Tag Archive for: seacoast nh

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/

Seven Smarter Ways to Manage Arthritis Pain Without Drugs or Surgery

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Seven Smarter Ways to Manage Arthritis Pain – Without Drugs or Surgery (Portsmouth & Seacoast, NH)

Arthritis is one of the most common causes of chronic joint pain and mobility limitations, affecting nearly 60 million adults in the United States. Many people in Portsmouth, NH and throughout the Seacoast live with persistent stiffness, swelling, and joint pain that can interfere with daily activities, exercise, and quality of life.

After an arthritis diagnosis, it’s common to feel like medication, injections, or even surgery are inevitable. While those options can be appropriate in certain cases, research and clinical experience show that many people can successfully manage arthritis pain using non-invasive, natural, and movement-based strategies that address inflammation, joint mechanics, and overall joint health.

Below are seven effective, evidence-informed approaches that help people in Portsmouth and the surrounding Seacoast region move better, feel better, and stay active — without relying solely on drugs or surgery.

1. Reduce Inflammation Through Nutrition

Inflammation is a major driver of arthritis pain and stiffness. When chronic inflammation persists inside a joint, it can irritate cartilage, surrounding tissues, and even underlying bone — leading to increased discomfort and reduced mobility.

Adopting an anti-inflammatory eating pattern can support joint health and help reduce symptom flare-ups. Foods rich in omega-3 fatty acids — such as salmon, sardines, and walnuts — are known to support joint lubrication and reduce inflammatory responses. Fruits and vegetables provide antioxidants that protect joint tissue, while spices like turmeric and ginger contain natural compounds that help regulate inflammation. Healthy fats like olive oil also contribute to better joint function.

Highly processed foods, excess sugar, refined carbohydrates, and fried foods tend to promote inflammation and may worsen arthritis symptoms over time.

2. Keep Joints Moving With the Right Kind of Exercise

Many people with arthritis in Portsmouth and Seacoast NH avoid movement out of fear that it will increase pain. However, inactivity often leads to more stiffness, muscle weakness, and decreased joint tolerance — ultimately making symptoms worse.

Gentle, consistent movement improves circulation, nourishes joint tissues, and helps reduce inflammatory buildup. Low-impact activities like walking, cycling, and swimming are excellent options. Pilates and yoga improve mobility, balance, and joint control, while strength training helps surrounding muscles absorb stress that would otherwise burden the joints.

When joints are supported by strong, well-coordinated muscles, everyday movements — like climbing stairs, getting out of a chair, or walking — become easier and less painful.

3. Manage Weight to Reduce Joint Stress

Body weight plays a significant role in joint health, especially in weight-bearing joints like the knees, hips, and lower back. Extra weight increases the force placed through joints with every step.

Studies show that losing even a small amount of weight can meaningfully reduce joint stress and arthritis pain. For the knees specifically, each pound of weight loss can reduce pressure by approximately four pounds during daily activities.

Regular walking is one of the simplest and most effective ways to support both weight management and joint health. Even small increases in daily movement can make a meaningful difference.

4. Understand How Hormonal Changes Affect Joint Health (Especially for Women)

Many women in Portsmouth and across New Hampshire notice worsening joint pain during perimenopause and menopause — and this is not just “getting older.” Declining estrogen levels can significantly impact joint health by increasing inflammation, reducing cartilage resilience, and affecting bone density.

As estrogen levels drop, joints may feel stiffer, more sensitive, and slower to recover from activity or minor injuries. This means arthritis management for midlife women often requires a more comprehensive approach that prioritizes movement, strength, and recovery — not just pain suppression.

5. Use Hands-On Therapies to Support Pain Relief and Mobility

Complementary therapies such as acupuncture and massage are widely used in Portsmouth and the Seacoast area to help manage arthritis pain and stiffness.

Acupuncture can influence pain pathways and improve circulation, while therapeutic massage reduces muscle tension, increases blood flow, and restores movement around stiff joints. Some people also benefit from cupping or heat-based therapies when combined with an active rehabilitation plan.

These non-invasive therapies are often most effective when paired with movement-based care such as physical therapy or corrective exercise.

