Tag Archive for: sciatica

sciatica

Sciatica That Won’t Go Away? Here’s What Most People Get Wrong | Portsmouth, NH Physical Therapy

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If you’ve ever felt a sharp, shooting pain that starts in your lower back and travels down your leg, you’ve probably been told you have sciatica.

And if you’re like most people here in Portsmouth or the Seacoast—you’ve already tried a handful of things to fix it.

Rest. Stretching. Maybe chiropractic care. Maybe even physical therapy or injections.

Maybe some of it helped… but the pain keeps coming back.

That’s usually the point where frustration really sets in.

Because now it’s not just about pain—it’s about not having answers.

The Problem: Why Sciatica Feels So Confusing

Sciatica is one of the most misunderstood conditions we see.

It’s unpredictable.
It moves around.
It can feel severe one day and barely noticeable the next.

And despite how common it is, most people never get a clear explanation of what’s actually causing it.

Sciatica is really just a description of symptoms—not a diagnosis.

It refers to pain that radiates from your lower back into your glutes and down your leg, typically caused by irritation of the sciatic nerve (or one of the nerve roots in your spine).

But here’s where it gets tricky…

Where you feel the pain is not always where the problem actually is.

Why Common Solutions Fail

Most treatments focus on the symptom—not the cause.

  • Pain medication dulls discomfort but doesn’t fix movement
  • Anti-inflammatories reduce irritation temporarily
  • Cortisone injections may help short-term—but don’t stop it from coming back
  • Generic stretching and strengthening often miss the real issue

Even worse—many people are told their problem is purely structural.

Things like:

  • Herniated discs
  • Bulging discs
  • “Tight piriformis”

While these can be part of the picture, they’re often not the full story.

Many people without back pain at all show disc bulges on MRI—meaning structure alone doesn’t explain symptoms. According to the Mayo Clinic, imaging findings don’t always correlate with pain.

So if you’re only chasing what shows up on imaging, you may be chasing the wrong thing.

The MRI Trap (And Why It Slows People Down)

This is one of the biggest mistakes we see.

Someone gets an MRI.
It shows a disc issue.
Everything becomes about “fixing” or protecting that disc.

But no one is asking:

What movements actually trigger your pain?
What positions make it better?
How is your body moving day-to-day?

Without those answers, treatment becomes guesswork.

And that’s why so many people feel stuck.

What Actually Works (And Why It’s Different)

The key to long-term sciatica relief is identifying what’s mechanically irritating the nerve.

That means looking at:

  • How your spine moves
  • How your pelvis moves
  • What patterns increase or decrease your symptoms

In most cases, there’s a specific movement pattern driving the problem.

Once you find it, everything changes.

Treatment becomes targeted.

Instead of doing random stretches or exercises, you focus on movements that:

  • Reduce pressure on the nerve
  • Restore normal motion
  • Prevent flare-ups from coming back

Sometimes, supportive treatments like shockwave therapy or EMTT can help calm inflammation.

But these are just tools.

The real solution is fixing the reason your nerve is getting irritated in the first place.

A Better Approach to Sciatica in Portsmouth, NH

If you live in Portsmouth, Hampton, or the Seacoast, you don’t just want pain relief—you want your life back.

You want to:

  • Walk along the beach without pain shooting down your leg
  • Get through a round of golf comfortably
  • Pick up your grandkids without hesitation

That’s exactly why we take a 1-on-1, movement-based approach at CJ Physical Therapy & Pilates.

Instead of chasing symptoms, we help you understand your body—and fix the root cause.

Learn more about how we help people with sciatica here:
https://cjphysicaltherapy.com/

Explore our physical therapy services:
https://cjphysicaltherapy.com/physical-therapy/

The Bottom Line

If your sciatica keeps coming back, it’s not because you haven’t tried hard enough.

It’s because the true source of the problem hasn’t been identified.

Sciatica isn’t just about a nerve.

It’s about why that nerve is being irritated in the first place.

When you shift your focus from symptoms to cause:

  • Progress becomes more consistent
  • Relief lasts longer
  • And you stop relying on temporary fixes

Ready for Real Answers?

If you’re tired of trying things that only work temporarily—and you want real answers—we can help.

At CJ Physical Therapy & Pilates, we specialize in figuring out what’s actually driving your pain so you can finally move forward with confidence.

Request a free discovery visit here:
https://cjphysicaltherapy.com/discovery-request-form/

Healthy couple exercising outdoors, promoting back-friendly fitness and injury prevention in Portsmouth, NH.

Why New Year’s Fitness Goals Backfire — And How to Protect Your Back

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Why New Year’s Fitness Goals Backfire — And How to Protect Your Back

Every January, it happens like clockwork.

Gyms fill up. Fitness challenges kick off. People recommit to moving more, getting stronger, and finally prioritizing their health. And honestly — that motivation is a great thing.

