Tag Archive for: Portsmouth physical therapy

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Cortisone Shots for Knee Pain? Why You Should Think Twice.

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Knee pain can be incredibly disruptive – turning simple, everyday activities like walking, climbing stairs, or even standing up from a chair into painful challenges. In search of quick relief, many people turn to cortisone shots. By targeting inflammation in the knee joint, cortisone injections can temporarily ease pain and swelling, making them an appealing option when you’re hurting.

But cortisone shots are just that – a temporary fix. And they come with significant risks and downsides that are often overlooked. Let’s take a closer look at why relying on cortisone injections may not be the best long-term solution for your knee pain – and what you can do instead to find natural, healthier, and lasting relief.

The Problems with Cortisone Shots:

1. Temporary Relief Without Addressing the Root Cause

Cortisone injections can offer pain relief that lasts for weeks or even months – but they don’t address the underlying issue of your knee pain. Instead, they mask your symptoms, allowing conditions like osteoarthritis, tendonitis, or mechanical imbalances to quietly worsen over time. By simply numbing your knee pain, cortisone shots act as a band-aid – covering up the real problem while harmful movement patterns and joint stress continue unchecked. This can eventually lead to more serious, long-term damage without you even realizing it.

2. Risk of Joint Damage

Since cortisone injections only offer short-term relief, many people end up getting them repeatedly. But over time, frequent cortisone shots can actually do more harm than good – leading to cartilage breakdown and weakening the tendons and ligaments around your knee. Research shows that repeated cortisone injections can accelerate joint deterioration, increasing your risk of needing knee replacement surgery down the line. This is especially concerning for active individuals who want to stay mobile, avoid major surgery, and protect their joint health for the long run. Many people aren’t aware of this – so it’s important to know the risks.

3. Disrupts Natural Healing

Inflammation, while painful and uncomfortable, is a vital part of your body’s natural healing process. It increases blood flow, delivers nutrients, and recruits immune cells to repair damaged tissue. Cortisone injections suppress this natural inflammatory response – easing pain and swelling temporarily, but at a cost. By interfering with inflammation, cortisone limits the delivery of key nutrients and healing cells needed to repair cartilage, tendons, or ligaments. Over time, this leaves your knee joint and surrounding tissues weakened, making full recovery harder to achieve. When knee inflammation does get out of control, it’s far better to choose natural healing accelerants that support your body’s repair process – rather than disrupt it.

4. Potential Side Effects and Complications

As with any injection or invasive procedure, cortisone shots come with potential risks, including infection. Other side effects can include increased blood sugar levels, skin thinning, and changes in pigmentation around the injection site. While these risks may seem minor, they deserve serious consideration – especially when the relief they offer is only temporary. Over time, repeated cortisone use increases the likelihood of experiencing these complications. It’s important to ask yourself if short-term relief is worth the growing list of potential long-term consequences.

What to Try Instead of Cortisone Injections:

When it comes to knee pain, I always advocate for natural and effective alternatives that not only alleviate discomfort but also promote true healing. Here are three proven methods that address the root cause of knee pain rather than just suppressing symptoms:

1. Regenerative Shockwave Therapy

Shockwave therapy is a non-invasive treatment that uses acoustic sound waves to stimulate the body’s natural healing processes. By creating micro-traumas in the affected tissues, shockwave therapy boosts blood flow and encourages tissue regeneration. This treatment has been shown to improve mobility, reduce pain, and help with conditions like calcific tendonitis and osteoarthritis. Unlike cortisone injections, which only mask symptoms and can contribute to tissue breakdown, shockwave therapy actively supports healing and long-term relief. When combined with EMTT (Electromagnetic Transduction Therapy), the effectiveness of shockwave therapy is further enhanced – EMTT penetrates deeper into tissues, increases cellular activity, and accelerates the healing process, giving you even faster and more lasting results.

2. Dry Needling for Muscle Imbalances

Dry needling is a highly effective technique for targeting muscle tightness and trigger points around your knee joint. By inserting thin needles into specific areas, this therapy helps release muscle tension, improve circulation, and restore proper function. Dry needling is particularly beneficial for individuals suffering from tendonitis, chronic stiffness, or muscular imbalances that contribute to knee pain. It encourages natural healing by allowing muscles to function more efficiently, reducing strain on your knee joint.

3. Working with a Mechanical Knee Pain Specialist

A mechanical knee pain specialist is trained to analyze movement patterns and pinpoint the underlying causes of your knee discomfort. Unlike general healthcare providers who may prescribe pain medications or generic exercises, these specialists take a customized approach – identifying joint misalignments, muscle imbalances, and faulty movement patterns to develop a personalized rehabilitation plan. They assess how the entire body contributes to knee mechanics, ensuring all contributing factors are addressed. This comprehensive, root-cause approach not only restores knee function and prevents future pain but also leads to more effective, lasting results compared to the temporary relief offered by cortisone shots.