6. Improve Joint Mechanics — Not Just Symptoms

One of the most overlooked causes of arthritis pain is poor joint mechanics. When joints don’t move properly, certain areas bear excessive stress, which can accelerate wear and increase pain over time.

Targeted mobility exercises, corrective movement, and joint retraining can help distribute forces more evenly across the joint. Many people in Portsmouth find that when their movement improves, their pain decreases — even when arthritis is still present.

This approach shifts the focus from masking symptoms to restoring function, which is often the missing piece for those who feel stuck despite trying multiple treatments.

7. Explore Non-Invasive Regenerative Technologies (Available in Seacoast NH)

One of the most exciting developments in arthritis care is the growth of non-invasive regenerative therapies available in and around Portsmouth, NH. Unlike injections or surgery, these treatments aim to stimulate the body’s natural healing processes.

Shockwave therapy uses targeted acoustic energy to improve blood flow, reduce chronic inflammation, and support tissue repair.

Extracorporeal magnetotransduction therapy (EMTT) uses high-energy electromagnetic fields to enhance cellular activity and reduce pain.

These therapies can help reduce pain, improve mobility, and speed recovery with little to no downtime. Unlike cortisone injections — which may weaken tissue over time — regenerative approaches focus on improving joint health at a cellular level.

Final Thoughts

Living with arthritis in Portsmouth or anywhere along the Seacoast does not mean accepting chronic pain or declining mobility. With the right combination of nutrition, movement, weight management, hands-on care, hormonal awareness, and modern non-invasive therapies, many people can stay active, independent, and pain-free for years to come.

Your body has an incredible ability to adapt and heal when given the right support. By taking proactive steps today, you can experience better movement, less pain, and a higher quality of life tomorrow.

Dr. Carrie Jose, Physical Therapy Specialist and Regenerative Therapy Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. To get in touch or request a free discovery visit with a physical therapy specialist visit cjphysicaltherapy.com or call 603-380-7902.

Holiday Stress

Don’t Let Holiday Stress Turn Into Pain: 3 Simple Strategies

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Don’t Let Holiday Stress Turn Into Pain: 3 Simple Strategies to Stay Healthy in Portsmouth, NH

The holidays are meant to feel warm, festive, and joyful. But for many people here in Portsmouth and the Seacoast area, they also bring a level of stress your body can’t help but absorb. Between shopping, hosting, traveling, and trying to squeeze everything in, your nervous system can go into overdrive. And when that happens, stress often shows up physically — tight shoulders, a stiff neck, a cranky low back, or even tension headaches.

The good news? You can interrupt this cycle with a few simple habits. These strategies can help you keep holiday stress from turning into neck, shoulder, or back pain — and they’re easy to start right away.

1. Try Belly Breathing to Reset Your Body’s Alarm System

When stress rises, your breathing becomes shallow. You might not notice it, but your brain definitely does. Shallow breathing tells your nervous system that you’re under pressure, and your muscles respond by tightening. I personally feel this tension through my rib cage and into my neck when it gets bad enough.

Just one or two minutes of deep, intentional breathing can reverse this entire pattern.

Wherever you are — in the car, standing in line on Congress Street, or even at a holiday party — try this:

✔ Take a slow inhale.
Fill your belly, sides, and lower back with air.

✔ Exhale naturally.
Let the air fall out without force.

Each deep breath acts like a reset button for your nervous system. It helps stop tension from turning into knots, spasms, or lingering pain in your neck or lower back.

2. Practice Gratitude (It Physically Changes Your Stress Levels)

Gratitude isn’t just a feel-good idea. It’s a simple mindset shift that has measurable effects on your body.

When you pause to focus on something positive, your brain reduces its release of cortisol — your main stress hormone. Lower cortisol leads to:

  • Lower muscle tension
  • Happier blood pressure
  • Better sleep
  • Less strain on your neck, back, and hips

A gratitude practice doesn’t need to be fancy. It can be as simple as:

  • Thinking of one thing you appreciate while drinking your morning coffee
  • Writing a single sentence in a journal before bed
  • Setting a daily alarm to remind yourself of something good

These tiny moments tell your body: “You’re safe. You can relax.” Your muscles respond in kind.