But then February and March arrive… and we start seeing a different pattern here at our physical therapy clinic in Portsmouth, NH.

Back pain flares up. Old injuries resurface. New aches suddenly derail workout routines. And many people quietly decide they’re “too old,” or that certain exercises “just aren’t for them.”

In reality, the issue usually isn’t motivation or effort. More often, unresolved or low-grade back pain quietly follows people into their New Year’s fitness routines — and when increased intensity, load, or frequency is layered on top of poor movement patterns, even the best intentions can backfire.

If your goal this year is to stay active and pain-free, the solution may not be doing more — but doing things smarter.

Why January Is a High-Risk Month for Back Injuries

January is one of the highest-risk months of the year for back injuries — and that’s no coincidence.

Back pain rarely appears out of nowhere, even when it feels sudden. In most cases, it develops gradually over months or even years due to prolonged sitting, repetitive bending or twisting, and subtle compensations the body makes without you realizing it.

The holiday season often magnifies these stressors:

  • Long car rides and travel
  • More time sitting on soft couches
  • Disrupted routines and less daily movement

By the time January arrives, many people are already showing early warning signs of a brewing back pain episode — stiffness, mild aches, or irritation.

Then comes the abrupt shift:
New workouts. Heavier lifting. High-intensity classes. Aggressive stretching. Movements the body hasn’t been prepared to tolerate.

This combination is why so many people start the year strong — only to find themselves sidelined weeks later with back pain or sciatica.

Exercise Is Medicine — But Only When the Dose Is Right

Exercise is one of the most powerful tools we have for preventing and resolving back pain — when the dose is appropriate.

When your back is healthy, general exercise and strength training can be excellent preventive tools. But when back pain is already present, a more specific and individualized approach is often needed.

Roughly 80% of back pain is mechanical in nature, meaning it comes from how your body moves, sits, bends, lifts, and responds to load — not simply from structural issues like arthritis or disc degeneration. In fact, research consistently shows that many people with disc bulges or degeneration have no pain at all.

When faulty movement patterns and underlying spine mechanics aren’t addressed first, working harder in the gym can unintentionally amplify the habits that caused the problem in the first place. This is a major reason New Year’s fitness routines fail — despite great intentions.

How to Pursue Fitness Goals in a Back-Friendly Way

The good news? You don’t have to choose between staying active and protecting your back.

A few simple strategies can dramatically reduce injury risk while supporting long-term fitness.

1. Reduce Prolonged Sitting

Sitting increases compressive forces on the spine by up to 40%. Spending most of the day seated and then jumping into intense workouts puts your back at a disadvantage before exercise even begins.

Breaking up sitting time every 30 minutes with brief movement or posture changes gives your spine a break and creates a healthier foundation for exercise.

2. Don’t Underestimate Walking

Walking restores natural spinal movement, improves circulation, and reduces hip stiffness — a common contributor to back pain.

Aiming for 6,000–7,000 steps per day (about 45–60 minutes spread throughout the day) supports spinal health, joint mobility, and cardiovascular fitness without overwhelming your system. If walking consistently worsens your back pain, that’s a sign to seek expert guidance — not to stop moving altogether.

3. Focus on Postural Variety, Not “Perfect Posture”

No posture is healthy if it’s held too long. The spine thrives on movement and variability.

Rather than chasing perfect posture, focus on changing positions often while maintaining general postural awareness.

4. Strengthen Your Core — Intelligently

Core strength is important, but it’s not always the fix for back pain people expect. Because back pain is often sensitive to position and load, generalized core exercises can sometimes make symptoms worse.

Targeted, well-coached strength training and functional movements — guided by a back-aware professional — help build stability at the right time and in the right way.

5. Don’t Wait for Back Pain to “Go Away”

Mechanical back pain rarely resolves with time alone. It adapts, compensates, and quietly becomes limiting.

The absence of pain doesn’t always mean the absence of a problem. Understanding why your back hurts — and which movements help or worsen symptoms — is far more effective than relying on short-term fixes.

Work Smarter, Not Harder This Year

A successful New Year’s fitness plan isn’t defined by how hard you push in January.

It’s defined by how consistently you can move throughout the year — and whether you can keep doing the activities you love without setbacks.

With the right approach, movement becomes the solution — not the reason you’re sidelined.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for the Seacoast Media Group.

To get in touch — or request a free discovery visit with one of our specialists — visit our website or call 603-380-7902.

sciatica

Struggling with Sciatica? Why What You’ve Tried Might Not Be Working

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Struggling with Sciatica? Why What You’ve Tried Might Not Be Working

If you’ve ever experienced a sharp, shooting pain that travels from your lower back down your leg, you’ve likely been told you have sciatica. And if you’re like most people, you’ve probably tried a few things – rest, stretching, physical therapy, chiropractic care, maybe even a cortisone shot – only to find the pain returns just as quickly as it went away.