A Smarter Path to Knee Pain Relief:

While cortisone shots may seem like a convenient and quick option, they do little to promote true healing of your knee pain and can actually cause long-term harm. Natural treatments – such as regenerative shockwave therapy, dry needling, and working with a mechanical knee pain specialist – offer a more effective and safer path to knee pain relief. Instead of masking pain, these alternative treatments address the root cause, restore function, and help prevent future injury – giving you real, lasting relief.

How Ignoring Back pain could ruin your New Year’s Goals

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Now is the time when people shift their focus to the New Year and start thinking about new and exciting goals for themselves.

According to statista.com – the three most popular New Year’s goals are 1) doing more exercise and improving their fitness, 2) losing weight, and 3) saving money.

Would you be surprised to know that if you are currently suffering from back pain – and you continue to ignore it – it could significantly impact your chances of success at achieving any of these goals?

Let me explain.

Let’s start with doing more exercise and improving fitness. Most people think that if they start exercising more – especially their core – it will solve their back problem. Not necessarily. While the research studies show (overwhelmingly) that exercise is one of the best treatments for back pain – what they don’t reveal is that there are typically some key things that must be in place in order for exercise to be effective. For example, you must have good mobility before you start focusing on stability (or strengthening). If you’ve got a stiff back, general exercise could be all you need, and you’ll notice improvement. But you won’t know until you get going and by then it could be too late.

What if your back is stiff because it’s compensating for something – say a bulging disc or muscle weakness?

If that’s the case, and you go all in with an exercise program in January, it’s only a matter of time (usually about 3 months in) before your back becomes worse, forcing you to abort your grand plan for the new year. When stability is there for a compensatory reason, it’s important to figure that out before adding more exercise or strengthening to the mix. This is one way back pain could derail your New Year’s resolution of doing more exercise and improving your fitness.

Say you want to lose weight. This is a fabulous goal. And if you’ve got back pain, losing weight will surely help. But once again, it’s critical to understand why you’ve got back pain in the first place. For example, being overweight is rarely the cause of back pain. A few extra pounds can certainly exacerbate your back problem, but it doesn’t usually cause back pain all on its own. The most common causes of back pain are mechanical (movement) problems.

In other words – bad movement habits such as sitting all the time, bending and rotating too much, or having terrible posture can all lead to back pain slowly over time.

If you lose weight, but never correct these mechanical/movement problems, your back pain isn’t going to improve. When it comes to the process of losing weight, in addition to watching your diet, more exercise is often incorporated into a weight loss plan. If you’ve got back pain, it’s more than likely due to poor movement habits. More exercise will not address these, and worse, could exacerbate the problem. If your back pain increases, not only will you not want to exercise, but you could be more inclined to sit at home and eat more – completely derailing your New Year’s resolution of losing weight.

Finally – we come to saving money. What on earth could back pain have to do with this? Well, you’ve probably heard the saying: “If you think wellness is expensive, try illness”. And this couldn’t be truer. When you ignore back pain, it’s only going to get more expensive to address later. As back pain worsens, you’ll have less willpower to bear it, and you’ll be more likely to opt for expensive fixes such as outpatient procedures and surgery. Not to mention the rehab that needs to take place afterwards for an optimal recovery and the expensive tests that need to take place before-hand to ensure you’re ready for surgery.

When you ignore a back problem it’s only a matter of time before it becomes unbearable.

And when we’re desperate, we make poor decisions, which often leads to more money spent than necessary. All that money (and more) that you set out to save as part of your New Year’s goals eventually goes to waste. Instead, get in front of your back pain. For 80% of back pain cases, there is a natural, movement-based solution. Natural solutions are far less expensive – and much safer long term compared to something like surgery. While the impact of ignoring back pain may seem indirect when it comes to a New Year’s resolution of saving money – it will impact you in some way – at some point – in a monetary way if you don’t address it now.

When you’ve got back pain (or any pain for that matter) that isn’t going away, it’s your body trying to tell you something. Don’t ignore it. It’s only a matter of time before it gets worse and starts to derail more than just your New Year’s goals.

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

Black Friday

6 Reasons NOT to miss our Black Friday Flash Sale

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These will be our BEST deals – on our best services – for the whole year!

We wanted to give you a heads up that our Black Friday Sale is starting ELEVEN DAYS from now on Sunday – Nov 24th. This is our biggest sale of the year on our most popular services. And it’s your chance to save insane amounts of money (one of the packages gives away over $2500 of FREE services!!)

In order to get access to this amazing sale – you must sign up HERE.

