Tag Archive for: Portsmouth NH

Man getting knee pain treatment

Four Surprising Contributors to Lingering Knee Pain

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Approximately 25% of adults suffer from lingering, chronic knee pain without any clear reason why.  For some, aging and arthritis is to blame, and it’s something to just “live” with. For others, they’re told it’s due to “wear and tear”. Yet despite one or more surgeries to “clean out the knee” – the pain lingers and persists. 

So why then, do some folks age, get arthritis, and put tons of wear and tear on their knees without any issue – where others suffer from chronic knee pain? The answers may surprise you. 

Let’s look at four lesser-known (and often overlooked) contributors that cause knee pain to linger and not go away.

1. “Hyper” mobility is lacking

I remember early on in my career (22 years ago) when “hyper” mobility was considered a bad thing. But since then, both research and experience have proven me wrong. If you’ve followed me for a while – then you know one of my favorite sayings is “mobility before stability”. That’s because a joint that moves fully and freely feels and functions better – and allows the muscles around that joint to work at their best. Too often, people mistakenly look at muscular strength first as the solution to solving pain, when they should be looking a bit deeper.  Regarding knees, you need a bit of what we call “hyper-extension”. But most practitioners tend to focus only on how well a knee is bending. For knees – just getting to straight isn’t good enough. You need a certain amount of “more than straight” – otherwise known as hyperextension. I see this problem most in knees that have had surgery.  If their full knee extension (hyperextension) wasn’t restored properly during rehab, or perhaps they didn’t have any rehab at all (common practice now after most arthroscopic knee surgeries), knee pain will persist. And it won’t go away no matter how much you try and strengthen it. Moral of this story – make sure you have full knee extension – which includes a bit of hyperextension – and that it matches your other knee. This could be a reason your knee pain isn’t going away.

2. It’s really a back problem

Did you know that 40% of the time, an extremity problem (aka: knee, shoulder, etc) comes from the spine – even when you don’t have any neck or back pain? It’s more common than you think for knee pain to be caused from your lower back, and when this gets missed, it’s a huge reason for lingering knee pain that never seems to get resolved. With a true knee problem, your symptoms tend to be pretty specific and localized to just your knee joint. But if your pain tends to move around your knee, or travels up and down your leg, there’s a good chance your knee pain is coming from your back. If you’ve been treating your knee for months (or years) – and it’s not going away –  consider that your knee problem is actually a back problem. This could be especially true if you’ve had cortisone injections and/or various procedures done to your knee with little or no effect.

3. Poor core strength

When it comes to core strength, most people associate it with something that’s important for resolving and preventing back pain. But good core strength is vital to good knee health as well. Your abdominals, low back muscles, hips, and glutes all make up what we call your “powerhouse” – otherwise known as your core. Your powerhouse – specifically your hips and glutes – have a huge influence on how well your lower extremities function. If your core is weak, your legs will need to work harder and eventually overcompensate. And knee joints often take the brunt of all this. The truth is, although your knees require a certain amount of stability to function well – they aren’t designed to be a stabilizing joint. That’s what your hips and ankles are for. If your core is weak (particularly hips and glutes), and your knees start trying to help out as an extra stabilizer, this could be the reason why they keep hurting. If you haven’t yet gotten your core strength properly assessed – do it – this could be the culprit.

4. Weak ankles

As I alluded to above – if your ankles aren’t strong enough to stabilize your foot and lower leg, your knees will kick in to help. If this pattern is allowed to continue – your knees will start to hurt – and will keep hurting until the pattern is discovered and fixed. Another interesting phenomenon that can occur in any joint (not just your ankles) is that when a joint lacks strength or stability – it will stiffen up to compensate. So in terms of your ankles – if they lack range of motion on top of being weak – your knees will really pay the price. This is particularly evident during activities such as running, hiking, pickleball, or tennis. You need really good mobility and stability of your ankles for these activities – or your knees will suffer in response. If you’ve got lingering knee pain and haven’t yet taken a look at your ankles – I recommend doing so – they could be the overlooked issue. 

Knee pain can be tricky to figure out – especially if it’s chronic. The key to successfully getting rid of knee pain starts with correctly identifying the cause. And from my experience – arthritis, age, and wear and tear serve as “excuses” when a practitioner doesn’t know where to look. If you’re suffering from chronic knee pain and haven’t yet explored any of the four lesser-known contributors I mentioned in this article – talk to a specialist who knows how to look at the big picture instead of just your knee – because the true cause could be elsewhere.

Are you local to Portsmouth, NH?

CLICK HERE to speak with one of my specialists for free.