So what gives?

Sciatica can be one of the most frustrating and confusing conditions out there. It’s painful. It’s limiting. It can move around. It can be there one day and not the next. And it’s quite often misunderstood – even by medical professionals.

Let’s break down what sciatica really is, why it keeps coming back, and what you can do to finally find lasting relief – naturally – and without having to rely on pain pills, injections, or surgery.

What is sciatica?

Technically, sciatica refers to pain that radiates from the lower back through the buttocks and down the back of one or both legs. This radiating pain is caused by compression or irritation of the sciatic nerve – or one of its nerve roots – in the lumbar spine.

But these days, “sciatica” has become a bit of a catch-all term for any pain that extends beyond the back. Some people don’t feel it in their back at all – they only feel it in the buttocks or hip. Others feel it strictly in their butt. And some feel it all the way down into their lower leg or ankle. The location and intensity of your symptoms will depend on how irritated the nerve is – and symptoms can even change throughout the day.

So what causes this nerve irritation? That’s the part many people miss.

It’s not always a disc herniation, even though that’s a common assumption. And it’s rarely due to your piriformis muscle – despite what Dr. Google might suggest when you search “sciatica.”

Most of the time, sciatica symptoms are mechanical in nature. In other words, they’re caused by poor movement patterns that, over time, lead to stiffness in your spine. This stiffness creates compensations that can begin to irritate nearby structures – sometimes that’s a disc that’s slightly out of place or degenerated, and sometimes it’s not a disc at all. Either way, the underlying issue is the same: stiffness and poor movement habits that cause irritation in the spine. And when one of the structures getting irritated happens to be a nerve – you get sciatica.

The MRI trap

Now that you understand the true, underlying cause of sciatica – let’s talk about MRIs for a moment. While they can be helpful in ruling out serious conditions, they’re often overused – and in many cases, misleading – when it comes to non-specific low back pain, including sciatica.

Studies show that people without any back pain at all frequently have bulging or herniated discs on MRI. So when someone with sciatica gets imaging done and sees a disc issue, it’s easy to assume that’s the problem. But correlation doesn’t always mean causation.

The result? People end up chasing structural problems that may have nothing to do with their pain. And meanwhile, the real issue – often a mechanical one – is left unaddressed.

Why traditional treatments often fail

Traditional treatments often fail for sciatica for a few reasons. If you miss the root cause – which is mechanical about 80% of the time – and instead chase the symptoms and compensations (tight muscles, weak muscles, inflammation, etc.) – you’ll find yourself running in circles with little to no relief – and certainly not the lasting kind.

Another reason treatments fail is because of the MRI trap. In other words – allowing your MRI to dictate your treatment plan instead of making sure the findings actually correlate with what’s going on with you in real life.

If you’ve sought help for sciatica and were only prescribed rest, painkillers, anti-inflammatories – or in more severe cases, a cortisone injection – then you’ve only been chasing symptoms. And pain relief is not the same as healing. If the mechanical or movement issue that’s irritating your sciatic nerve hasn’t been resolved, the pain will almost always return. Sometimes worse than before.

That’s why it’s not uncommon for someone to feel amazing after a cortisone shot – only to be back in pain three weeks later. Or to get surgery for a herniated disc – only to find out months later that the pain is still there, or now shows up at another level in the spine.

So what actually works?

The key to lasting relief from sciatica is identifying and correcting the true source of nerve irritation. And most of the time, that comes down to improving how your spine, pelvis – and sometimes even your hip – are moving. This has to happen first before you focus on things like core strength or correcting muscular imbalances.

Yes, inflammation can be a factor – and when it’s present, it can make mechanical therapy less effective. The good news is we now have natural treatment strategies, like shockwave therapy and EMTT, that can help calm inflammation – without having to rely on anti-inflammatories or cortisone shots.

A physical therapist who is specially trained – and skilled at identifying mechanical problems – is the best person to evaluate your movement patterns and determine exactly what’s triggering your pain. Often, a very specific movement or series of movements can not only relieve pressure on the sciatic nerve, but also help restore normal function so the pain doesn’t come back.

A mechanical approach to treating sciatica is drastically different from traditional physical therapy methods that focus mostly on stretching, strengthening, or even hands-on work. And while stretches and manual therapy might feel amazing and seem helpful in the short term, they still fail to address the real, underlying mechanical cause of your sciatica.

You need to identify the faulty movement patterns in your spine and reduce the tension on your nerves. Once you do that – your body can take over and heal itself naturally.

The best part about this type of approach? It’s repeatable – and something you can eventually manage completely on your own. That’s how you keep your pain gone and get long-lasting relief.

