Tag Archive for: Portsmouth NH

Man holding his head in pain from a headache in Portsmouth NH, neck-related headache concept

5 Signs Your Headaches May Be Coming from Your Neck

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Is Your Neck the Hidden Cause of Your Headaches? Here’s How to Tell

By Dr. Carrie Jose, Physical Therapy Specialist | CJ Physical Therapy & Pilates, Portsmouth, NH

Headaches are one of the most common and frustrating problems people face — affecting almost half the population at some point in their lives. If you get them regularly, you already know how much they can interfere with your work, sleep, and overall energy.

What makes managing headaches so tricky is how often they’re misdiagnosed. Many people are told they have a primary headache disorder — like migraines, tension headaches, or cluster headaches — when the real problem is secondary, meaning it’s caused by something else in your body.

One of the most overlooked culprits? Your neck.
A type of secondary headache known as a cervicogenic headache actually originates from your cervical spine (neck). It’s often mistaken for migraines or tension headaches — but the treatment approach is very different.

5 Signs Your Headaches May Be Coming from Your Neck

1. Your headaches worsen with certain neck movements

If turning or tilting your head seems to trigger your headaches — or if they start after holding your head in one position too long (like sitting at a desk or bar) — that’s a clear sign your neck could be the source.
When specific motions or postures worsen your pain, it’s a strong indication your headaches are cervicogenic.

2. You notice stiffness or restricted motion in your neck

If your neck feels stiff or it’s hard to look over your shoulder, that loss of mobility could be fueling your headaches. When neck joints don’t move freely, surrounding muscles and nerves can become irritated — creating pain that mimics a tension headache. Restoring neck mobility can relieve this irritation and stop headaches at their source.

3. Your neck muscles are frequently tender or tight

Persistent tightness around your neck and shoulders often goes hand-in-hand with cervicogenic headaches. This can come from posture issues, stress, or fatigue — but often there’s a deeper mechanical cause.
When that’s addressed, the tightness and resulting headaches fade naturally.

4. You feel your headache at the base of your skull or down one side

If your headaches begin at the base of your neck and travel upward or down into your shoulder blade, it’s almost a sure sign your neck is involved. These patterns match the nerve pathways from your cervical spine — a common clue for cervicogenic headaches.

5. Massage or chiropractic adjustments help — but only temporarily

If you feel better after a massage or adjustment, but your headaches return, that’s a strong clue your neck needs a mechanical assessment. Hands-on care offers short-term relief — but combining it with corrective exercises that restore neck mobility and strength provides lasting results.

What to Do Next

If you’ve been battling stubborn headaches and haven’t had your neck evaluated — it’s time. Cervicogenic headaches are often overlooked but very treatable when you address the true source.

The good news? If your headaches are caused by your neck, you can manage them naturally — without pills, injections, or procedures.

Working with a specialist who understands the mechanical causes of neck-related headaches can help you find lasting relief and regain control of your life.

Ready to discover if your headaches are neck-related?
Request a Free Discovery Consultation at CJ Physical Therapy & Pilates in Portsmouth, NH, or call 603-380-7902to speak with our team.

About Dr. Carrie Jose

Dr. Carrie Jose is a Doctor of Physical Therapy and Mechanical Pain Expert, specializing in helping people in the Seacoast area find natural, long-term solutions for pain — without relying on pills, injections, or surgery.

She is the owner of CJ Physical Therapy & Pilates in Portsmouth, NH, and writes regularly for Seacoast Media Group on topics related to physical health, pain prevention, and natural movement.

Holding Knee with Arthritis

Want to Avoid a Total Knee Replacement? Start Here.

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Every year, around 700–800,000 Americans undergo total knee replacement surgery – and that number continues to climb.

Here in Portsmouth, NH, we see this trend too – but what if many of those surgeries weren’t actually necessary?

It’s true that knee replacements have an excellent success rate, with more than 90% lasting 20 years or more. But here’s something most people don’t realize…

Only 15% of people who show signs of osteoarthritis on X-ray actually have symptoms. That means the majority of folks walking around with “bone-on-bone” arthritis don’t have any pain at all. Meaning, “severe arthritis” showing up on an X-ray isn’t the be-all-end-all diagnosis you thought it was.

So why do so many end up under the knife?

Because structural findings on imaging – like arthritis, bone spurs, or meniscus tears – are often blamed for pain that may actually have another cause. If you want to avoid knee replacement surgery, it’s critical to understand what’s really behind your pain and whether you’ve exhausted all your options first.

