Tag Archive for: Portsmouth NH

Sciatica

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

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

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

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

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

What to Avoid:

1. Soft beds and couches 

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

2. Child’s pose and stretching forward.

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

3. Letting your MRI dictate treatment.

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

What to Do:

1. Go for Walks. 

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

2. Pay attention to your Posture.

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

3. Talk to a Mechanical Pain Specialist.

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

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

orthopedic surgery

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

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

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

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

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

 

1. Imaging does not always correlate with symptoms

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

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

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

2. Risk of Over-diagnosis and Overtreatment

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

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

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

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

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

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

Are you local to Portsmouth, NH?

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

CLICK HERE to request a Free Discovery Visit.

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

tight hips

Tight hips? Try strengthening instead of stretching.

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When you’ve got tight hips, it can interfere with your ability to enjoy walking, running, golfing, and just exercise in general.

Tight hips are not only annoying and achy, but they often contribute to lower back pain as well. But perhaps more frustrating than the tight hips themselves is the fact that no matter how much stretching you do – they never seem to loosen up. Typically when I hear this, it’s a big red flag for me that tight hip muscles aren’t actually your problem.

In other words, just because it feels like you’ve got tight hips – doesn’t mean they actually are tight.

 

Let me explain.

Your hip muscles can literally be shortened and constricted – in which case – they need lots of stretching. But they can also be “tight” due to weakness or being overworked. When muscles are overtaxed or undertaxed during an activity, they aren’t going to function well and they will find a way to compensate. And this compensation strategy can lead to chronically tight hips over time.

But here’s the thing…

When your hips are tight due to weakness and overcompensation, stretching will not help. Stretching might feel good in the moment, or give you temporary relief, but the tightness in your hips will continue to return until you identify and fix the real underlying problem.

Let’s take your psoas (one of your hip flexors and pelvic stabilizers) as an example to illustrate this concept…

Your psoas is one of your deep hip flexors that also has a connection to your lower back. Although it is capable of flexing (bending) your hip in some capacity – it has more of a stability role. When functioning properly it will assist in exercises like the crunch or sit up, and also work alongside your deep abdominals and glute muscles to help you maintain good upright posture when you’re sitting or standing.

Unfortunately the psoas gets blamed for a lot of things – most notably – tilting your pelvis forward because it’s “tight” and causing lower back pain. The theory is that if you stretch, massage, and “release” your psoas muscle, then you will balance out your pelvis, and your back pain and hip tightness will disappear. But sadly, this is rarely the case. More often than not, your psoas is tight because it’s overworking to compensate for your deep abdominals/core not working properly.

Do your hips ever cramp or feel achy during abdominal work?

Your inclination will be to stretch them but this will simply not work. You have to get your abdominals and deep core to start working properly so that your psoas can actually relax. Once your hip flexors are no longer doing all the work, they won’t feel tight anymore.

This concept of tightness due to overworking and compensation can happen to any muscle in your body. With hips in particular, your psoas along with your piriformis and TFL (tensor fascia latae) are the most common victims. We’ve already spoken about your psoas, but your piriformis and TFL love to compensate for weak gluteal (butt) muscles.

An overworked piriformis leads to difficulty sitting cross-legged and a tight TFL can be painful and lead to IT band problems. You can stretch all you want, but if you don’t address the underlying cause and give these muscles a chance to relax, your hips will constantly feel tight. Plus, stretching in and of itself is a form of load on your muscle. You don’t want to add more load to an already tired and angry muscle.

The moral of this story is that if you’ve got chronically tight hips and stretching all the time isn’t solving your problem, then consider a different approach. Most people don’t consider strengthening an area that feels tight but this could be what you’re missing.

When it comes to hips – the things to look at are your deep abdominals/core and your glutes/butt muscles. Often there’s an underlying weakness in one or more of these areas that you just can’t recognize. Do yourself a favor and talk to an expert who gets this.

Are you local to Portsmouth, NH?

Consider reaching out to one of my specialists by requesting a 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 get in touch, email her at [email protected].

Medicare cuts

Medicare cuts coming in Jan. Why you should pay attention.

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On Nov 1st, the Federal government issued a final ruling that’s going to result in Medicare cuts of 4.5%. In an already dysfunctional and overcrowded healthcare system – this is going to be a problem for you (the consumer) – and here’s why…

Healthcare is ultimately a business. And its goal is to make a profit. Revenue and profit come from things like procedures, tests, images, and surgery – not from disease prevention and keeping people healthy.

What does that mean for you?

Health care specialities such as orthopedic surgery, neurology, and gastroenterology (for example) – those that are procedurally-driven – generate higher revenues and get paid more for their services.

On the flip side – disciplines like primary care physicians, rehab therapies (like physical therapy), and endocrinologists (those that manage chronic conditions like diabetes and osteoporosis) – get paid less.

The consequence is that the disciplines who actually need more time with you- so they can get to know you and your lifestyle – because that’s what is required to give you a good strategy for disease and injury prevention- are forced to do more work for less.