Bottom line: treat the source, not just the symptoms

If you’re dealing with sciatica – or think you might be – don’t settle for short-term relief. Look beyond the symptoms. Find someone who can assess your movement, test what improves or worsens your pain, and give you a clear plan of action.

Because when you treat the root cause – not just the nerve – you don’t just get relief. You get your life back.

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

Speak to one of my specialists by clicking HERE.

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

Why Your Hamstring Isn’t Healing – 3 Signs It’s Something Else

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Hamstring Pain is common – especially in active adults over 40.

But what’s less commonly talked about is how often a hamstring injury is misdiagnosed. If you’ve been stretching, foam rolling, and rehabbing your “hamstring strain” for weeks or months with little to no improvement – there’s a good chance your pain isn’t coming from your hamstring at all.

That’s because certain types of back problems can mimic hamstring pain almost perfectly. And if you don’t recognize the signs, you may end up chasing the wrong problem for far too long.

So how can you tell when your hamstring isn’t healing because it’s not really your hamstring?

Let’s take a look at what a true hamstring strain typically looks like – and then go over three clear signs that something else is actually going on.

What a true hamstring injury looks like:

A hamstring strain usually happens suddenly – often during an explosive movement like sprinting or lunging. You’ll feel a sharp pain in the back of your thigh, and possibly notice swelling, bruising, or tenderness. In the early stages, walking or bending your knee might be difficult. But with the right combination of rest, movement, and strengthening – most hamstring injuries heal well and don’t linger – especially when properly diagnosed and rehabbed.

If your pain doesn’t follow that pattern – or seems to be sticking around far longer than expected – there’s a good chance your spine is actually to blame.

Here are three key signs your “hamstring strain” might be something else entirely:

1. The pain never really goes away

A true muscle injury will hurt when it’s injured – but it heals. If your pain feels dull, achy, and persistent – especially after long periods of sitting or standing still – that’s a red flag.

This type of pain often stems from nerve irritation in the lower back, not muscle damage in your leg. It’s common for certain spinal problems to refer pain down the back of the thigh, which is why this gets misdiagnosed so often. But unlike a muscle strain, nerve-related pain doesn’t improve with time or basic rehab – and may even get worse with certain types of movement or exercise.

2. You notice tingling, numbness, or odd sensations

Muscles don’t cause tingling. Nerves do. So if your hamstring injury is accompanied by numbness, tingling, or an odd “buzzing” feeling in your butt or leg – it’s almost certainly a nerve issue. The sciatic nerve, which originates in your lower spine, travels right through the area where most people feel hamstring tightness. When that nerve gets irritated, it can create sensations that feel like they are coming from your hamstring – but aren’t.

If you’re experiencing these kinds of nerve symptoms – it’s a strong indicator that your spine (not your hamstring) is the real source of the problem – and it needs to be addressed.

Contact us to see how we can help relieve your pain.

3. Your pain travels below your knee

This one’s especially important. Your hamstrings attach just above and behind the knee – so any pain you feel below your knee can’t be coming from your hamstring.

If your discomfort travels down your calf or even into your heel, the likely culprit is your spine. Research shows that as much as 40% of lower leg pain originates from the lower back – even when there’s no actual back pain. So it’s very possible to have a perfectly healthy hamstring – but still feel pain there due to a nerve referral from your spine.

What to do next

If any of these signs sound familiar – don’t keep treating your hamstring like a muscle strain – it won’t help – and could even worsen your problem. Plus, the longer you focus on the wrong issue, the longer it will take to get better.

Instead, seek out a physical therapy specialist who understands how to properly screen and assess your spine. They’ll be able to figure out if your lingering hamstring pain is related to a problem in your lower back. And once you identify the true root of your pain – you can finally get the treatment you need – and get back to doing the activities you love.

Request a free Discovery Visit at CJ Physical Therapy

Active senior man in sportswear suffiering from pain in his back after cycling, in park in summer.

Exercise-induced Leg Soreness or Sciatica? How to Tell the Difference.

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It’s that time of year – when people set goals and take action to improve their health, get back in shape, and ramp up exercise routines.

But what happens when your body isn’t ready for what your mind has planned? How can you tell if the soreness you feel is “good pain” – or a problem brewing?

This concept is particularly confusing when it comes to leg pain. Whether it’s ramping up your strength training, more frequent Peloton rides, or getting back to running/jogging… These activities will make your legs sore. The problem, however, is that leg soreness can mimic a common (and sneaky) condition called “sciatica” – that if missed or ignored – could completely derail you from your health and fitness goals. So it’s important you know the difference and what to watch out for – especially if you have a history of sciatica or back pain. 