3. Move Daily to Break the Stress Cycle

Chronic stress triggers your fight-or-flight system. It’s helpful if you’re running from danger — but in modern life, most of our stress comes from calendars, inboxes, and long to-do lists. If that stress energy has nowhere to go, it lingers in your body as muscle tension.

Movement is how you release it.

Personally, I love walking around Portsmouth and the Seacoast. I aim for 10,000 steps a day. When the weather is too cold or I’m stuck on Zoom, I use a walking pad. I always feel better afterward.

But walking isn’t the only option. You can also:

  • Go to the gym
  • Stretch for a few minutes
  • Run up and down your stairs
  • Do 30–60 seconds of jumping jacks

Just 5–10 minutes at a time is enough to tell your brain the stress has passed. Once that happens, your cortisol levels naturally come back down — and tension is less likely to settle in your joints, neck, or back.

Your Body Will Thank You

You may not be able to eliminate holiday stress (and if you figure out how, please let me know!) — but you can prevent it from turning into pain. Small habits, repeated throughout the season, make a huge difference. And you can keep using these same habits long after the holidays.

But if you’re already dealing with significant tightness or pain that isn’t improving, these strategies might not be enough on their own. A mechanical pain specialist can help you identify the true root cause, calm things down quickly, and give you a clear plan so you enter the New Year feeling better — not worse.

If you need help or guidance, we’re here for you.

Dr. Carrie Jose, Physical Therapy Specialist & Mechanical Pain Expert, writes for Seacoast Media Group and helps people on the Seacoast get rid of back, neck, hip, and shoulder pain naturally.

For more resources or to get in touch, visit www.cjphysicaltherapy.com or call 603-380-7902.

sciatica

Why Your Back Pain Isn’t Going Away – Even After Rest, PT, and Chiro

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In my 23-year career, back pain is probably the one problem that frustrates people the most. It affects your sleep, your mood, your energy, and your ability to enjoy the things you love. Plus, it becomes even more frustrating after you’ve tried all the “right” things – like physical therapy, chiropractic treatment, and even good old-fashioned rest.

If this sounds like your story, you are not alone. I work with people every week who have done everything they were told to do – and they’re still in pain. And it’s not because they didn’t try hard enough. It’s because the true root cause of the problem was missed.

I always say… If your treatment plan isn’t working, you either have the wrong diagnosis or a poor treatment strategy.

Let’s take a closer look at why some of the most common treatments for back pain – rest, physical therapy, and chiropractic care – don’t always work.

Rest is Not a Cure

When your back hurts, resting feels like the safest and most natural thing to do. And for an acute injury, some rest is helpful. But debilitating back pain episodes aside, resting for more than a day or two can actually make things worse.

Your spine needs movement. Movement keeps your discs hydrated, your joints nourished, and your muscles coordinated and strong. Avoiding movement out of fear can lead to stiffness, weakness, and more pain – not less.

Your nervous system relies on movement – and your body’s response to it – to help it learn and recover after injury. If you shut everything down at the first sign of pain, your brain can start to associate movement with danger. That’s how chronic pain problems begin.

The reality is, if rest alone cured back pain, we wouldn’t have so many people still suffering from it.

Your Physical Therapy Isn’t Prescriptive

The research tells us that exercise is one of the most effective treatments for back pain – which is why physical therapy should be the gold standard. Physical therapists are trained to be movement experts. They should be prescribing exercises that are designed to take your back pain away – and keep it gone – while using hands-on work and modalities selectively to help you move with less pain and more efficiency.

But sadly, this doesn’t always happen. I often see clinics that rely heavily on passive modalities like ultrasound or electrical stimulation for short-term relief. Then the exercise “prescription” ends up being a generic list of stretches and core exercises you could find on YouTube.

If your physical therapy didn’t work, it’s possible the true root cause of your back pain wasn’t correctly identified. Many cases of back pain are due to “derangement syndrome” – when something in your spine (like a bulging disc) disrupts normal movement. Unless you correct the way your spine moves – and learn how to maintain that correction – the pain keeps coming back.