Eventually, something has to give…

Family medicine doctors have to see patients every 10 minutes and that’s if you can even get in to see them in a timely fashion. Physical therapists have to see multiple patients per hour, resulting in 12-16 patients per day.

These caseloads and demands are not supportive of a health care practitioner truly getting to know you as a person, what your concerns are, or what your particular lifestyle and burdens are. (A recent commentary by Shirlene Obuobi, MD in the Washington Post illustrates this dilemma quite well.)

These are all critically important factors if you want to get effective treatment and advice that’s going to match your needs and deliver the outcome you want.

The consequence is sub-par preventative care. And you risk unnecessarily getting shuffled off to the “specialist” who uses fancy tests and procedures (instead of getting to know you and asking questions) to make (often costly) decisions about your health.

Now, my intention here is not to paint specialists who use procedures and tests as their norm of examination as the “bad guys”.

The problem is you, the patient, is getting pawned off on them too soon because the people who are meant to protect you and help you defend against disease and injury are getting crushed (and not valued) by the health insurance companies.

Medicare tends to be the leader and everyone else follows suit. If these 2023 cuts go through, commercial insurers will be next.

So what can you do?

First, you must do everything in your power to become educated about health and wellness. Then, you can prevent disease and injuries on your own.

This may require hiring certain, key, preventative health care professionals to guide you – such as getting your own dietician, your own physical therapist, and your own mental health professional. Ironically, we already do this without even thinking about it when it comes to our dental care.

Why wouldn’t we want to do this with other aspects – like digestive, mental, and musculoskeletal health?

Health insurance companies add red-tape when it comes to accessing these services. An example is requiring a referral. Referrals that our already overburdened primary care physicians don’t have time to give. This leads me to my second recommendation. Start thinking outside the box. Be willing and able to invest in the health care you both desire and need.

Going outside of insurance and paying out of pocket for preventative care services is not as expensive as you think. Your options could open up exponentially. Especially if you budget and plan for it. At some point, it’s not going to be in your favor to rely on your health insurance to fund all your healthcare needs anymore. It’s clear they’re not interested. Instead, look at your finances and start budgeting.

One of the best ways to do this is to open up a health savings account. If your health plan doesn’t allow for that, then open up a separate savings account to save on your own. More and more practitioners are ditching insurance – if not leaving their respective professions altogether. Do you want to stay out of the hospital? Or big corporate health care systems and see someone private who has the time to care about you? You will have to pay. Personally, I believe this is the way to go but I understand it’s not for everyone.

However, with some planning and foresight, it could be.

I hope things do eventually change for the long-term. Stay educated, take control over the administration and funding of your health care in the short term. This is a far better alternative than heading to Washington and fighting Congress on your own.

Are you local to Portsmouth, NH? CLICK HERE to request a Free Discovery Session with us – we’ll ask you what’s been going on – and see if we’re the right 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, or request a free copy of one of her guides to back, neck, knee, or shoulder pain, email her at [email protected].

Plantar Fasciitis

Are Flip flops Aggravating Your Plantar Fasciitis?

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Now that summer is here – it’s flip flop and sandal season for many. Unfortunately, this also typically results in a rise in foot pain and plantar fasciitis cases. One of my readers recently wrote to me and asked about this.

Here’s what Jennifer wanted to know:

“Now that I’m wearing flip flops again, I noticed that my plantar fasciitis is acting up. Is there anything I can do? Do I need to stop wearing flip flops?”

This is a great question Jennifer. In order to answer your question, let’s look at a few reasons why plantar fasciitis occurs in the first place. Ideally, if you can stay on top of your plantar fasciitis and/or prevent it all together, flip flops won’t even be an issue.

First – what is plantar fasciitis? 

It’s inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot. Your plantar fascial runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you land on your foot your arch falls or flattens – this is called pronation. The response to this action is that your foot then stiffens or supinates – this is where your foot gets the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked – leading to inflammation/plantar fasciitis.

What causes your plantar fascia to become overworked?

Basically anything that impacts or disrupts the natural mechanics of your foot to pronate and supinate. Most commonly, poor mobility in either your ankle or 1st toe is the culprit – but even tight hips and weak glutes can cause problems all the way down to your foot. Anything that impacts the way your foot hits the ground has an opportunity to influence the level of force and energy transmitted through your foot and arch when you walk, which in turn impacts the natural pronation/supination mechanism. When disrupted, your plantar fascia will attempt to compensate for the pronation/supination mechanism. If this continues to happen, your plantar fascia eventually becomes angry and irritated – resulting in plantar fasciitis. 

Flip flops, or any other shoe for that matter, can either “protect” your arch, or cause it to overwork. Technically speaking, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. Sadly, this is rarely the case for many people. Because of how much we sit, and how little we walk around barefoot, the bottoms of our feet are simply not as conditioned as they could be. This is really the problem – not so much what you put on your feet. If you’re accustomed to wearing supportive and cushioned shoes all the time, and then suddenly switch to flatter, less supportive flip flops in the summer, it’s going to be a shock to your foot. And if you’re prone to plantar fasciitis, it’s going to flare up during flip flop season.