Here are some key things you to look out for – that will help you tell the difference between normal leg soreness from exercise – versus sciatic pain that’s caused from your back:

Exercise-induced leg soreness…

With exercise-induced leg soreness – you’ll typically feel pain deep in your muscles (especially those you specifically worked on) – and your legs may feel tender to touch or even “swollen”. This type of soreness comes from challenging your muscles beyond their usual capacity – something you want to do during exercise. The soreness is caused by microscopic damage to your muscle fibers – triggering an inflammatory response. This inflammatory response then triggers a repair phase in the area of the “damaged tissue” (aka your muscles). It’s in this repair phase that your body builds back stronger muscles – so that they’re more resilient the next time you exercise. 

Another key characteristic of exercise-induced leg soreness is that it will typically occur anywhere from 24-72 hours after the activity. This phenomenon is known as “DOMS” (delayed onset muscle soreness) and it will usually dissipate in a similar amount of time. The soreness you feel from DOMS is often felt symmetrically (in both legs) – because most exercises are done using both sides of your body. But even if you’ve done an activity that favors one leg over another – the pain you experience during the DOMS period will occur when you’re moving or stretching the affected muscles – and not so much during periods of rest.

Now let’s look at sciatica…

Sciatica is a problem that comes from your spine and that causes pain in your buttock and/or leg. In between each vertebrae (the bones that make up your spine) are small spaces that allow the nerves originating from your spinal cord to exit. These nerves control everything from sensation, to pain, to muscle strength. If the nerves in your lower back get irritated – or structures around those nerves get irritated (for example, bulging discs) – anything in your leg (or butt) that those irritated nerves “touch” can also be affected. This is the phenomenon known as sciatica.

The tricky part about sciatica is that the timeline of your pain – and the feeling you experience – can be very similar to the leg soreness you get from exercise. Just like exercise-induced leg soreness – sciatic pain can include a deep ache in your muscles, tenderness to touch, and a feeling of swelling. People often describe to me a feeling of “heaviness” in their leg when they are experiencing a sciatic episode. Sciatic pain can also come on 24-72 hours after exercising or activity.

But with sciatica – one of the most important factors you need to pay attention to is how your pain behaves. Leg soreness from exercise arrives in a fairly predictable manner – and leaves in a fairly predictable manner. And you generally won’t have much pain at rest.

Sciatica, on the other hand, is more unpredictable.

Although it can come on in the same time frame as exercise-induced leg soreness – it won’t just “go away” in the same, predictable amount of time. Pain from sciatica can linger – particularly at rest – and with activities such as sitting, driving, standing too long, or walking. It can end up in just one leg even though it started in both – and it tends to come and go. For example – you’ll think it’s better – only to suddenly wake up with a sore leg again – or bend the wrong way and have the pain annoyingly return. And finally – sciatic pain won’t go away completely with stretching or massage (although it’s tempting to think it did). 

But one of the most important things to notice about the behavior of sciatic pain versus exercise-induced leg pain is whether or not numbness or tingling is present. It’s possible to have sciatic pain without numbness and tingling – but it’s not possible to have it with healthy, exercise-induced leg soreness. That’s because only nerve irritation can cause the sensation of numbness and tingling in your leg. And speaking of nerve irritation… If your leg soreness “goes away” – but you’re left with a lingering back ache – your leg pain was almost certainly a sciatic episode that has temporarily resolved – and it’s only a matter of time before it returns with a vengeance.

So there you have it – next time you notice leg pain after exercising – pay attention to how your pain behaves.

How long does it last? Does it come and go? Is it only in one leg vs both? Do you have any numbness? Does it linger or return with mundane activities such as sitting or standing?  If the answer to any of these questions is “yes” – and especially if you’ve got a history of back pain – you must consider that it could be sciatica. To make sure – seek out the help of a mechanical back pain specialist who can tell you for certain.

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.

herniated disc

Why Cortisone Shots Don’t Work for Sciatica

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If you’ve ever suffered from sciatica – then you don’t need me to tell you how debilitating the condition can be.

From shooting and searing pain into your buttocks that can run all the way down to your foot – to numbness, tingling and loss of strength… sciatica has the ability to significantly impact your quality of life. What’s worse? It typically comes out of nowhere – making this condition even more frustrating to deal with.

It’s no wonder that a majority of people resort to “quick fixes” like cortisone shots – in hopes it will put an end to their back pain and sciatica suffering. According to the American Academy of Family Physicians (AAFP), epidural steroid injections (a type of cortisone shot) are among the most common interventions for chronic low back pain and sciatica. In a study published in The Spine Journal in 2015 – it was reported that approximately 50% of patients with sciatica opted for cortisone shots for pain relief as part of their treatment plan. 

But just because cortisone shots for sciatica are popular and considered “standard” – it doesn’t mean they are best practice.