Here are three key things to look at before you resign yourself to surgery.

1. Don’t Let an X-ray Decide for You

Too often, people are told they need a knee replacement because their X-ray “looks bad.” But your level of pain and function – not your imaging – should be what drives your decision.

If you can still walk, climb stairs, and do most of your favorite activities with manageable discomfort – why rush into major surgery with months of recovery and potential complications?

Knee replacement can be life-changing for those in severe, unrelenting pain – but if you’re still functioning relatively well, it’s worth holding off. You may find that a targeted approach to movement, strength, mechanics, and healing can relieve your pain and keep you active for years – without surgery.

And if you’ve already tried physical therapy and exercise but still feel limited, regenerative treatments like Shockwave Therapy and EMTT (Extracorporeal Magnetotransduction Therapy) can help bridge the gap. These non-invasive technologies work by stimulating tissue repair, reducing inflammation, and improving circulation – essentially helping your body heal itself. For many people with chronic knee pain or mild arthritis, regenerative therapy has been a game changer – providing relief and better mobility without needles, surgery, or downtime.

In short, before deciding your knees are “too far gone” just because an X-ray told you so – explore whether your body still has the capacity to heal. You might be surprised at how much function and comfort you can restore with the right approach.

2. Check Your Back (Yes, Really)

One of the most overlooked causes of persistent knee pain is your spine.

A study published in the Journal of Manual and Manipulative Therapy found that over 40% of people with isolated limb pain responded to treatment directed at their spine – even when they didn’t think their back was involved. Plus, even without this study, I’ve seen this all too often in real-life practice.

That means your “knee pain” could actually be coming from irritation in your lower back or nerves. If your knee pain comes and goes, varies with position, or you also experience back stiffness or leg tingling – don’t ignore it or assume it’s all in your knee.

Getting evaluated by a Portsmouth, NH mechanical pain specialist who can test whether your pain is spine-related or knee-related can save you from years of ineffective knee treatments…

3. Assess Your Mobility, Not Just Your Arthritis

If your knee is truly arthritic and severely damaged, it will usually feel stiff and restricted all the time. But if your stiffness fluctuates – maybe it loosens up after you stretch, or feels fine one day and tight the next – that’s a big clue your pain could be mechanical – not degenerative.

Sometimes, a small meniscus fold or mechanical joint restriction is the real culprit, and when the joint is moved the right way, the restriction disappears – along with your pain. Unfortunately, this won’t show up on an X-ray or MRI – and many clinicians miss it unless they’re trained in mechanical diagnosis.

Before agreeing to surgery, find out whether your joint motion can be restored naturally. When you regain full, pain-free movement, your knee may not need replacing after all.

The Bottom Line:

Knee replacements absolutely have their place. For some people, they’re the best path to relief and mobility. But far too many people jump to surgery because they were told their X-ray “looked bad” instead of being evaluated properly for the true source of their pain.

If you’re over 40, dealing with nagging knee pain, and want to avoid surgery as long as possible – start by getting your back checked, your movement analyzed, and your regenerative options explored by someone trained in mechanical pain and tissue healing.

You might just find there’s still plenty of life left in your knees – and the added bonus will be you avoiding a major surgery.

Are you local to Portsmouth, NH?

CLICK HERE to request a free discovery visit with one of our specialists in downtown Portsmouth.

Dr. Carrie Jose, Physical Therapist and Mechanical Knee Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or reserve a seat in her upcoming Masterclass on How to End Knee Pain Naturally – CLICK HERE.

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.

 

Arthritis Pain Isn’t the End – How to Stay Active for the Long Haul

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Arthritis is one of the most common conditions I see in my clinic – and one of the most misunderstood.

Many people assume it’s just an inevitable part of aging, but what’s often overlooked is how much can actually be done to manage it naturally and effectively.

What frustrates me most is the message many people still hear – that arthritis pain is something you just have to “live with,” managed only through pills, injections, or eventually surgery. But the truth is that while arthritis may not be something you can erase or reverse – there are countless ways to manage your symptoms naturally, safely, and effectively – without becoming dependent on quick fixes that often backfire in the long run.

Here are just a few of the approaches I recommend to my patients who want to stay active and independent well into their later years – even with arthritis.