On Sun Nov 24th the sale will start – and you’ll get daily emails updating you on the packages we have available, when things sell out, etc…

Now if saving BIG wasn’t enough…

Here are SIX very important reasons why you don’t want to miss out on our Black Friday specials this year…

1. Without your Health – you have nothing

When your health, independence, and mobility begin to decline – you start missing out on activities that you love. And It’s very easy to say to yourself… “I’ll just wait until the New Year” – or – “I’ll get started when I have more time” – or – “I’ve got so many other expenses right now so my health can wait”…

Nothing should EVER come between you and your health. Because if you wait (or ignore) it, you risk either losing it forever, or spending a lot of time and money to get it back. Whether it’s healing a nagging injury that regular physical therapy or cortisone shots have failed – or getting to the root cause of a back pain or sciatica problem that keeps coming back – we’ve got some amazing specials and huge savings that will make it easy for you NOT to have to wait any longer 🙂 Now is the time to address and invest in your health.

2. Use your left-over FSA money (before you lose it!)

Do you have a Flexible Spending Account (FSA) through work that you forgot about or maybe haven’t used? Well I have some good news for you… you can use your Flexible Spending money toward ALL of the services we have on sale this year. Typically you lose whatever is left in your FSA at the end of the year (Dec 31st) – so don’t let it go to waste!

Put it towards your health – and save a ton of money while doing it – by taking advantage of our Black Friday specials!

3. Help with your New Year’s Resolutions!

January is our busiest month every year, and for good reason… People LOVE to make health-related New Year’s resolutions for themselves. But what if you’ve got a nagging pain or injury? The last thing you want is for it to return or get worse just when you’re in the groove. Our Black Friday Specials can help you with that!

Work with our Physical Therapy Specialists to get to the root cause of your problem and finally get a treatment plan that works (and lasts). Or try Regenerative Shockwave Therapy to help speed up the healing of a stubborn injury that regular physical therapy or cortisone shots have failed.  Whatever your health goals are for now or the New Year – get help from our experts at the best rates you’ll have access to ALL YEAR.

4. This only happens ONCE per year

This is our biggest sale of the year – PERIOD. And it only happens once. You’ll never see our prices this low.

If you’re new to our community – and the ONLY reason you haven’t started working with us yet is because of your budget – then you will be very pleased with the specials we have for you. Our regular clients already know the value we provide – and that is why they consistently choose us over the cheaper alternatives available. And it’s also why they are super excited about this sale – because they plan to stock up on their favorite services.

Sign up for our Black Friday Sale NOW and see for yourself what all the hype is about 🙂

5. Try Out Services You’ve Been Curious About

Have you been eyeing one of our specialty services, like Regenerative Shockwave Therapy? This sale is the perfect time to explore them – at an unbeatable rate. Maybe you want to see how these services could change your mobility, pain, or recovery time? Here’s your permission slip to take the leap and see what you’ve been missing out on!

6. Recession-proof your Health

It may seem counterintuitive to spend money on your health right now given the economic state. Your insurance should pay for it – right? Well here’s why you might want to reconsider that thought – and put the control of your health back into your own hands…

Medicare and other health insurance companies have already cut their reimbursements for this year – and will continue to do so in years to come. Why should you care about this? Because it means the quality of your health care at traditional, insurance-based clinics only has one way to go – and that’s DOWN.

Providers are going to get paid less to take care of you, which means the quality of your care WILL suffer (just to “keep the lights on”). By investing in your own health – and not relying on an insurance company to do it for you – you stay in control of your health journey and have a better chance of avoiding the rabbit hole of expensive and unnecessary surgeries.

So… sign up for our Black Friday Sale… and join the CJPT revolution of getting active, healthy, and mobile – WITHOUT things like pills, procedures, or surgery 🙂

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, call 603-380-7902, or CLICK HERE to get early access to the Black Friday Flash Sale!

Holding Knee with Arthritis

Four Overlooked Reasons Your Knee Pain Won’t Go Away

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If you’re one of the many people out there suffering from chronic knee pain – and wondering why it won’t just go away – you’re not alone.

Most of the folks I speak with in this situation have been told it’s simply due to arthritis, old age, or general wear and tear – and there isn’t much that can be done about it. First of all, that’s not true. But second – one of the biggest reasons people are led to believe that there’s nothing that can be done about their chronic knee pain is because they’ve tried just about every treatment out there – and nothing has worked.

What’s the biggest culprit for that? Almost always – it’s misdiagnosis.  Meaning, something crucial was overlooked when it comes to the underlying reason for your knee pain (and structures in and around your knee joint get blamed instead).

Here are 5 of the most common overlooked reasons that can lead to misdiagnosis of your knee pain – causing it to linger and not go away:

1. You’re Focusing On Knee Strength Over Mobility

Focusing on knee strength and overlooking mobility is something I see far too often – and it’s a big reason knee pain lingers longer than it should.  Mobility refers to the joint’s ability to move through its full range of motion, which is crucial for proper alignment and injury prevention. Without sufficient mobility, strength exercises can place undue stress on the knee, leading to compensations and pain.