First of all – even if a cortisone shot “works” (almost 50% of the time they don’t) – the results are typically temporary.  Only 20-30% of patients have been able to report sustained relief past a few month’s time. Everyone else reports anywhere from a few weeks to 3 months relief. The problem with the majority of people only experiencing temporary relief from cortisone shots in their spine – is that  you risk “chasing the pain” with more cortisone shots (or prescription meds), acceptance of your condition and continued suffering (I call it “bad back syndrome”), or opting for spine surgery, that in most cases, is totally preventable.

OK – statistics aside – why exactly don’t cortisone shots work for sciatica?

The reason cortisone shots don’t work is because they are attacking symptoms instead of the root cause of your sciatica. Cortisone shots are great when you have an out of control inflammatory reaction to an injury. This presentation is distinct and rare. We call it “chemical  pain” and it’s essentially the result of your body’s natural inflammatory process going a bit haywire.

What makes chemical pain distinct from mechanical pain (which accounts for 80% of all sciatica/low back pain) is that most “mechanical” sciatica will come and go throughout the day – and will be better or worse during certain activities and positions. For a simple example – your sciatica may “scream” at you if you’ve been sitting for too long – but will ease up and feel better if you stand up and stretch. This is a classic presentation of mechanical sciatica.

Chemical pain does not behave like that. It literally hurts all the time and the only thing to relieve it is drugs.

And even that is temporary – thus – justifying the more invasive cortisone shot when accurately diagnosed. The tricky thing about mechanical sciatica/low back pain is that it occurs slowly over time and is the result of abnormal stress and strain on your discs and spinal nerves. It’s a “lifestyle” and movement condition at its root – not an inflammatory condition. While the cortisone shot may succeed in temporarily getting rid of the inflammation – it won’t ever get rid of the mechanical cause – which means you’re more likely to prolong the true problem over time. A cortisone shot, at its best, puts a bandaid on your sciatica. And this is the number one reason why so many people end up in a vicious cycle of treatments, and end up getting both unnecessary and preventable spine surgery.

So what should you do for your sciatica instead of a cortisone shot?

First, trust the research and evidence – which says there’s an 80% chance your sciatica has a mechanical root cause – and that the inflammation you’re experiencing is instead – a symptom. Research aside, I can vouch for this over the 22 years I’ve been helping people get rid of sciatica naturally. 

Second, medical doctors (unfortunately) are not trained in recognizing, diagnosing, or even treating mechanical pain. You need a mechanical pain specialist to help diagnose and get rid of mechanical sciatica – if you want it done the right way and for the long term. Plus – the best thing about working with a properly trained mechanical pain expert first – is that it’s fool-proof. If it’s not a mechanical cause – and it indeed is an inflammatory process “gone wrong” inside your spine – they will rule it out quickly – and refer you for a cortisone shot (appropriately).

So here’s the good news…

There’s an 80% chance your back pain or sciatica is a mechanical problem at its source. Which means that when working with the right medical professional(s) – you can successfully get rid of it naturally – and avoid cortisone shots altogether. I’m a huge advocate of natural, DIY treatment approaches whenever possible – because although small – there are real risks associated with invasive procedures like cortisone/epidural injections. And when those adverse reactions occur – they are often irreversible. 

Why not give yourself the shot at a natural approach to your sciatica before diving into an invasive one?

I’m not talking YouTube exercises and Google – I’m talking actually mechanical pain specialists. I know a lot of them. So if you’re struggling to find one in your area – please reach out. I’d love to help.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media group. To get in touch, or grab a seat in her upcoming Masterclass: “Put an end to back pain naturally – without surgery, procedures, or pills – CLICK HERE.

Woman sleeping facedown on a bed.

Tips and Solutions for Morning Back Pain

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Tips and Solutions for Morning Back Pain: Causes and How to Fix it

One of the most common complaints from people suffering from chronic back pain is how stiff and sore their back feels first thing in the morning. For some, it seems random – almost like they’ve “thrown their back out” overnight. For others, it’s a daily struggle, waking up achy no matter how good they felt before bed.

But why does morning back pain happen? Isn’t sleep supposed to be restorative to help your body heal?

The truth is, back pain shows up differently for everyone. And while it’s easy to blame your mattress, the real causes of morning back pain could be due to other factors – like your sleeping position, lack of regular exercise, and bulging dics. 

Let’s dive into each of these potential triggers and look at ways you can address them naturally:

 

Poor Sleeping Position

Your sleep posture can make or break how your back feels when you wake up. But what’s interesting is that the “wrong” sleeping position really depends on the root cause of your back pain. There is no one-size-fits-all. For example, some people find that lying on their back with legs elevated feels wonderful, yet for others, this position leaves them feeling stiff and sore come morning. Others experience tremendous relief sleeping on their stomach, while for some this position places a lot of strain on their spine and they wake up very stiff and achy.