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

Back Surgery

Before Back Surgery – Try specialized physical therapy first

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 Expert Tips to Treat Back Pain Naturally and on your Own

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Back pain impacts approximately 31 Million Americans at any given time, and our health care system spends $50 Billion per year on low back pain treatment.

It’s the single leading cause of disability keeping people out of work, and it’s the second most common reason for doctor’s visits. Back pain is a big problem in this country. But the even bigger problem, in my opinion, is how the traditional medical system treats and manages those suffering from back pain.

Despite what you may have been told, getting rid of back pain on your own is entirely possible and preventing it can be even easier.

But it starts with understanding what the true cause of back pain is for most people. Eighty percent of back pain is “mechanical” in origin, which means it’s not due to any serious pathology like cancer, infection, or fracture. Mechanical back pain is the result of abnormal or unusual forces occurring in the structures of your spine – like your ligaments, muscles, discs, and vertebrae. These abnormal forces can accumulate slowly over your lifetime or happen quickly in a single event – such as picking something up the wrong way. The good news is that if abnormal forces can cause your back pain, then reversing those forces can get rid of your back pain. Surgery and other medical procedures won’t do that. They only impact the structure or irritant that is aggravated, like when you remove a piece of your bulging disc. The goal for true back pain recovery is to eliminate what is causing those structures to be aggravated in the first place – and the best way to do that is with healthy movement you can do on your own!

Here are 5 tips to help you minimize abnormal forces on your spine so you can avoid procedures and surgery!

 

1. Stop sitting so much

Compressive forces on your spine increase by 40% when you sit – and it goes up even more if you’re slouched! Over time, these compressive forces will start to aggravate the ligaments and discs in your spine. Because it happens slowly, you may not notice right away, so one of the best things you can do is interrupt your sitting at least every 30 min. This minimizes the accumulation of abnormal forces on your spine throughout the day.

2. Walk more

Our spines were designed to be upright and moving. Walking is one of the best and easiest ways to promote this. When you walk regularly, it helps to promote good mobility and blood flow, which can act like lubricant for the structures in your spine. Walking also helps to keep your hips from getting tight. Tight hips can cause abnormal forces to occur at your pelvis, which in turn, will create abnormal forces on your spine.

3. Vary your posture

You might be wondering why I didn’t say “maintain good posture”. To be honest, perfect posture all the time is kind of a myth when it comes to back pain. The truth is your spine is quite resilient and should be able to tolerate lots of different postures – even bad posture for a short period of time – without pain. The problem is when we assume the same posture all the time. Imagine if you never straightened your knee, eventually it would get stiff and be difficult to move in that direction. The same thing happens in our spines. One of the best things you can do is choose activities (like Yoga or Pilates) that work your spine through lots of different postures and range of motion. This helps keep your spine happy and healthy and it minimizes abnormal forces from the same repeated postures or activities day after day.

4. Strengthen your core

The stronger you are, the more resilient your body is going to be – period. When it comes to back health, having a good strong core is going to minimize stress on ligaments and even discs. When the muscles around your spine are strong, it’s going to be easier for you to lift and carry things, which is one of the most common ways people injure their backs. If your abdominals, glutes, and hips aren’t doing their job, your spine ends up taking more of the stress – and this can lead to both pain and injury. Pilates is my favorite way to strengthen your core because the exercises are designed to target your abdominals.

5. Educate yourself

There is a lot of misinformation out there when it comes to both diagnosing and treating back pain. You should never let an MRI or X-ray alone dictate what your treatment should be. Remember, the structures in your back don’t get spontaneously irritated. Irritation typically occurs due to abnormal forces on your spine. If you only address the irritated structure – like with an injection, procedure, or surgery – you’re not actually fixing the problem. The best way to address abnormal forces in your spine is with movement – movement that is designed to even out the forces in your spine and relieve pressure from those structures that have become aggravated.

If you’re currently suffering from back pain and want to avoid having to resort to medication, procedures or surgery – then give these tips a try. But if you’ve tried these tips and you continue to struggle – then consider consulting with a mechanical back pain expert who can help you get rid of back pain naturally – and with corrective movement and lifestyle strategies.

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

Three Red Flags Your Hamstring Strain is Probably Something Else

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

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

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

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

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

1. You have chronic hamstring pain

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

2. Numbness and Tingling in your butt or leg

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

3. You feel pain below your knee

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

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

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

Are you local to Portsmouth, NH?

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

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

Is Exercising Hurting Your Back? 5 Reasons Why.

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Is Exercising Hurting Your Back? 5 Reasons Why.

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

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

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

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


1. It’s the wrong type of exercise

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

2. Stability training is introduced too soon

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

3. Your aren’t activating your core

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

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

4. You aren’t breathing properly

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

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

5. You’re using improper form

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

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

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

Are you local to Portsmouth, NH?