When it comes to mobility, it’s important to compare right and left knees, as well as look at “hypermobility” – because it all matters. You want to make sure you’re optimizing mobility according to the person, and not a “textbook” definition. By improving and optimizing mobility in your knee first, you ensure that your knee can move freely and efficiently, reducing the risk of strains or overuse injuries when you begin to load the joint with strength training.

2. The Real Culprit Could Be Your Back

Did you know that 25% of the time – pain in your knee can come from a source in your lower back – even when you don’t have any back pain? Pain that moves around your knee, is challenging to pinpoint, or aches into your thigh or lower leg are all signs that your knee pain could actually be a back problem. Specialized movement screening of your lower back should be required for anyone suffering from any kind of knee pain – but it’s not.

Precautionary low back screening by a mechanical pain expert is rarely done – and it’s one of the biggest reasons I see for knee pain misdiagnosis. When knee pain is coming from your back – and you miss it – people not only suffer from knee pain longer than they should – but they risk being prescribed unnecessary cortisone shots, procedures, and surgeries in knees that never even had a problem to begin with.

If your knee pain isn’t going away and especially if the pain moves around – consider your lower back.

3. Your Knees Are Compensating For Weak Core Muscles

Your core – made up of four major muscle groups (your abdominals, lower back muscles, glutes, and hip muscles) plays a critical role in stabilizing your body, supporting proper posture, and distributing weight evenly during movement. When any part of your core is weak or not functioning optimally, your body will compensate by placing excess strain on other areas, such as your knees. Workload that is normally better handled and supported by say – your hips and glutes – will be taken over by your knees.

The result is increased stress in your knee joints and surrounding structures – which can lead to pain, inflammation, and even injury over time. Additionally, when you lack adequate core strength, your body lacks the stability needed to control movements efficiently, which can be another factor in forcing your knees to work harder than they should. If you’ve got lingering knee problems and never looked at strengthening your core properly – get started now. This could be one of the overlooked factors leading to a misdiagnosis of your knee problem and subsequent chronic knee pain.

4. Stiff Ankles Are Putting Stress on Your Knees

We already talked about how important it is to focus on knee mobility. But it’s equally important to focus on the mobility of joints above and below your knees, namely, your ankles. Ankle stiffness can be due to a number of factors – such as footwear, poorly rehabilitated injuries (like chronic ankle sprains), and repetitive/overuse activities that involve heavy use of your feet, ankles, and calves.

When your ankles are stiff, especially during activities like running, squatting, or even walking – your knees will compensate.

The result may not be noticeable right away – but over time – this extra compensation can result in unwanted knee pain. And if you never identify that the cause might be stiff, overused ankles – then you’ll continue to blame the irritated structures of your knee joint instead. If your ankles always feel tight, or your lower legs get fatigued frequently during repetitive movements, this could be a sign that your lingering knee pain is the result of compensation for stiff ankles. Improving ankle mobility might be the missing solution to freeing up your knees.

Chronic knee pain does not have to be something you accept – and it certainly doesn’t require a cortisone shot, procedure, or surgery to fix it. Most knee pain (at least 80%) can be resolved naturally. But it starts with the correct diagnosis. If you’ve been suffering from knee pain for a long time and feel like you’ve already tried everything – consider one of these four overlooked reasons. And to be sure – visit a mechanical knee pain specialist who can check all of these things out and give you an accurate diagnosis of your lingering knee pain.

Are you a local to Portsmouth, NH?

If so, CLICK HERE to speak to one of my specialists. They can help you discover effective strategies to finally relieve your knee pain and get back to doing what you love!

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Knee Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or request a seat in her upcoming Masterclass to end Knee Pain naturally – without pills, procedures, or surgery – CLICK HERE.

6 Tips for Healthy and Mobile Knees this Summer

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When you’ve got persistent, nagging knee pain, it can significantly impact your quality of life, and put a real damper on your summer. The good news is there are many things you can do naturally and on your own to help keep your knees healthy, especially with the increased activity that often comes with summer. 

Here are six of my top tips to ensure your knees stay strong and pain-free during your summer adventures:

1. Strengthen Your Hips and Core

Your hips and core provide essential support and stability to your entire body, but especially your lower limbs and knees. Strengthening these important muscle groups is key for not only relieving knee pain – but preventing it as well. Weakness or imbalance in your hips and core can lead to poor alignment and compensatory stress on your knees during movements like walking, running, or squatting. So when you focus on strengthening your hips and core – you’ll improve your overall biomechanics – and reduce the wear and tear by minimizing the load placed through your knees during summer activities.