Generally, the most back-friendly sleeping position is on your side. Side-sleeping makes it easier to keep your spine in a neutral, supported position, which reduces stress and tension while you sleep. It’s more challenging to find a neutral spine position when on your back or stomach. If lying on your side bothers your hips or shoulders, you can try placing a pillow under your waist and head, along with one between your thighs, to provide extra support and maintain better alignment. A pillow topper over a firm mattress makes side-sleeping a lot more comfortable as well. Small adjustments like these can significantly improve how your back feels in the morning and allow you to wake up feeling more refreshed.

Lack of Regular Exercise

A lack of regular exercise is one of the most overlooked reasons for waking up with a stiff, sore back. When you’re not moving enough during the day, your muscles (especially those supporting your spine) become weak and tight. Inactivity also reduces circulation, which means less blood flow delivering oxygen and nutrients to your muscles, joints, and discs. Without this nourishment, your tissues stiffen, and when you’re sleeping overnight, that stiffness builds. But regular movement doesn’t just strengthen muscles and nourish tissues – it keeps essential body systems like circulation, digestion, and even your nervous system running smoothly – setting the stage for more restful, regenerative sleep.

Incorporating consistent activity into your daily routine helps break this cycle. Simple exercises like walking, yoga, strength-training, and stretching encourage better blood flow throughout your body. The result? You’re less likely to experience that locked-up, achy feeling when you wake up – and you’ll likely notice deeper, better quality of sleep, too. Movement during the day primes your body to recover more efficiently overnight, reducing the likelihood of morning back pain.

Bulging Discs

This is one of the most common causes of morning back pain that I see. Your vertebral discs play a crucial role in your spine’s health by absorbing shock, holding your vertebrae together, and allowing for movement. What many people don’t realize is that your discs are made up mostly of water. Over the course of a typical day, your discs compress and lose some of that water content. But at night, while you’re lying down, they re-hydrate and can regain up to 17-25 millimeters in height.

While that might sound beneficial, it can actually be problematic if you’re dealing with an irritating, bulging disc. A bulging disc already has the potential to limit movement in your spine. But when it fills up with fluid overnight, it becomes even stiffer, leading to increased restriction and pain when you wake up.

If you’re consistently waking up feeling locked up, in significant pain, or hesitant to move – there’s a strong chance a bulging disc is contributing to your discomfort. Seeking guidance from a mechanical back pain specialist can help you get a proper diagnosis and develop a plan to manage and treat your bulging discs effectively and naturally – so you can avoid resorting to injections or procedures right away.

Don’t Always Blame your Mattress

If you’re dealing with morning back pain, hopefully this article has helped shed some light on why it’s happening. Before you go out and spend a fortune on a new mattress – consider addressing these common causes first. Take a look at your sleeping posture, evaluate whether you’re moving enough throughout the day, and rule out whether bulging discs might be part of the problem.

The good news is that 80 percent of all back pain cases can be treated naturally – and without the need for injections, procedures, or surgery. More often than not, the solution to a pain free back lies in simple, movement-based approaches that strengthen, support, and restore your body’s natural function.

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 a free copy of her guide to back pain – click here.

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].

Back Pain

5 Reasons Exercise is Hurting Your Back

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The research continues to show that the best “treatment” for back pain is exercise.

But what do you do when exercising causes back pain instead of helping?

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

But when it doesn’t work they are at a loss.

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

Here are 5 reasons why exercise is causing your back pain…

1. It’s the wrong type of exercise

The research isn’t wrong about exercising and back pain. It doesn’t always reveal the specifics on the type of exercise that’s being done. For example, walking is considered one of the best activities for back pain sufferers. For the majority it will help significantly. But I also have clients who get worse just walking to their mailbox at the end of the driveway.

What the research is really saying is that movement – not necessarily “exercise” – is what’s really good for back pain – even acute back pain. But you need to make sure it’s the right type of movement for YOUR specific type of back pain. If you get the type of exercise or movement wrong – you’ll feel worse. It’s one reason why exercise will sometimes hurt your back instead of help.

2. Stability training is introduced too soon

Stability training is an important part of back pain recovery – but I often see it introduced too soon. Mobility is something you always want to look at first. If you don’t have full mobility in your spine, there is a reason. You want to make sure you explore that fully and get the spine moving the way it should be before you begin stabilizing or strengthening it.

Every now and then I stabilize first, but it’s rare. More often than not I see that people with long standing back pain are suffering from a mobility problem that was missed. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You want to figure that out first before jumping ahead to stability training of your core and spine.

3. Your aren’t activating your core

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

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

4. You aren’t breathing properly

Not breathing properly – or not breathing at all – can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly.

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

5. You’re using improper form

The last and most common reason why exercising might be hurting your back is because you aren’t doing it right. There’s a lot of people out there who think posture and form don’t really matter. But they do.