Physical therapy must be prescriptive in nature. If you just want general exercises, you can find them online or go to the gym. Your back might eventually feel better – but you’ll never know what fixed it, and you’ll have no way to fix it again when the pain returns.

For a more prescriptive approach to back pain relief, reach out to see how we can help.

Chiropractic Adjustments Aren’t Always Enough

Chiropractic care can sometimes be the difference between being unable to move and finally being able to straighten yourself out – especially during an acute episode of back pain. But most chiropractic care is passive. It has its place, but problems arise when people rely solely on adjustments to stay out of trouble. Chiropractic care should be paired with prescriptive, active movement that retrains your nervous system and gives you tools to manage your pain.

Another issue I see is people who have relied on adjustments for years. Eventually, they realize the pain keeps coming back. That’s often because the joint being mobilized provides only temporary relief, while the root cause isn’t being addressed. Chiropractic adjustments also aren’t very specific. Your spine often needs precise movements, in a specific direction, repeated over time. When it comes to disc or nerve problems, it can take thousands of reps of the right movement to resolve the irritation and get the pain to stop. A chiropractic adjustment can sometimes disrupt that carefully prescribed movement plan – and then you’re back at square one.

This all might sound a bit “technical” to you, and that’s because it is. It’s also why so many people still suffer from back pain despite trying everything.

But don’t overthink it. Ask yourself: Is chiropractic care still helping? Are you relying on the adjustments less and less? If yes, you’re on the right track. If not, it may be time for a new approach.

What to Do Instead

There’s no one-size-fits-all solution for back pain. But successful treatment usually starts by asking better questions and taking the time to uncover the real root cause.

Is it your muscles? Your joints? A disc? A nerve? Or the way your brain and nervous system have adapted over time?

A thorough, mechanically based assessment often reveals things that X-rays and MRIs miss. In fact, imaging can sometimes lead to too much information – and send you down a path of unnecessary treatments that should be reserved as a last resort.

Once the true source of your problem is found, a plan that emphasizes active movement, education, and progressive activity is far more effective than passive treatments or rest alone. Passive treatments can help reduce symptoms quickly, but long-term success depends on learning how to care for your back with the right tools, the right guidance, and the right movements.

If your back pain isn’t going away – even after rest, PT, or chiropractic – it’s not a sign that you’re broken or destined for surgery. It could just mean the true cause of your pain hasn’t been found yet.

If you’re tired of chasing quick fixes and want real answers, we can help. Schedule a free Discovery Visit to uncover the root cause of your back pain and find out if we’re the right fit to help you get lasting relief.

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.

Knee Pain

Top Causes of Knee Pain and How to Get Lasting, Natural Relief

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Knee pain affects millions of people worldwide, often interfering with daily activities such as walking, squatting, climbing stairs, and even getting in and out of the car.

It is one of the most common musculoskeletal complaints, second only to back pain. Whether your knee pain started suddenly or has worsened over time – you might be wondering – what’s really causing it? And can you get rid of it naturally?

The good news is that, in most cases, yes. Many common causes of knee pain can be addressed without medications, injections, or surgery. Here are some of the top reasons behind knee pain and what you can do to find lasting, natural relief that doesn’t involve medication, injections, procedures, or surgery:

1. Patellofemoral Pain Syndrome (Runner’s Knee)

Also known as “runner’s knee,” patellofemoral pain syndrome (PFS) is characterized by pain in the front of the knee, usually just below or behind the kneecap. This condition is often caused by improper movement patterns and muscle imbalances that place excessive pressure on your kneecap, leading to inflammation and discomfort.

To alleviate PFS, it’s important to avoid excessive kneeling, squatting, or repetitive knee bending until the pain subsides. For long-term relief, focus on strengthening the muscles surrounding your knee, particularly the hips and thighs, to improve stability and reduce stress on your kneecap. Corrective exercises that promote proper kneecap tracking, such as step-ups and lateral band walks, can help to further optimize knee function and prevent future flare-ups.

2. Iliotibial Band Syndrome (ITBS)

ITBS causes pain on the outer side of the knee and is commonly seen in runners and cyclists. The iliotibial (IT) band is a thick band of connective tissue running from the hip to the knee, and when it becomes tight or inflamed, it can lead to irritation and pain.