Move Every Day (Even When You Don’t Feel Like It)

When your joints ache, movement is usually the last thing you want to do. But ironically, it’s one of the best things you can do. Gentle, consistent exercise increases circulation, nourishes your cartilage, and keeps inflammation from settling in. Walking, biking, or swimming are excellent choices because they don’t put excess stress on your joints. Practices like yoga or Pilates improve balance and mobility, making daily activities easier and reducing the strain on your joints. And strength training – despite what many believe – is actually good for arthritis because it takes pressure off your joints by making the muscles around them stronger.

Even five to ten minutes of daily activity can mean the difference between feeling stiff all day or moving with more freedom. The less you move, the worse arthritis tends to get – so finding ways to stay active is one of the best investments you can make in your future health.

Fuel Your Body With Anti-Inflammatory Foods

What you eat matters. An anti-inflammatory diet can help reduce the swelling and stiffness that drive arthritis pain. Omega-3 rich foods like salmon or flax seeds, antioxidant-packed fruits and vegetables, and spices such as turmeric and ginger all have powerful healing effects. At the same time, cutting back on processed foods, refined sugars, and fried items can significantly improve how your joints feel – and it brings benefits for your overall health as well.

Think of food as medicine, because for arthritis it truly can be. Many of my patients notice a big difference in their pain levels and energy simply by reducing sugar and processed foods while adding more colorful fruits, vegetables, and healthy fats.

Prioritize Weight and Posture

Every extra pound you carry puts additional strain on your hips, knees, and back. Even small amounts of weight loss can dramatically reduce pressure on your joints and give you noticeable relief. But here’s something many people miss – posture can play just as big a role.

When you sit, stand, or walk with poor posture, you create uneven forces through your joints. Over time, this increases wear and tear, and can be aggravating to an already arthritic joint. Learning how to align your body correctly can protect your joints just as effectively as losing weight. The way you move every day, whether you’re getting out of a chair or bending to pick something up, can either help your arthritis or make it worse.

Don’t Let MRIs or X-rays Dictate Your Treatment

One of the biggest mistakes I see is when people let imaging results control their decisions. While MRIs and X-rays are useful in certain situations, they are not the whole story. Numerous studies have shown that people with severe degenerative changes on their scans often have no pain at all. In fact, research suggests that as many as 60–70% of people over the age of 50 show some level of arthritis or disc degeneration on imaging – even if they feel perfectly fine.

This matters because once you’re told your pain is due to what’s seen on a scan, you’re far more likely to be funneled toward procedures you may not need. Cortisone injections, for example, only mask pain and actually weaken tissue when used repeatedly. Arthroscopic surgery for knee arthritis has been shown to accelerate the very degenerative changes it’s supposed to help.

And then there’s the dreaded phrase: “bone-on-bone.” While this sounds scary, it does not automatically mean you need a joint replacement. Many people live full, active lives with joints that appear “bone-on-bone” on imaging, as long as they are moving well and keeping their surrounding muscles strong. If you rely only on what the picture shows, you risk missing out on safe, natural solutions that can help you stay mobile and independent.

Explore Longevity Treatments that Boost Healing

One of the most exciting developments in arthritis care right now is the rise of non-invasive therapies that actually help your joints heal and last longer. The combination of Shockwave Therapy (ESWT) and EMTT (Extracorporeal Magnetotransduction Therapy), for example, helps to stimulate blood flow, reduce inflammation, and restore mobility at the cellular level deep inside your joint.

Unlike cortisone shots, which only provide temporary relief while weakening tissue, these therapies encourage your body’s natural ability to repair itself. Many of my patients have experienced less pain, more mobility, and faster recovery – without downtime or drugs. Instead of masking symptoms, these treatments support long-term joint health and help you stay active well into the future.

A Final Word of Encouragement

If you live with arthritis – it doesn’t mean you are destined for a life of pain or dependence on invasive treatments or pills. Your body has an amazing capacity to heal when given the right environment. Whether it’s moving a little more each day, adjusting your diet, improving your posture, questioning unnecessary procedures, or exploring longevity treatments – there are always steps you can take to improve your quality of life.

Arthritis may be common, but it doesn’t have to define you or your future.

With the right strategies, you can stay active, independent, and doing the things you love for years to come. Local to Portsmouth, NH and looking for help?

Consider speaking to one of my specialists. CLICK HERE to book a free discovery visit.

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.

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.