The best thing you can do to prevent and treat plantar fasciitis is to not neglect your feet.

Performing consistent mobility exercises for your toes and ankles is key, as well as conditioning for the strength and stability of your arch. Balance exercises, toe exercises, and plyometric (jumping) exercises are all important, as well as making it a point to walk around without shoes as often as you can. If you’ve already got an ongoing problem with your foot, then I wouldn’t recommend haphazardly incorporating these exercises into your routine without guidance. Talk to an expert who can help you. Plantar fasciitis, when addressed correctly, is very treatable, and you could be back to enjoying flip flops in no time.

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

CLICK HERE to request a discovery call with our Client Success Team to see if we would be a good fit for 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, or request a free copy of one of her guides to back, neck, knee, or shoulder pain, email her at [email protected].

5 benefits of adding pilates to your fitness routine

5 Benefits of Adding Pilates to Your Fitness Routine

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5 Benefits of Adding Pilates to Your Fitness Routine 

Pilates has been around for about 100 years, and it still amazes me how many people have NOT heard of this incredible exercise method.

If you didn’t already know – it was first created by Joseph Pilates and initially gained popularity among the dance community as a way to recover from and prevent injuries. But you don’t have to be a dancer to practice Pilates or enjoy the benefits. It has become increasingly popular for the over 50 crowd – and for good reason…

Unlike what’s often touted in the media, the benefits of a regular Pilates practice go way beyond a lean beach body and 6-pack abs.

For Mr. Pilates, his method was created out of a quest to improve his overall health in a holistic way that went beyond what could be achieved with traditional strength-training methods. He suffered from various health ailments – and thanks to his incessant curiosity and fascination of the human body and what it was capable of – he eventually came up with his transformational method of total body conditioning.

Personally, I’ve been incorporating Pilates into my own work as a physical therapist for over 10 years, and I practice Pilates myself weekly. I love and believe in it so much that I’ve designed my entire business model around it!

Pilates is a full body strengthening system that emphasizes breath, precision, coordination, and core strength.

The better you can understand and connect to your body, the easier it is to prevent injury and push your body to limits you otherwise may not have thought possible.

Here are 5 Benefits of Adding Pilates to Your Fitness Routine – and why you should consider adding a regular Pilates practice to YOUR fitness routine as well…

 

1. Pilates helps with back pain.

Once you hit 40, your risk of back injury starts to climb, and a regular practice of Pilates is a safe and sustainable way to help keep your back pain-free and strong. Pilates focuses on core strength but is also a well-balanced exercise system. Full body strength and balance is a critical component for life-long back health – something that isn’t always addressed in traditional back pain rehabilitation programs or strength-training regimens. We even have specific Pilates classes geared towards people with back pain!

2. Pilates strengthens your whole body – not just your core.

Pilates is known as the staple of core training – but it doesn’t just stop there. Pilates strengthens your arms, glutes, hips, and legs in a way that helps them to not only be strong – but work together in a balanced and coordinated fashion. I call this “balanced strength” – and it’s one of the keys to truly enhancing your fitness and performance levels.

3. Pilates improves your flexibility and mobility.

People use these terms synonymously but they are actually quite different. Flexibility refers to muscle length and pliability. Mobility refers to joint range of motion. Flexibility without mobility is useless – and you need a balance of strength and flexibility to optimize mobility. In other words – a balanced joint – one that is strong and flexible – allows the joint to move fully and freely – which optimizes its mobility. Pilates emphasizes continuous, slow, and precise movements through a large range of mobility. This allows you to work on both strength and flexibility simultaneously – and thus – your mobility as well.

4. Pilates puts minimal stress on your joints.

Aging is a real thing and along with it comes arthritis. The key to combating arthritis is optimizing the area around the affected joint or joints. When you have good mobility, and balanced strength, you have less compressive forces on your joints. Arthritis doesn’t like compressed, crowded joints. So when you strengthen and stretch your whole body in a good, balanced way – arthritis becomes less painful and stiff. Pilates helps with all this while not causing any added stress on your joints in the meantime.

5. Pilates trains your nervous system.

Your nervous system is responsible for conducting messages from your brain to your muscles. If that’s not in-tune – you could develop compensations and inefficient movement patterns that eventually lead to pain and injury. Pilates emphasizes precise and coordinated movements, which enhances and reinforces this brain to muscle connection. You can’t just go through the motions when you do Pilates. You have to use your brain and really concentrate on what you’re doing. This helps to train your nervous system – resulting in smoother, more coordinated movements – and better balance as well.

Are you interested in learning more about pilates and seeing if it’s a good fit for you?

CLICK HERE to check out our in studio pilates offerings!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group.