2. Get (and Stay) Mobile

One saying you’ll hear me repeat over and over is: “mobility before stability.” When you’ve got stiffness in your joints, the surrounding muscles will try to compensate. Muscles don’t work as well when the joint they are in charge of moving doesn’t have full and free mobility. I see this a lot in people suffering from knee pain.

Good and optimized joint mobility will enhance your body’s ability to move efficiently and with proper body mechanics, thus, reducing the strain on your knees. By increasing (and maintaining) your flexibility and range of motion, your body will move more freely and distribute forces more evenly throughout your joints and muscles (including your knees).

3. Don’t Sit so Much

Knee pain can come directly from your knee, but also from your spine (even when you don’t have any back pain). Interrupting your sitting throughout the day (I recommend once every 30 min) addresses both potential causes. For knees in particular, prolonged periods of sitting can cause stiffness and lead to poor blood circulation in and around your knee joint. That’s why sometimes after sitting for a while, you can experience sharp stabbing pain in your knee when you go to move.

Sitting for extended periods can also lead to tightness in the hip flexors and hamstrings, which can negatively impact knee alignment and function. When you take regular breaks to stand, stretch, and move around – you relieve knee pressure, maintain good joint mobility, and prevent muscle imbalances that (when left unaddressed) can gradually creep up and ruin your summer.  

4. Keep Moving

Regular movement and exercise helps to stimulate blood flow. If you’ve got inflammation in your knees causing pain, good blood flow helps to actually reduce inflammation by delivering essential nutrients and oxygen while also removing waste products. If your knees are on the arthritic side, engaging in low-impact exercises like walking, swimming, cycling, or Pilates can help build strength and endurance around your knees without putting excessive stress on your joints.

Regular movement also helps lubricate your knee joints, which can reduce friction and discomfort during summer activities. Perhaps the biggest benefit of regular exercise and movement is the release of endorphins, which are your body’s natural painkillers that can help alleviate discomfort in any joint, not just your knees.

5. Wear Sensible Footwear

The right (or wrong) footwear can greatly impact how your knees feel when walking, running, or standing. Proper footwear provides the necessary support and cushioning to reduce knee strain. And depending on the mechanics of your feet and ankles, the right footwear can help improve overall alignment and stability. 

In the summer, people love wearing sandals and flip flops. However, if you’re prone to knee problems, you may want to reconsider this choice or only wear them for short periods when you won’t be standing or walking for long. Flip flops, in particular, offer little support and can exacerbate knee pain. By choosing shoes that prioritize comfort, support, and proper alignment, you can effectively reduce knee pain and enhance overall joint health for a happy and active summer.

6. Work on Your Balance

Good balance is crucial for stability, control during movement, and reducing fall risk, especially in summer activities like paddleboarding, pickleball, and walking on the beach. When you work on your balance, it helps reduce knee strain by ensuring your postural muscles, feet, and ankles work together to distribute forces evenly. Without this coordination, your knees overcompensate and suffer. When you make a conscious effort to improve and maintain balance – it will help to decrease the stress on your knees by getting other joints and muscle groups to “join the party.”

If you’ve been suffering from knee pain for a while and you’re worried about it ruining your summer – get started on any of these six tips and see if they help. Now, if knee pain is getting in the way of you being able to incorporate any of these tips, then it’s time to consider expert help and speak with a physical therapy specialist.

The right therapist will help you identify the root cause of your knee pain and come up with a treatment plan that not only gets rid of your knee pain, but teaches you how to keep it gone – naturally and 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 get in touch or to download her Free Report on Knee Pain – CLICK HERE.

Pain when gardening

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

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

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

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

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

1. Avoid bending from the waist

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

2. Take frequent breaks

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

3. Pivot instead of twist

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

4. Use gardening tools wisely

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

5. Raise your gardens

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

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

Are you local to Portsmouth, NH?

CLICK HERE to speak with a specialist for free.

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

Why Your Nagging Shoulder Blade Pain isn’t Going Away

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The prevalence of shoulder pain tends to increase and become more severe as we age – especially for folks in their 50’s and beyond.

When people complain of shoulder pain – it can manifest in a lot of different ways. Sometimes pain appears in the front, sometimes on the very top of your shoulder, sometimes deep inside your joint… But probably the most annoying and uncomfortable type of shoulder pain I hear about is the one that occurs deep inside your shoulder blade. 

It’s tough to get to, tough to pinpoint, and even harder to make go away.

It kind of feels like middle back pain – but also feels like shoulder pain – so which is it? And more importantly… Why isn’t it going away?

There are many reasons why we get shoulder pain and there’s a good explanation why it can move around and appear in so many places. It’s the most mobile joint in your body, which lends itself to lots of ways to get injured. And to add even more confusion – 47% of all shoulder pain originates from a source in your spine (neck) – even when you don’t have any neck pain.