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

Top 5 Arthritis Myths That Keep People in Pain

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If you or someone you love is living with arthritis — then you already know how frustrating it can be. Daily tasks become harder, favorite activities fall by the wayside, and you may start to wonder: “Will things ever get better?”

Even worse, many people living with arthritis fall victim to misguided advice.

Let’s look at five of the most common myths about arthritis management — and shed some light on what you can actually do instead:

Myth #1: “There’s nothing you can do — it’s just part of getting older.”

This is one of the biggest and most damaging myths of all.

While it’s true that arthritis becomes more common as you get older — and it’s considered a normal part of aging — it doesn’t mean you have to live with chronic pain or disability. In fact, many people with visible (even advanced) arthritis on X-rays and MRIs are living active, healthy lives with minimal to no pain at all.

Research supports this. A 2015 study published in Arthritis & Rheumatology found that more than 30% of adults over 60 had radiographic evidence of knee osteoarthritis — but only a portion of them had symptoms. In other words, just because your joints show signs of “wear and tear” doesn’t mean you’re doomed to pain.

The real issue is how you move — and how you use your joints. Strategic exercise, strength training, and natural therapies can drastically improve your mobility and reduce pain — regardless of your age or what your imaging says.

Doing nothing, on the other hand, is one of the worst things you can do.

Myth #2: “You should rest and avoid activity to protect your joints.”

If your joints hurt, don’t move them — right? That might make sense if you have an injury that requires an initial rest and healing phase. But that’s not the case with arthritis. When you avoid movement in an arthritic joint, you actually worsen your symptoms.

Too much rest leads to stiff joints, weakened muscles, and poor circulation — all of which contribute to more pain and less function over time. Movement helps lubricate joints, strengthen muscles, and prevent further degeneration.

I’m not sure why this myth is still so common — especially when just about every major orthopedic organization (including the CDC and the Arthritis Foundation) agrees that regular, low-impact physical activity is one of the best things you can do for arthritis.

The key is doing the right kind of movement. So if you’re struggling, work with an expert who can help you figure out the proper, targeted activity your body needs. But whatever you do — don’t fall for this myth.

Myth #3: “If your joint is bone-on-bone, surgery is the only option.”

Hearing the phrase “bone-on-bone” from your doctor can feel like a death sentence for your joint. And the typical recommendation? Joint replacement surgery.

But what if I told you that “bone-on-bone” isn’t always the actual reason for your pain — and that you’ve got options beyond a major procedure like surgery?

The first thing to understand is that what shows up on your imaging (like X-rays and MRIs) doesn’t always match up with your symptoms. A 2018 study in BMJ Open found that nearly half of people with severe osteoarthritis on imaging had little to no pain. And many people with significant joint pain showed only mild arthritic changes on their images.

Translation? “Bone-on-bone” isn’t necessarily the root cause of your problem. I’ve seen many people with this diagnosis successfully avoid major surgery and keep their original parts far longer than they thought possible.

When faced with this kind of diagnosis, the best thing you can do is pause — and explore your options. Surgery will always be there if you need it. But don’t rush into it or assume it’s your only option.

Myth #4: “Cortisone shots and medications are the best way to manage arthritis.”

Cortisone shots may provide short-term pain relief for arthritis — but they don’t actually fix anything. Worse, repeated cortisone injections have been shown to damage cartilage and accelerate joint degeneration over time.

One study published in JAMA (2017) showed that patients receiving cortisone injections for knee arthritis had worse cartilage loss at two-year follow-up than those who received a saline placebo — despite experiencing no significant difference in pain relief.

NSAIDs (like Advil) and prescription pain medications can also help dull pain, but they come with side effects — and, just like cortisone, do nothing to address the root cause of your symptoms.

If you’re relying on medication or repeated cortisone shots just to get through the day — or to delay surgery — it’s time to explore options that promote natural healing instead of just masking symptoms.

Shockwave Therapy and EMTT are two non-invasive regenerative therapies that do exactly that. These cutting-edge technologies enhance your body’s natural healing processes by targeting inflammation and tissue damage at the cellular level. And while more research is still needed, promising clinical evidence suggests these therapies may actually help reverse — or significantly delay — the progression of arthritis.

Do your own research — and be open to natural, forward-thinking treatment options that support your long-term joint health.

Myth #5: “Arthritis means you’ll never get back to the activities you love.”

This is one of the most heartbreaking myths — and it’s simply not true.

