, typically you’ll find that you can relieve it temporarily by changing positions, moving, or going for a walk. But if it’s chemical pain – your back will hurt constantly – it will feel hot and inflamed – and nothing will seem to touch it. While rare, if your herniated disc is causing this type of pain response, then you’ll likely benefit from a cortisone shot. You need to get rid of those chemicals and the cortisone shot will do just that

But most cases of back pain – even those involving a herniated disc – are instead considered “mechanical” in origin.

Mechanical pain is responsible for 70-80% of all musculoskeletal injuries and it has to do with your mobility and movement patterns. Unlike chemical pain – mechanical pain does respond to changes in movement and position. It’s why most people suffering from herniated discs will feel better when they walk, move, or exercise. They can also temporarily relieve their back or leg pain by standing up (for example) after having been sat for a long time. The key recovery tool for mechanical pain is movement – identifying where your mobility restrictions are and where your faulty movement patterns or habits exist. Once you figure this out – the structural component (aka the herniated disc) is irrelevant and you can live with it for years to come without issue. If you’re suffering from back pain or sciatica, and have been told you have a herniated disc, and what I’ve just described is your typical pain pattern – you will likely not benefit from a cortisone shot and instead need a proper movement/mechanical assessment from someone who’s an expert in this sort of thing.

Now here’s where things get confusing…

If you’ve got a herniated disc – it has the ability to irritate the structures surrounding it – everything from muscles to nerves. I’ve seen people aggravate a herniated disc by simply sneezing or coughing. When your herniated disc gets “angry” and irritates the surrounding structures, you will experience localized inflammation. But it’s different from the dysfunctional inflammatory pattern I described previously. It’s still possible to make this inflammation go away on its own – without drugs – because it’s not in a permanent “chemical” state. But when you’ve got a highly sensitive and painful herniated disc it’s very tempting to get a cortisone shot to relieve the pain.

But here’s why I urge you to think twice… The cortisone shot may provide you with temporary relief – but it will be a bandaid.

Because at the end of the day – the cortisone shot will not address the root cause – the underlying mechanical problem that is causing that herniated disc to keep getting angry. What you risk is that during those periods of “pain relief” – you continue to do things that make that herniated disc worse – because you can’t feel what’s going on. If you keep masking the pain pattern with cortisone shots, and keep unknowingly making your herniated disc worse, you may get to the point where you can’t fix it naturally anymore and will be looking at a surgical fix instead.

Ok – so that was a lot of information and scientific terms thrown at you. But at the end of the day – here’s what I want you to remember and think about if you’re considering getting a cortisone shot for your herniated disc… 

If you can influence your back pain with any sort of movement or activity – then it’s not the type of pain that warrants a cortisone shot. Cortisone shots do nothing to affect a structure (aka herniated disc) – they only eliminate chemicals that are causing pain. And the short-term pain relief from the cortisone shot will not outweigh the potential long-term and harmful consequences you could experience by not addressing the root cause. But if you’re experiencing the sort of back pain that is hot, inflammatory, and not responsive at all to movement, activity, or positional changes – then you’ve got a situation where a cortisone shot might be beneficial – and could get you over the hump that is needed for movement and activity to actually help.

At the end of the day, before you consider any kind of injection or procedure, be sure you’re well-informed and have asked all the questions necessary to be sure that a natural alternative is not still available and worth trying.

If you are 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 the best fit to help you. Click here to request 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 request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

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

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Regenerative Shockwave Therapy

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

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

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

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

1. Pain Management:

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

2. Improved Mobility:

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

3. Blood Flow Stimulation:

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

4. Reduces Scar Tissue:

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

5. Accelerated Recovery:

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

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

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

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected] or CLICK HERE to talk to one of our specialists.