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

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

4 Spine-saving tips for less pain during Holiday Travel

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

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

Tip #1: Interrupt your sitting

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

Tip #2: Use a lumbar pillow

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

Tip #3: Maintain a neutral spine while you sleep

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

Tip #4: Stay Hydrated

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

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

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

Request a free discovery visit by clicking here. We will ask you all about what’s been going on and see if we would be the best fit to help you 🙂

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

6 Essential Habits that Build your Immunity

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

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

1. Stay Hydrated

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

2. Exercise Regularly

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

3. Get some Sleep

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

4. Eat Well

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

5. Be Social

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

6. Get Outside

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

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

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

syringe

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].

Active and Mobile

Seven Tips for an Active and Healthy Thanksgiving

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Thanksgiving is one of my absolute favorite Holidays. I love all the food, sweets, time with family, the Macy’s Day Parade, afternoon naps, and football. While it’s historically been a time for indulgence and relaxation, more and more people are opting for a more active and healthier Thanksgiving Day. And there are numerous benefits for doing so… boosted mood and energy levels (which can make your day even more enjoyable), improved digestion, happier hips, knees, and back, and you’ll offset some of the extra calories you may have consumed.

If you’re looking to be more active and healthy this Thanksgiving – here are seven tips to make it easy for you:

  1. Interrupt your sitting

We were not designed to sit for prolonged periods, so getting up frequently is an easy way to not only incorporate movement throughout your day, but to help keep away back, hip, and knee stiffness. I recommend standing up at least once every 30 min. This could be a fun “job” to give a young child. Make them accountable for watching the clock and remind you to stand up. This is quite possibly the easiest and most effective strategy to keep your knees, hips, and spine from getting painful and stiff – and it’s an easy way to stay a bit more active this Thanksgiving.

  1. Sign up for a Turkey Trot

Thanksgiving Turkey Trots are a popular event in most towns and it can be a really fun event for the whole family. Turkey Trots are typically 5K’s – or 3.2 miles. If you’re not able to sign up for an actual race, grab your friends and family and create your own Turkey Trot within your neighborhood. This is a great way to get your blood flowing and joints lubricated first thing in the morning. Plus, it will help offset some of those extra Thanksgiving calories. 

  1. Stretch during Commercials

Whether it’s the Macy’s Day parade, football, or both – it’s easy to find yourself lounging for hours on a soft sofa or recliner. A very easy way to keep yourself from sitting or slouching too much, and to incorporate some healthy movement into your day, is to get up during commercials. It’s the perfect opportunity to do a quick 2 min exercise or stretch.  It doesn’t have to be complicated. Choose from a quick set of squats, heel raises, planks, or back stretches. And make it fun. Get a plank or squat competition going with your most competitive family members – you know who they are.

  1. Walk your Dessert Off

While skipping dessert is of course an option – why not just walk it off instead? Choosing to walk off your dessert rather than skipping it strikes a balance between indulgence and staying healthy. Plus, opting for a post-meal walk has many benefits. It aids digestion, helps regulate blood sugar levels, and it’s good for your hips, back and knees. A post-meal walk is an opportunity to get some much needed lengthening and stretching of our muscles and joints after being parked in a chair for a length of time. It’s also one of the best and most natural exercises you can do for yourself – but it’s especially great to do after a big meal like Thanksgiving – and before you settle in for the evening.

  1. Help with clean-up

Don’t be shamed into “just sit down and relax” because you’re a guest. Helping with clean-up (or set-up) is an easy and effective way to keep moving during your Thanksgiving Holiday. Not only will your Thanksgiving host love you – but your body will too. If you’re suffering from back problems, be careful bending and leaning over – especially if it’s repetitive – when you’re collecting or washing dishes. But otherwise, carrying heavy plates, moving chairs, and wiping down tables can burn quite a few calories and it’s good for your body.

  1. Stay hydrated

Staying hydrated is important all of the time – but especially on a day like Thanksgiving. Good hydration will help regulate your digestion, which is particularly important given the heavy and often rich foods we typically consume during this holiday. Plus, water aids in breaking down food, allowing for better nutrient absorption and preventing digestive discomfort. Staying hydrated also helps with maintaining your energy levels and keeping your mind clear. When it comes to appetite, we often mistake thirst for hunger, so when you stay hydrated, you have more control over your portions and are less likely to overeat. When you stay hydrated – it not only supports your body’s essential functions – but making healthier choices becomes easier – which will contribute to a more balanced and enjoyable Thanksgiving Day.