I’ve worked with countless clients who believed their days of hiking, gardening, traveling, or playing with grandkids were behind them — only to regain full function and freedom after following a personalized treatment plan.

And while surgery sometimes is the best option — especially if you’ve waited until your arthritis has become advanced — there’s a lot you can do to improve your outcome. Working with a specialist to build strength and prescribe targeted movement can make recovery faster and easier.

Plus, emerging research shows that using regenerative therapies like Shockwave and EMTT both before and after surgery may help accelerate healing and improve long-term outcomes.

Managing arthritis is absolutely possible when you take a natural, proactive, and personalized approach. You just need the right plan — and the right team to guide you.

Final Thoughts:

Arthritis is real — but don’t let myths and outdated advice keep you stuck. If you’re not sure where to start — or feel like you’ve already tried everything — speak with someone who specializes in mechanical pain and natural joint care. Often, the most effective solutions are the ones no one has told you about yet.

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.

When your Back Hurts – is Rest Helping or Hurting?

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Whenever someone finds out I’m a physical therapist, the next question is almost always something like… “What can I do for [insert the blank] injury?” And when it comes to back pain specifically, people often ask me: “Should I be resting it?”

It’s no surprise that the vast majority of folks I speak with about back pain have been told by well-meaning friends, family, or even doctors that rest is the best thing for back pain — especially when you first hurt it. But what if I told you that rest might actually be the worst thing you can do? That resting and doing nothing — even when you’ve acutely hurt your back — can actually delay recovery and even make your back pain worse in the long-term.

Conventional advice tells us that back pain should be treated with ice, inactivity, and as little movement as possible — and when it feels better — to start slowly moving it. That advice makes sense on the surface — after all, if something hurts, shouldn’t you avoid using it? But research (and decades of clinical experience) shows us that this approach can actually prolong healing, increase pain sensitivity, and make it more likely that your back pain will return again and worse, become a long-term issue.

Why Rest Doesn’t Work

Modern health research is very clear on this: too much rest after a musculoskeletal injury like back pain leads to muscle deconditioning, joint stiffness, poor circulation, and even heightened pain sensitivity. A well-known review published in The Lancet concluded that staying active is one of the best things you can do for non-specific (mechanical) low back pain. In fact, people who remain as active as possible — within reason — recover faster and are less likely to develop chronic symptoms.

Here’s why: your joints and tissues thrive on movement. Motion promotes circulation, reduces inflammation, and helps your muscles and nerves return to normal function. When you stop moving, the opposite happens. Your muscles tighten, your joints stiffen, and your brain becomes more sensitized to pain signals. That’s how a small tweak in your back can turn into months (or years) of recurring pain if you’re not careful.

Movement is Medicine

Now, this doesn’t mean you should ignore your pain and go back to the gym, golf, or even all your daily house chores the next day. There’s a difference between smart movement and overdoing it. But most people fall on the other side of the spectrum — they stop moving entirely, waiting for the pain to just “go away.”

What I recommend instead is gentle, intentional movement that keeps your body active without making things worse. Walking, for example, is one of the best low-impact ways to get your spine moving and your blood flowing. If walking feels okay, it’s a great first step toward healing.

Specific exercises tailored to your pain are also incredibly powerful. These movements help “reset” your nervous system, calm down overactive muscles, and restore balance to the structures around your spine. In my clinic, I call these “first-aid movements.” They’re often simple, but highly specific — and they can help you move from debilitating pain to something much more manageable.

But What If Movement Feels Impossible?

I get it — sometimes your back pain is so bad that even getting out of bed or walking across the room feels unbearable. If you’re stuck in this kind of pain cycle, you may not be able to figure out on your own what’s safe to do. And in those cases, the worst thing you can do is wait it out or rely on generic advice from Google or YouTube.

This is where working with a mechanical back pain specialist can be a game changer. A trained expert can evaluate your pain based on movement patterns — not just an image or MRI — and guide you toward the exact movement your body needs to start calming the pain down. In fact, I often see patients go from 10/10 pain to 3/10 in their very first session, simply by finding and repeating the movement that’s right for their spine.

That kind of progress might seem like magic — but it’s just smart biomechanics. The body wants to heal, but it needs the right inputs. A movement-based mechanical specialist knows how to give your body those inputs safely and effectively.