While many people resort to foam rolling for relief, this only provides temporary symptom management. To address ITBS at its root, focus on strengthening the glutes and core, as weak glutes often lead to overcompensation and excessive strain on the IT band. Correcting pelvic imbalances and optimizing hip mobility will also be key for long-term relief. Additionally, taking a temporary break from any aggravating activities will allow the inflammation to subside and the tissues to heal properly, provided you’re taking an active approach to tissue healing versus rest only.

3. Tendinitis (Jumper’s Knee)

Tendinitis occurs when the patellar tendon, which connects the kneecap to the shinbone, becomes inflamed. This condition is common in athletes and individuals who engage in frequent jumping or repetitive knee movements.

A common treatment for tendinitis is cortisone injections, but these only provide temporary relief and may contribute to further tissue damage over time. Instead, consider regenerative treatments like Shockwave Therapy, which naturally enhances your body’s ability to reduce inflammation and accelerate tendon healing. Once inflammation is managed, strengthening the hamstrings, glutes, and calf muscles will provide better knee support and reduce tendon strain. Incorporating eccentric exercises, such as slow step-downs, can also help build tendon resilience and prevent future injuries.

4. Osteoarthritis

Osteoarthritis (OA) is the gradual degeneration of cartilage in the knee joint. While it is a natural part of aging, experiencing constant pain and limited mobility does not have to be. Many people believe that knee arthritis inevitably leads to surgery, but the truth is that optimizing movement and reducing inflammation can be powerful tools in managing OA long-term, even with “bone on bone” OA.

Rather than relying on cortisone injections and pain medication, consider alternative treatments such as Regenerative Therapy (specifically EMTT) to target inflammation deep at the cellular level. From there, implementing corrective exercises that strengthen the muscles surrounding the knee – particularly your quadriceps, hamstrings, and glutes – can reduce joint stress and help prevent inflammation from returning. Since inflammation is the primary driver of pain in OA, addressing it naturally through movement and strength training can help you avoid major surgery while still finding lasting relief.

5. Meniscus Tears

The meniscus is a piece of cartilage that cushions the knee joint. Over time, wear and tear can lead to meniscus tears – which cause pain, stiffness, and occasional knee locking. Many people assume that surgery is the only solution, but research has shown that placebo surgery can be just as effective as actual meniscus surgery, suggesting that natural recovery is possible.

Managing a meniscus tear naturally involves first addressing the inflammation caused by the tear. As previously mentioned, EMTT and Shockwave Therapy (especially when combined) can be particularly effective in reducing pain and inflammation, often providing immediate relief. Beyond that, focusing on proper knee mechanics is essential. In many cases, the issue isn’t the tear itself, but rather a lack of mobility and movement in the knee joint that continues to aggravate it. A mechanical knee pain specialist can help identify and correct these dysfunctions. Once inflammation is controlled and knee mechanics are optimized, strengthening and conditioning the surrounding muscles can provide long-term relief without the need for injections or surgery.

Finding Long-Term Relief Naturally

For most cases of knee pain, the key to lasting relief is movement – not rest, avoidance, injections, or surgery. Whether your pain is caused by an overuse injury, muscle imbalance, or arthritis – addressing the root cause with targeted exercises and mobility work is essential. Reducing inflammation naturally is also crucial for long-term joint health. If you’re struggling to determine the root cause of your knee pain or finding the right treatment approach – consider working with a mechanical knee pain specialist who can guide you toward the best non-invasive, long-term solutions.

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.

Active and Mobile

Seven Tips for an Active and Healthy Thanksgiving

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

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

  1. Interrupt your sitting

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

  1. Sign up for a Turkey Trot

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

  1. Stretch during Commercials

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

  1. Walk your Dessert Off

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

  1. Help with clean-up

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

  1. Stay hydrated

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

  1. Make your dishes health-conscious

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

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

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

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

pain

Your Pains Location May Not be it’s Source

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Pain is both a confusing and scary topic.

