Tag Archive for: Portsmouth NH

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].

7 Reasons Everyone over 50 Should be Walking

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A meet a lot of folks who think (or have been told) they need to “slow down” once they get into their 50’s and beyond – especially if they have arthritis or an injury. But this can’t be farther from the truth. As we age, regular movement and exercise becomes even more critical – especially if you’re injured or suffering from arthritis. 

If it’s been awhile since you’ve exercised, or you’re looking for something you can do that’s accessible and where you can be consistent, then let’s talk about all the benefits a walking routine can bring you – especially if you’re in your 50’s and beyond.

Here are 7 reasons why I think everyone over 50 should be walking:

  1. It’s good for your cardiovascular health

The leading cause of death in older adults continues to be cardiovascular disease. A regular walking routine can help combat this by improving your heart health, increasing your blood circulation, it reduces bad cholesterol, and raises the good cholesterol. Plus – the rhythmic nature of walking gets your heart pumping at a steady rate – which is great for your overall cardiovascular health.

  1. It makes your muscles and bones stronger

As we age, losing both bone density and muscle mass are normal and common. But there are things you can do to counteract this process – and regular walking is one of them. Since walking is a weight-bearing activity, it’s good for strengthening your bones and reducing the risk of osteoporosis and fractures. Walking also engages several of your muscle groups at once – which helps them to stay active and strong.

  1. It’s boosts your mental health

Ever heard of walking meditation? It’s a thing. Walking has been shown to significantly reduce symptoms of depression and anxiety, and it’s an opportunity to get your mind off the day to day, self reflect, and even meditate as I mentioned above. Plus – if you assume a regular walking routine with friends or loved ones, the social aspect can be so beneficial to your mood and mental health. To further enhance the mental benefits of walking – try to get out in nature. The fresh air – plus tranquil sounds and smells – is not only cleansing for your mind – but for your soul as well.

  1. It helps you manage weight

Along with bone density and muscle mass, your metabolism also takes a hit as you get older. But regular walking can help counteract this. Regular walking burns calories to help you maintain a healthy weight, which is critical for avoiding chronic diseases such as diabetes and heart disease. Plus, being at a healthy weight can increase your energy levels, it’s easier to move around and do your daily tasks, and you’ll have less stress on your joints.

  1. It improves your joint health

A lot of people don’t realize this – but arthritis is something that occurs naturally as you age and it’s not something to be feared. But because we fear it, we unknowingly avoid activities that are good for us and that actually help arthritis. Walking is one of these activities. Movement is one of the best things you can do for arthritis, and walking in particular helps to lubricate your joints, especially your knees and hips. Regular walking also helps to make the structures and soft tissue around your joints loose and flexible – which is important for successful management of arthritic joints.

  1. It helps enhance your balance and coordination

As we get older, falls become a major concern because lower bone density means you’re more prone to fractures. It gets more difficult to work on balance and coordination after you’ve lost it – so maintaining it is key. A regular walking routine does just that. Each step you take requires coordination of several muscles as well as balance – and the repetitiveness of wal

king helps enhance your body’s natural ability to quickly correct and stabilize itself – all helping you to decrease your risk of falling.

  1. It’s low impact and adaptable

One of the reasons I recommend walking for folks over 50 is because of its low-impact nature. Unlike jogging or other high-impact exercises, walking is gentle on the joints and can be easily adapted to your current fitness level. Whether it’s a slow-paced walk around the block or a brisk hike up a hill, walking can be tailored to suit your individual needs and goals

If you’re over 50 – incorporating regular walking into your routine can be a game-changer. It’s a simple yet profoundly effective way to get and stay fit – and you’ll find it improves your quality of life in ways that are beyond physical. Walking nurtures your mind and soul, is a great way to catch up with friends and stay social, and you can literally do it anywhere. If you’re not already incorporating a regular walking routine – what are you waiting for? And if an injury is what’s stopping you – talk to an expert who can help you get rid of your pain and get started in a way that is safe for your body.

Learn more about our next exclusive free live event – Fit After 50 – 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].

Before you get a Cortisone Injection – Ask these questions

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

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

First… the benefits…

Quick Relief:

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

Targeted Treatment:

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

Alternative to Surgery:

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

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

Cartilage Damage and Weakening of Tendons:

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

Risk of Infection:

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

Short-term Relief:

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

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

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

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

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

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

  • What are the alternatives?

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

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

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

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

Orthopedic dry needling

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

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

What exactly is orthopedic dry needling?

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

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

1. Pain Relief 

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

2. Better Mobility

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

3. Enhanced Muscle Function

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

4. Faster Recovery

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

Should you consider orthopedic dry needling?

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

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

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

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.