Therefore, misdiagnosis of shoulder pain is very common and it’s probably the most common reason I see for that nagging shoulder blade pain not going away – no matter how many times you massage it, stretch it, or “theragun” it.

If you’ve had nagging shoulder blade pain for a while now and it’s not going away – there’s a really good chance it’s not actually a shoulder problem and you’ve been misdiagnosed. 

Let’s look at a few key signs and considerations to help you figure out if that nagging pain in the middle of your shoulder blade has been misdiagnosed:

1. Location of your pain?

When your pain is coming from a source within your shoulder, the pain will be localized to your shoulder joint. “True” shoulder pain is typically felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But the pain will never radiate below your elbow. If the nagging pain in your shoulder blade ever causes pain past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area) – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem. 

2. Do you experience numbness, tingling or burning?

If the nagging pain in your shoulder blade is ever associated with numbness, tingling, or burning – these are signs of nerve irritation, or perhaps nerve compression. If that’s happening – the problem is almost certainly coming from your neck. It’s very common for things like bulging discs to compress nerves, or limit movement, which can irritate nerves in your neck. The nerves in your neck will commonly refer symptoms into your upper shoulder/upper trap area, down your arm, and… you guessed it… right into the middle of your shoulder blade. And remember – you could be experiencing the referred symptoms without much (or any) pain in your neck. If you’ve got symptoms of numbness, burning, or tingling in your arm or shoulder along with nagging shoulder blade pain – and you haven’t yet gotten your neck examined by a mechanical pain specialist – there is a good chance you’ve been misdiagnosed. 

3. Does posture affect your pain?

Do you notice that your shoulder blade pain changes depending on your posture? This is another tell tale sign that your shoulder blade pain is likely coming from your neck. Our heads are inclined to remain upright on top of our shoulders to look ahead at what’s in front of us. So when you slouch your middle back – your neck will always compensate so your head can look forward. Ever hear of the term “forward head posture”? That’s what we call the compensation your neck makes for curved, slouchy posture in your middle back. And in forward head posture, you will stretch out and eventually irritate the nerves in your lower neck. The nerves in your lower neck – particularly the areas of your C6 and C7 vertebrae – refer right into the middle of your shoulder blade. So if you notice the pain easing when you sit upright or lie down, and increasing with long car rides or sitting at a computer (when your back tends to be slouched) – there’s a very good chance the pain in your shoulder blade is coming from your neck.

The good news is that even if you’ve been misdiagnosed for some time, nagging pain in your shoulder blade is typically a mechanical problem and can be fixed naturally with a corrective movement prescription, postural training and education, and strengthening the areas around your neck and middle back. You don’t need to resort to injections or pain killers. Do me a favor though – don’t try and fix this problem yourself or by looking up exercises on YouTube. We call it a movement prescription for a reason – and it should be prescribed to you by a physical therapy specialist who has a deep understanding of the intricacies of mechanical pain and how it all works. If you want help finding someone like this in your area – get in touch – I’m happy to help.

Holding Knee with Arthritis

Torn Meniscus? Is Surgery Worth it?

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It’s estimated that approximately 750,000 arthroscopic knee surgeries are performed every year – the majority of them being due to a torn meniscus.

But at a cost of about $4 billion per year – is this surgery even worth it?

Let’s investigate…

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee. The biggest set of pro’s for this procedure is that it’s quick, recovery is fairly minimal, and you will typically experience an immediate relief of pain.

Sounds worth it – right?

Not so fast. There are many cons to this procedure as well, many of which are not realized until it’s too late. So it’s worth a second opinion and considering all of your options before you jump in.

First, as with any surgical procedure, even if it’s minimally invasive, there are risks. Complications include nerve damage, excessive bleeding, infection, reactions to anesthesia, persistent stiffness and swelling, or blood clots. While these risks tend to be rare, they don’t outweigh the other long-term considerations you should be aware of.

Looking to avoid a knee replacement in your future?

Then you’ll definitely want to think twice about getting arthroscopic meniscus surgery. Research tells us that people who undergo arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that quite possibly could have been avoided. This is because you’re removing vital cushioning and shock absorbing mechanisms (the meniscus) from your knee joint. Plus, a meta-analysis published in Oct 2020 in the Knee Surgery, Sports, Traumatology, Arthroscopy journal revealed a 36% failure rate by year two – and a 13% failure rate by year five for meniscus repairs – resulting in more surgery and eventual knee replacement.