There’s lots of advice out there on what to do when you experience pain and it’s hard to know who to listen to. Should you rest – exercise – apply heat – apply ice – see a doctor – get an MRI – or just wait it out to see if it goes away on its own? Any or all of this advice could be right – but it’s irrelevant until you accurately determine where your pain is coming from.

For example, if you have pain in your knee, and it’s coming from your back, the best knee treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the most common reasons why so many people suffer longer than they need to, and it’s one of the biggest contributors to unnecessary procedures and surgery. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain, alone, is not a reliable way to figure that out.

Let me explain.

I’ve met people who’ve suffered from unrelenting tennis elbow for years – despite treatment protocol after treatment protocol – only to find out it was coming from their neck. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, they found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms, even when there wasn’t any spine pain. In other words, the pain they were feeling in their knee, elbow, or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you.

But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 40% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear. But what most people don’t realize is that these findings are quite normal and happen naturally as you age.

Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite the science proving this over and over – doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery – they let images and an inaccurate diagnosis lead the way.

Whenever I meet someone with isolated extremity pain, especially if it came on suddenly and out of nowhere, I always consider that it could be coming from their spine.

How can you figure this out?

Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time if it’s not addressed.

Moral of this story… If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source, and that where your pain is may not be where your problem is. And if you’re considering some kind of surgery or procedure, you definitely want to rule out that the problem could be elsewhere.

Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your elbow, knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

Looking for help and local to Portsmouth, NH? Click here to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get one of her free guides to knee and back pain, visit www.cjphysicaltherapy.com or email [email protected].

orthopedic surgery

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

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

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

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

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

 

1. Imaging does not always correlate with symptoms

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

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

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

2. Risk of Over-diagnosis and Overtreatment

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

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

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

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

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

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

Are you local to Portsmouth, NH?

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

CLICK HERE to request a Free Discovery Visit.

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

Man getting knee pain treatment

Is Your Knee Problem Really a Problem? How to tell.

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Is Your Knee Problem Really a Problem? How to tell.

Knee pain is the second most common musculoskeletal complaint after back pain. Studies say that 1 in 4 adults now suffer from chronic knee pain, and the number of swollen and stiff knees has risen 65 percent in the past four decades. But just because you have knee pain – doesn’t mean you have a knee “problem”. Knee pain can be tricky to figure out – especially if it’s chronic. Over the course of my career, I’ve seen so many cases of chronic knee pain that weren’t getting resolved because the real problem was coming from someone’s back or ankle. One of the most important factors in successfully resolving knee pain for good is correctly identifying its source.

So how do you know if your knee problem is really a knee problem?

First – pay attention to how and when your knee pain started. If you’ve had a fall or some kind of trauma directly to your knee, and you experience knee pain or swelling shortly after, odds are pretty good you have an isolated knee problem. People who perform regular, intense activities like soccer, hiking, skiing, football, and basketball are much more at risk for an isolated knee injury. Typically, you’ll know exactly when and how you hurt your knee. You may even recall a specific pop or strain of some kind.

Osteoarthritis (OA) of the knee is another example of a knee problem that could really be a knee problem. However, this one is tricky because if you’re over the age of 50, you most likely have OA in your knee, and it will show up on your X-ray whether you have knee pain or not. So what commonly happens is that if you’ve had knee pain for a while, and you get an X-ray that shows you have OA, the OA will get blamed for your knee pain. So yes – knee OA can be an isolated knee problem – but knee OA tends to be an over-diagnosed source of knee problems.

So what are the clues that tell you your knee problem might not be a knee problem?

One of the biggest clues that you’ve missed the correct source of your knee pain is that it doesn’t go away no matter what you’ve tried, or it keeps coming back.

This is the biggest complication I see with folks suffering from long-lasting knee pain.  They’ve iced it, taken pain medication, foam rolled, stretched, and strengthened – but their knee pain doesn’t get resolved.  And once your problem becomes chronic, knee doctors start to get involved.  This is great if you’ve actually got a knee problem. But if your knee pain is a symptom of something else, then you risk getting recommended unnecessary knee surgeries or procedures.