Finding the Middle Ground

The key takeaway is this: while you may need to modify your activity levels when your back flares up, the goal should never be total rest. There is always some kind of movement you can do — and the sooner you find it, the sooner your healing process will begin.

If you’ve been dealing with back pain for more than a few days, and especially if it’s stopping you from doing the things you love, don’t wait around hoping rest will fix it.

The better alternative?

Talk to a professional who understands movement, mechanics, and pain. A customized plan — not a generic rest-and-wait approach — is what truly sets people on the path to lasting relief. Movement is powerful medicine — especially when it’s prescribed correctly.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists for free 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.

Back Pain, Herniated Discs, and Cortisone Shots: What You Need to Know

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A recent conversation about cortisone shots and back pain due to herniated discs inspired me to write this article.

The person I was speaking with was quite misinformed about when cortisone shots are useful – and when they aren’t. By the way, it’s a very common misunderstanding. But since I hate seeing people undergo unnecessary injections or procedures – I’m here to educate. 

So let’s break it down: when is a cortisone shot a good idea, and when should you think twice?

When Cortisone Shots Work

Cortisone shots can be highly effective if your pain is primarily caused by inflammation, which is what I call “chemical pain.” Chemical pain results from your body’s inflammatory response to an injury. This response produces chemicals and nutrients that help heal the area, but sometimes the process gets “stuck”. The lingering chemicals cause persistent pain that doesn’t respond to movement or rest.

If your back pain is constant, feels hot and inflamed, and doesn’t improve with positional changes, you might have chemical pain. In these cases, a cortisone shot can eliminate the chemicals causing the pain and provide relief. 

In other words – exercise – which is the best treatment for herniated discs and back pain – won’t work well when you have chemical pain. Historically that’s when cortisone shots are necessary. But in 2021 – an amazing technology called Electrocorporeal Magnetotransduction Therapy (EMTT) came to the United States and works just as well (if not better) than cortisone, except it’s natural and non-invasive. EMTT uses a high-frequency magnetic field that can penetrate up to 6 inches into the body – so it can heal inflammation in places like your lower back down to the cellular level. I’ve seen great results from it – so I’m starting to recommend this over a cortisone shot for anyone that needs it. 

When Cortisone Shots Don’t Work

Most back pain (even those related to herniated discs) – aren’t chemical in nature. It’s mechanical, meaning it stems from issues with mobility and movement patterns. Mechanical pain – responsible for 70-80% of all musculoskeletal issues (including back pain) – will improve and resolve with precisely prescribed corrective-movement exercises. How do you know if you’re in this category? If your back generally feels better after walking, stretching, or changing positions – it’s almost certainly mechanical – because it’s responding to movement. If this sounds like you – a cortisone shot won’t address the root cause.

The key to resolving mechanical pain is identifying and correcting mobility restrictions and faulty movement patterns. Once you do this, the structural issue (like the herniated disc) becomes less relevant. Many people live symptom-free with herniated discs once they’ve addressed their underlying movement pattern problems and mobility.

The Gray Area

Here’s where it gets tricky: a herniated disc can irritate surrounding structures like muscles and nerves, causing localized inflammation. This type of pain can feel intense, but it’s not quite the same as chemical pain. But it will be tempting to get a cortisone shot for quick relief. The thing is – it will only be a temporary fix. The shot won’t address the underlying mechanical issues that caused the disc to “act up” in the first place. Worse, masking the pain can lead you to unknowingly worsen your problem, potentially leading to more procedures or surgery. In most cases, this type of inflammation can resolve naturally without drugs. Something like EMTT that I already mentioned, and other regenerative therapies like Shockwave Therapy work great for this type of inflammation.

Take Home Points:

Before you consider cortisone shots, take a moment to evaluate your pain:

  1. Does movement or activity influence your pain? If yes, it’s likely mechanical and won’t benefit from a cortisone shot.
  2. Is your pain constant, hot, and unresponsive to movement? If yes, you might benefit from a cortisone shot to calm the inflammation and enable movement to help.
  3. There are some amazing Regenerative Therapy Treatment technologies available now that serve as natural, non-invasive alternatives to cortisone shots if you are really inflamed. Plus – they work with your body’s own anti-inflammatory systems by giving them a boost.

Ultimately, cortisone shots don’t fix structural problems – they temporarily eliminate pain due to inflammation. While this can be useful in specific situations, it’s crucial to address the root cause of your pain to prevent long-term issues and seek healthier alternatives when you can.