If you’re lifting weights – especially when frequently and repetitively – you want your spine to be in good alignment. It might not hurt the first time you lift with improper for. But it will hurt when you get to your 100th rep. Same goes for body weight exercises. Just because you aren’t adding load to your spine doesn’t mean you can’t aggravate it by doing something with poor form over and over. That’s really where people get in trouble. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture or it’s going to catch up to you and cause you unnecessary back pain.

If exercising is currently hurting your back…

Consider speaking to one of my specialists – they’ll ask you all about what’s been going on – and see if we would be a good fit to help you!

If you’re local toPortsmouth, NH – Click here to book a free discovery visit.

herniated disc

Suffering from Sciatica? The Do’s and Dont’s

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Four out of five people will experience a debilitating back pain and Sciatica episode at one point during their lives. Sometimes this looks like severe back pain that lasts a few days and eventually goes away on its own.

But for some – especially those that have experienced more than one debilitating back pain episode over the course of their lifetime – they experience searing pain down their leg that may or may not persist over a period of time.

When you experience back pain followed by radiating leg pain – this is known as “sciatica”.

Sometimes the pain will only go to your knee, or be a dull ache in the side of your hip and leg. But other times it can manifest all the way down to your foot and be accompanied by numbness, tingling and a loss of strength.

The good news is that there is plenty you can do on your own to help yourself recover from sciatica naturally. But there’s just as much you can do – unknowingly – to make your situation worse.

Here are some Do’s and Don’ts when it comes to sciatica.

The Dont’s:

1. Avoid resting in bed or on the couch.

While it may feel better in the moment – lying in bed or on the couch will ultimately aggravate your sciatica. Sciatica is caused by pinching or irritation of the nerves in your lower back. When you lie in a slouched posture (such as in bed or on the couch) you will put unwanted pressure on these nerves, thus aggravating your symptoms.

The trickiest part about this is that you typically won’t notice the aggravation when you’re resting. You’ll notice it after the fact when you stand up or try to move around, and mistakenly assume the movement is what’s aggravating you instead of the relaxed posture you were just in.

2. Avoid child’s pose and stretching forward.

This is another big misconception about sciatica because it tends to feel really good when you’re “in the moment” and stretching your back forward. Not always, but often, sciatica is caused by a bulging or herniated disc that is pinching your nerve.

The position of bending forward does temporarily relieve pressure on your nerves – which is why it feels good at first – but it doesn’t last.

Stretching forward also opens up the space between your vertebrae. This can influence the protrusion (bulging) of your disc. If you allow your disc bulge to protrude more onto that nerve – your nerve will become more angry and aggravated – as will your sciatica.

3. Don’t let your MRI decide treatment.

As I mentioned in our first two examples, sciatica often involves bulging discs and irritated nerves. And an MRI will typically confirm this. But here’s the thing – tons of people out there have bulging discs showing up on their MRI’s and no symptoms at all.

What matters is whether or not your bulging disc is interacting negatively with your nerve – and that is typically influenced by poor movement strategies.In other words, if you learn how to move better, you can actually make your bulging disc inconsequential and your sciatica will dissipate.

So you should never let your MRI, alone, determine your treatment protocol when you’re suffering from sciatica. What’s more important is how your sciatica symptoms behave during movement. Research has shown this to be more reliable than imaging alone because it tells us in real time what’s happening to your nerves.

The Do’s:

1. Keep moving.

While it may seem counterintuitive to move when you’ve got pain running down your leg – it’s one of the best things you can do.

Try to stand and walk upright as much as you can and pay close attention to what happens in your leg. If the symptoms in your leg start to subside, then you’ll know that your body is enjoying that particular movement and that it’s helping your sciatica.

But here’s the catch – make sure the relief lasts. Lasting relief (vs temporary) is what we’re looking for and it tells us if the movement you’re doing is a good thing for your sciatica.

2. Watch your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. Remember that sciatica typically involves a pinched or irritated nerve – and irritated nerves are highly sensitive to postural changes in your lower back (especially slouched postures).

Whether you’re standing, sitting, or lying down – be sure to maintain a small curve in your lower back to minimize your slouch. This helps to keep pressure off your discs and already aggravated nerves.

3. Talk to a Movement Specialist.

While it’s entirely possible to rid yourself of debilitating sciatica without pain pills, procedures, or surgery, you’ll find it easier to do so under the guidance of a movement specialist who specializes in understanding back pain and sciatica.

Yes – you can get an MRI and go see a surgeon – but they aren’t movement specialists. They are surgical specialists. In order to get rid of your sciatica the natural way (with corrective movement strategies) – you need to work with someone who’s an expert in this.

Have you been dealing with back pain or sciatica? Or do you know someone who is?

If you”re local Portsmouth, NH, and you want help NOW for your back pain – Request a Free Discovery Session from one of my specialists. They’ll tell you if we can help and get you set up on a treatment plan right away!

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].