And then there’s the elephant in the room…

It’s more common than you think for knee pain to be coming from somewhere other than your knee, even when your MRI shows a meniscus tear. Knee pain can be caused by problems in your ankle, hip, or back. One study showed that 40% of the time – knee pain comes from a source in your spine – even when you don’t have any back pain. MRI’s add even more confusion to this because degenerative changes, which are normal as we age and very commonly lead to a torn meniscus, make surgeons think your meniscus is the cause of your knee pain when it might not be. The only way to truly determine the cause of your knee pain (in the absence of trauma) is through a proper mechanical exam that involves repeated movement testing to reveal the actual pain generator. 

The truth is – 70-80% of all knee problems can be resolved naturally and without surgery.

An early research study from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery to repair a torn meniscus?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain. If you’ve gotten physical therapy and it wasn’t effective, people are led to believe that the physical therapy “didn’t work”. But more often than not, you didn’t get physical therapy from a specialist – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery. 

If you’re young and involved in high-level sports, meniscus surgery is likely worth it for you.

But for most people, especially those over the age of 40, there’s a 70-80% chance you can get full relief of your knee pain, and full restoration of knee function without any type of surgery or procedure. This is not a popular opinion by the way, so be careful who you speak to for a second opinion. But for me, both the research as well as my 22 years of clinical experience tell me that most people (especially those over age 40) can resolve their knee pain naturally and with better long-term results if they avoid arthroscopic knee surgery – even when there’s a meniscus tear.

Is running bad for your knees?

Turns out – Running isn’t Bad for your Knees

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Is Running Bad For Your Knees?

I love to play family-feud style trivia. And if there was ever a question – “Name an activity that is bad for your knees” – I know that running would be the number one answer. 

But this is simply not true – and there is research to prove it.

There is a common myth that continued running will eventually cause, or accelerate arthritis in your joints. But in a 2013 study published in Medicine & Science in Sports & Exercise (the American College of Sports Medicine’s flagship journal) this theory was debunked. The results of the study concluded that runners were statistically less likely to develop knee and hip arthritis compared to other types of exercise. In a more recent study from 2020, published in PeerJ, it was found that although running does indeed create a lot more “pounding” in your knees compared to something like walking – this process actually helps to “build-up” your cartilage and make it stronger – which is a huge factor in helping to slow down arthritis.

But what about those that do get knee pain when they run? What’s the explanation?

Healthy running comes down to having optimized running form and body mechanics – otherwise it could become problematic for your knees.

So if you’re having knee pain when you run – instead of blaming the sport – consider one or more of the following:

Check your ankle mobility

Ankle mobility is going to influence the way force from the ground hits your foot, which can in turn impact how force (load) impacts your knee. According to Trail Runner Magazine, “if your ankle can’t move adequately, then excess forces are shifted up to the knee. The knee may be forced to flex, and/or rotate, and/or tilt more than it should. This may result in loads that the tissues of the knee can’t handle.” Everything from the types of shoes you were to old ankle sprains can all have an impact on how well your ankle moves. A specialist in movement and joint mechanics can help you test and improve your ankle mobility – and let you know if it’s impacting your knees when running.

Don’t just run – strength train too.

There’s a widely perpetuated myth out there that runners don’t need to strength train. That’s simply not true! Adding strength training to your running regimen makes it way less likely that you’ll suffer an injury. When it comes to protecting your knees, developing strong lower limb muscles is critical. The hamstrings and quadriceps play a crucial role in stabilizing the patella, otherwise known as the kneecap. Running is an extremely repetitive action and consequently requires durability and endurance from your joints — something that is lost quickly when you neglect strength training.

How’s your core?

It may seem like running is all in the legs, but in reality, so many of our physical actions stem from the core. You derive all your power, speed, and stamina from your core muscles, and if they are weak, all your joints suffer — including your knees. A stable core is key for maintaining balance and rhythm while running. It also keeps your weight distributed between your legs and prevents undue stress from resting on your knees. My favorite way to improve core strength is Pilates, especially for runners, because this exercise system gives your joints a nice break. But any core strengthening routine that focuses on using your body weight and minimizing stress on your joints is going to be beneficial for you if you’re a runner.

Practice good running form

It doesn’t matter if you’re a marathon runner or an occasional jogger — good running form is essential. It determines where and how the impact of every step is distributed throughout your body. But here’s the thing… Good running form is dependent on optimized joint mobility and strength – so simply changing your form might not be enough – and could even cause you more problems. You want to figure out why you’re running with a “bad” or inefficient form – correct what’s causing it – and then work to train your body to run in a more efficient way. This will not only help your knees – but all your other joints as well.

If you’re someone who loves to run and wants to keep running – I have good news for you – it’s not bad for your knees. But if you’re currently having knee pain while running – you’ll want to look at and consider one more of these strategies to figure out why. The best thing to do is enlist the help of an expert – such as a specialist physical therapist or movement expert – who can help you diagnose where your knee pain is coming from and get you on a path to fix it.

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].