Local to Portsmouth, NH? Schedule a free discovery visit with us today and take the first step toward lasting relief and better movement.

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.

When exercise hurts your back instead of helps

Six Ways to Help Manage Knee Arthritis and Stay Active

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Knee arthritis is one of the most common forms of osteoarthritis, affecting more than 80% of cases and impacting at least 19% of Americans over the age of 45.

For many, a diagnosis of knee osteoarthritis leads to chronic, debilitating knee pain that stops them from doing their favorite activities. Sometimes it’s due to the limiting belief that once you have arthritis, you have “bad knees” for life. Other times it’s because you’ve been told you have “bone on bone” in your knee and that you should scale back on activity so you don’t make it worse.

This line of thinking is flawed and often leads to unnecessary injections, procedures, and surgery. Because being active is one of the best things you can do to manage your arthritis and protect your knees.

But what if movement and activity hurt?

Here are six ways to help manage arthritis in your knees so you can stay active and keep doing the things you love:

1. Strengthen Your Hips and Core

When you have poor control of your hip and core muscles, you get more stress through your knee joint. The strength of your upper leg muscles is very much dependent on your hip and core strength. Your thigh bone (femur) connects your knee and your pelvis, and your core strength controls your pelvis. If your pelvis isn’t stable, your femur is going to have a difficult time staying in alignment, which will ultimately have an impact on your knee joint. If you’ve got arthritis in your knees – it’s critical you minimize any added stress to your knee joints. Strengthening your core and having good hip strength will help prevent and minimize the symptoms of arthritis – keeping you active for longer.

2. Keep Your Knees Mobile

Mobility before stability is my mantra. And I say this for just about every joint in your body. But it’s especially true for your knees. There are joints whose primary function is stability, and there are those whose major function is mobility. Your knee needs to be mobile. Its major purpose is to bend all the way so you can squat and pick things up, and it needs to straighten all the way to give you stability when you need it. When either of these motions is lacking, your ligaments and surrounding muscles will suffer, adding more wear and tear to your joint, which can aggravate arthritis symptoms. When folks are told they have arthritis – a lot of folks just “accept” that their knees are stiff. But the truth is that even a 10% improvement in your knee mobility can lead to significant functional gains, help you better manage arthritic knee pain, and avoid major interventions.

3. Don’t Stop Your Activities

When people find out they have arthritis – and especially if they’ve been told it’s “bone on bone” – they often think that slowing down or stopping activity will help protect their knees. This couldn’t be farther from the truth. Study after study shows that severe joint pain among adults with arthritis is worse with inactivity. When you remain active, you keep blood flowing, your knee joints mobile, and your muscles strong. These are very important factors in managing your arthritis. Plus – sometimes the knee pain you feel when you’re doing certain activities has nothing to do with your arthritis. Statistics show that only 15% of patients with evidence of knee osteoarthritis on X-ray even had symptoms. That means that the other 85% are walking, biking, and running around enjoying their favorite activities – despite what their X-ray says. The point here is to keep doing your activities – it’s one of the best ways to prevent arthritis from advancing and protect your knee joints as you age. If you’re really struggling with this – it’s time to talk to a knee expert who can help you.

4. Optimize Your Footwear and Walking Mechanics

Many people don’t realize how much their feet impact their knees. If you’re wearing unsupportive shoes or walking with poor mechanics – your knee joints will absorb more stress than they should. Over time, this increased strain can exacerbate arthritis symptoms. Consider wearing supportive shoes that align your feet properly and provide adequate cushioning. Walking is a really good activity for your knees and arthritis. So if you’re experiencing frequent knee discomfort while walking, a professional gait assessment can help identify areas of weakness or imbalance that might be contributing to your pain as well as help you find the perfect pair of footwear.

5. Opt for Natural, Joint-Friendly Pain Relief

Your knees work hard every day. And if you have arthritis – finding relief without relying on medications or invasive treatments/injections can be a game-changer and minimize any downtime. There are plenty of natural pain relief strategies that will help minimize inflammation and keep you moving comfortably. Heat therapy and corrective stretching techniques are great for reducing stiffness by keeping blood flowing and muscles relaxed and flexible. Similarly massage and foam rolling can improve circulation and ease muscle tension around your knee joint. Regenerative treatments like shockwave therapy, EMTT, and dry needling are becoming popular alternatives to cortisone shots – as they work with your body’s own mechanisms to stimulate healing versus causing joint damage over time. By integrating natural pain relief methods into your routine, you can better manage knee arthritis and stay active without unnecessary reliance on medications or invasive procedures.