  1. Make your dishes health-conscious

It’s easier than ever to make your traditional Thanksgiving recipes more health conscious. Start by reducing the amount of sugar and salt in recipes, and consider natural sweeteners like honey or maple syrup instead. When it comes to stuffing and flour – opt for whole grains instead of refined ones. Incorporating more fruits and veggies can boost the nutritional value of traditional dishes, and sticking to lean meats such as turkey breast is a healthier choice compared to something like ham. Lastly, watch your portion sizes. Don’t dump everything you see onto your plate – however tempting it might be – and eat slowly. The faster you eat – the more you tend to eat. 

There you have it – seven easy tips to make your Thanksgiving more active and healthy.

I hope you have a wonderful Holiday and get to spend it with those you love most.

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].

avoid back pain when raking leaves

6 Tips to Protect your Back when Raking Leaves

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Leaves are everywhere right now in New England, which means for many, the tedious task of raking them is right around the corner. I love Fall – but I don’t love raking leaves. And raking leaves is even worse when you’re suffering from back pain. The good news is there are many things you can do to protect your back when raking leaves. 

Here are 6 of my most popular tips to protect your back when raking leaves:

1. Warm up before you start.

Just as athletes warm up before a game, so should you before raking. Beginning any physical activity without preparing your body can lead to unwanted strains and injuries. For raking, focus on warm up activities that target your back, shoulders, and legs. Something like a quick walk around the block before you start is an excellent way to warm up. It gets blood flowing to your legs and arms, and the gentle rotational aspect of walking is great for your spine and torso. You could also include some basic stretches into your warmup such as torso twists, shoulder shrugs, and arm circles. This gets some lubrication into your joints and spine to help protect your back once you start raking.

2. Choose the Right Rake.

With any repetitive activity such as raking – good ergonomics is essential. Ergonomics refers to how safe and efficient you are in your working environment. Bad ergonomics will typically cost you unnecessary energy and labor – and can often result in an injury. When it comes to raking, choose a rake with a handle that is long enough so that you can maintain upright posture while using it, and go for one that is light in weight yet still durable. A good, ergonomic rake might require a bit more investment than you were intending, but it will be worth it in the long run because ultimately, a back injury will cost you much more. And knowing how to protect your back from injury is priceless.

3. Bend with your legs and hips

When performing repetitive activities or lifting something heavy, one of the most vulnerable postures for your back to be in is the combined position of flexed (bent forward) and rotated. To protect your back and avoid injury, you want to use your legs and hips to bend and lift. If you’ve got the right rake, it will be easy to maintain an upright posture while raking. And then when it’s time to scoop up the leaves and deposit them, you’ll want to squat using your hips and knees, and pivot with your trunk and pelvis. Avoid lifting with a curved back and twisting from your waist or spine. Maintaining these habits on a regular basis (not just when raking) will help you protect your back from strain or injury that could otherwise be very easily avoided.

4. Take regular breaks

Continuous and repetitive raking can tire out your muscles and make them more susceptible to injury. Plus, when you get into the monotony of raking, the mindlessness of the activity makes it easy to not pay attention to things like maintaining good posture and using good body mechanics. An easy way to combat this is by taking regular breaks. I recommend at least once every 30 min. Set an alarm on your phone or watch to remind you – and when it goes off – stop what you’re doing, put the rake down, and give yourself a quick upright back stretch. This very simple and easy strategy will go a long way in protecting your back when raking leaves.

5. Engage your Core

You don’t need six-pack abs to protect your back while raking leaves, but simply being mindful of your core can be super helpful and certainly won’t hurt you. Most back injuries occur when you least expect it – and when you aren’t paying attention. When you’re raking leaves, or any other mindless, repetitive activity for that matter, make an effort to think about gently drawing in your lower abdominals while you perform the activity. It’s a subtle move, and you should be able to easily breathe and talk while doing it. If you struggle to breathe and talk normally – you’re overdoing it.  This simple act of engaging your core will help keep your spine more supported and stable while raking and it will help protect your back.

6. Keep Moving Afterwards

What you do after raking is equally as important as what you do during to help protect your back from pain and injury. One of the biggest mistakes people make after a repetitive or strenuous activity (like raking) is to slump on the couch or recliner and “rest”. This is one of the worst things you can do to your spine because it’s more pliable and vulnerable right after strenuous activity. And when you put your spine in a relaxed, flexed position while it’s vulnerable – you’re just asking for an injury. You won’t notice it while you’re resting – but you might feel a tweak or strain when you go to stand up – or even up to several hours later. Do yourself a favor and perform some gentle stretching after raking, or go for another walk to help relax your back. And be mindful of your resting postures for a few hours after raking. This is an easy way to protect your back during raking season.

Hopefully these tips give you a few things to think about before you go raking all those leaves in your yard – but most importantly – help you protect your back and avoid unwanted back pain this fall season.

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].