Vertigo

Vertigo and Fall Risk: 5 Ways to Safeguard Yourself Against Unexpected Falls

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Vertigo is often described as a distressing sensation of spinning that makes you feel as if the world is moving around you – or that you are spinning yourself. It’s an unsettling experience – and can be dangerous – as it puts you at a greater risk for falling. Over 3 million older adults are treated in the emergency room every year due to fall-related injuries. One out of five of those falls causes serious injury – like a broken bone or head trauma. 

If you are suffering from vertigo, it’s critical that you take time and due diligence to get to the bottom of what’s causing it so that you can safeguard yourself against unexpected falls. The good news is this is entirely possible. But first, it’s important for you to know that vertigo is a symptom, and not a diagnosis. Vertigo is the result of a disturbance in your inner ear (vestibular system). It can be caused by various things, namely, Meniere’s disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and cervicogenic dizziness… just to name a few. Once you’ve identified the root cause of your vertigo – the correct treatment approach is possible. I can’t tell you how many horror stories I’ve heard from people suffering from vertigo longer than they needed to – all because they didn’t get the right tests to diagnose the cause – or were prescribed medication they didn’t actually need. All the while, continuing to live with a constant fear of falling and never knowing when their next vertigo attack would occur.

The reason suffering from vertigo puts you at such risk for falling is because when it comes to balance, we rely on three bodily systems. One is your vestibular system, which vertigo disrupts. The other two systems are your vision and proprioception. All three systems are responsible for helping you orient and visualize yourself in space. When you have vertigo – you’re forced to rely on (and train) the other two. 

The good news is there are strategies you can employ to compensate for a mal-functioning vestibular system.

If you suffer from vertigo – here are five simple and effective strategies that can help minimize your fall risk and enhance your safety:

  1. Remove Hazards: Roll Up and Stow Away Rugs

In a home environment, even seemingly harmless elements like rugs can pose a significant risk. Rolling up and storing rugs minimizes the chance of tripping or slipping, providing a safer space to move around, especially during vertigo episodes. Smooth, obstacle-free floors reduce the likelihood of unexpected falls and help maintain stability.

  1. Illuminate Pathways: Install Night Lights for Nighttime Mobility

Navigating through the house at night, especially when experiencing vertigo, can be daunting. Installing night lights along hallways, staircases, and near the bathroom provides essential visibility and helps prevent accidental falls. With well-lit pathways, you can confidently move around during the night, reducing the risk of missteps or collisions with objects.

  1. Exercise Caution: Walk with a Companion and Use Hiking Poles

Engaging in physical activity is crucial for maintaining health, but doing so alone when experiencing vertigo can be risky. Pairing up with a friend for walks provides both companionship and an added layer of safety. Additionally, using hiking poles offers stability and support, especially when dizziness strikes unexpectedly, allowing for more secure movement during outdoor activities.

  1. Focus and Reorient: Lock Your Gaze on a Steady Object during Dizziness

During vertigo episodes, it’s common to feel disoriented and unsteady. A practical technique to regain stability is to lock your gaze on a stable and fixed object. This method helps recenter your focus and gradually reduces the sensation of spinning or imbalance, allowing you to regain control of your body and surroundings.

  1. Safe Driving Practices: Stabilize Focus and Minimize Distractions

When vertigo strikes while driving, it’s essential to prioritize safety. If feeling dizzy behind the wheel, fixate your gaze on a stationary object—such as the dashboard or the road ahead—to regain a sense of stability. Additionally, reduce all distractions by turning off the radio and refraining from engaging in conversations with passengers. Prioritizing focus and minimizing external stimuli can help mitigate the risks associated with vertigo while driving.

While these strategies can be helpful – please know that you don’t have to let vertigo keep running your life and stop you from doing what you love. With proper treatment, you can stay out of the hospital, stop taking medication and move out of the fall risk category with the support of a good vestibular specialist. Diagnosing vertigo is a step-by-step process that starts with a detailed medical history and extends to various physical examinations. Vestibular specialists will employ a range of tests, including specialized balance assessments for fall risk, to pinpoint your exact cause of vertigo. Navigating through these diagnostic tools is crucial for developing a treatment plan that works. Once the correct diagnosis is made, treatment can begin immediately to start retraining your brain. The key is to train your brain to stop relying on the damaged part of the inner ear (that leads to vertigo and dizziness) – and help it to rely on your other two balance systems instead so that you can stay safe and improve your balance.

Interested in learning more about Vertigo?

Join us for our Free Online Masterclass for Vertigo Sufferers! It’s happening January 23rd, from 6-7pm via zoom – click here to reserve your seat before they’re all out.

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 seat in her upcoming Masterclass for Vertigo Sufferers – visit www.cjphysicaltherapy.com – or call 603-380-7902