6. Manage Your Inflammation with Diet and Hydration

Chronic inflammation worsens arthritis symptoms, but the right diet can help. Anti-inflammatory foods like fatty fish, leafy greens, berries, and turmeric support joint health, while omega-3s from fish oil reduce inflammation at a cellular level. Collagen powder and glucosamine-chondroitin can support cartilage health and joint lubrication. Hydration is also key. Water keeps joints cushioned and prevents excess friction. Simple dietary changes, paired with the right supplements, can make a significant difference in managing knee arthritis.

Final Thoughts

Even if you’ve been told you have “bone on bone” or advanced arthritis, you can still improve your knee health. The best thing you can do for your knees is to keep moving. And if pain is getting in the way – I hope these strategies help you manage your symptoms naturally – so you can avoid resorting to medications, injections, or surgery.

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.

Why Your Knee Pain Isn’t Going Away – And What You Might Be Missing

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Knee pain can be stubborn. If you’ve tried stretching, strengthening, injections, or even surgery with little to no relief – it might be time to consider looking beyond your knee. Many people are told their pain is due to “wear and tear,” arthritis, or simply aging. But here’s the thing… There are plenty of people out there with these very same conditions who have no knee pain at all.

So, what gives?

It turns out that knee pain isn’t always a knee problem.

If you’re still dealing with persistent discomfort despite following every piece of conventional advice, one of these four lesser-known culprits might be the real reason behind your lingering knee pain.

1. It’s Not Your Knee—It’s Your Back

Did you know that nearly 40% of extremity pain actually originates from the spine – even if you don’t have back pain? The nerves that control your knee function start in your lower back. If they’re irritated, compressed, or not functioning properly, your knee could suffer the consequences.

A key sign that your knee pain is actually coming from your back is if your pain moves around, travels up or down your leg, or worsens when you sit for long periods. If your knee treatments aren’t working, it’s worth investigating whether your back is the real issue by talking to a mechanical back pain specialist.

2. Your Core is Weaker Than You Think

When people hear “core strength,” they usually think about back pain or six-pack abs – but your core plays a massive role in knee health, too. Your core, hips, and glutes work together to stabilize your lower body. If these muscles are weak, your knees pick up the slack, leading to unnecessary strain and chronic discomfort.

Signs of a weak core affecting your knees include feeling unstable on one leg, difficulty maintaining good posture, or knee pain that worsens after prolonged activity. The solution? Strengthening your core and hips can take the pressure off your knees and keep them moving the way they should.

3. Your Ankles Might Be the Problem

Your ankles act as the foundation for your entire lower body. If they lack mobility or stability – your knees will compensate – leading to stiffness, pain, and dysfunction. Poor ankle mobility can make everyday movements like walking, running, and squatting much harder on your knees.

If you struggle with ankle flexibility or feel unsteady during activities like hiking, running, or sports – your knee pain may actually stem from weak or restricted ankles. Addressing ankle stability and mobility could be the missing link to finally getting relief.

4. Your Knee Isn’t Moving the Way It Should

One of the most overlooked aspects of knee pain is mobility. There might actually be nothing at all wrong with your knee – but if it doesn’t move as well as it should – structures within and around your knee joint will slowly start to get irritated. Most rehab programs focus on bending the knee – but proper knee function also requires slight hyperextension – and this is where I see a lot of problems for people. If your knee stops at “just straight,” it may still be restricted, causing long-term dysfunction and discomfort.

Pro-tip: This is especially common after surgery, where full mobility isn’t always restored. If one knee doesn’t move like the other, it’s time to work with a mechanical knee pain specialist who can prescribe corrective movements to help you regain that lost range of motion.

What to Do Next

If you’ve been dealing with knee pain that just won’t go away – there’s a good chance you either have the wrong diagnosis – or the wrong treatment plan. You may need to stop focusing on the knee and start to look elsewhere in your body. The real problem might be coming from your back, core, ankles, or mobility restrictions somewhere leading to secondary stress on your knee joint.

A mechanical pain specialist who understands the bigger picture can help pinpoint the true cause of your pain and create a plan that actually works to finally get your knee pain resolved.

Are you local to Portsmouth, NH?

Consider speaking to one of my mechanical knee 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.