I spoke to a woman the other day who had surgery on her knee to clean out some cartilage and wear and tear from arthritis. It was supposed to be a “quick recovery” and take her pain away. Well, three months later, her knee is feeling worse than pre-surgery. And to fix the new pain she has, they tell her she will need even more procedures. Her initial problem wasn’t coming from knee OA – it was coming from something else. And now she’s going to have even more problems because she had surgery she never needed.

How does something like this happen?

The biggest reason is because of the over-reliance on imaging to form a diagnosis and treatment plan. If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60-80% chance they’ll find arthritis or meniscus (cartilage) tears, whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee – and then blame your knee pain on it. But here’s the thing – and research backs this up – there is no way to tell for certain from a picture of your knee where the true cause of your pain is coming from. The only way to tell if what you see in the imaging is actually the cause of your pain is with proper movement testing. If you don’t do that, you risk getting an unnecessary procedure when the real problem might be coming from somewhere else.

In conclusion…

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your leg – there is a good chance your knee pain is a symptom of a mechanical problem elsewhere – typically your back or your ankle.

Before you think about getting images of your knee, or undergoing some kind of surgery or procedure, you’ll want to make sure you get a thorough screen by a mechanical pain expert. Never rely on imaging to tell you the full story.

Remember that knee problems can be resolved 80% of the time without procedures or surgery. You just have to have some patience and make sure you’re working with someone who understands mechanical pain and the importance of looking at the whole body – beyond just where the pain is.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

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

knee replacement surgery

Three Things to Consider before Knee Replacement Surgery

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Total knee replacement (TKR) surgery has been around for decades, and generally speaking, results are very good. 90% of folks can expect up to a 20 year success rate. The most common reason for a knee replacement is to resolve advanced arthritis.

But what if advanced arthritis isn’t the true cause of your knee problem? Do you really need a knee replacement?

Only 15% of patients with evidence of knee osteoarthritis (OA) actually have symptoms. That means the other 85% don’t have any pain at all. These results are consistent for other joints as well. Signs of degenerating joints, bone spurs, and even meniscus tears all occur normally as you age. While some of the time these things can be the cause of your knee pain – more often than not it’s something else – or a combination of things – that are fully responsible for your joint pain or dysfunction. Evidence of knee OA shouldn’t be the only factor determining your decision of major knee surgery.

Here are three important things to consider before deciding if a total knee replacement is right for you:

 

1. How severe is your knee pain?

This is one of the most important factors to consider before undergoing major knee surgery. The X-ray might say you’ve got “bone on bone” arthritis and terrible OA – but if your knee pain is fairly tolerable – and you can still do most activities you love – why take the risk of major surgery when you could wait? Even though knee replacement surgeries are quite common and successful – there are still risks and complications.

The most common risk is infection. But you could also end up with blood clots, problems with anesthesia, or an ill-fitting prosthesis that doesn’t function right. Not only that, but people tend to underestimate the 6-12 month recovery that comes afterwards. If your knee pain is severe and intolerable, and you’ve already tried physical therapy, then you’re probably a good candidate for knee replacement, and the potential risks are likely worth the reward for you. But if your pain isn’t that bad yet, it might be a good idea to wait, and get a second opinion. There could be other reasons for your knee pain beyond arthritis. If those factors get addressed, you might find you don’t need surgery at all.

2.  Does your back hurt?

In a recent study by Rosedale, et. al (published in the Journal of Manual and Manipulative Therapy), it was found that over 40% of patients with isolated extremity pain, who did not believe their pain could be originating from their spine, responded to spinal intervention.  What does that mean in plain English? It means that you can have knee pain coming from your lower back and not even know it. Severe knee OA doesn’t come out of nowhere. It gradually progresses over time. But when you have knee pain that comes on for no reason, has good days and bad days, and especially if you have knee pain and back pain at the same time – you must get your spine evaluated before undergoing any type of intervention for your knee.

Luckily most surgeons consider knee replacement as a last resort. But if your spine is causing your knee pain and you miss it – you’ll end up down the path of failed knee treatment after failed knee treatment. Then suddenly it will seem as if you’re at your last resort, especially if you’re over 50 and have (normal) evidence of knee OA on your X-ray.  Always get your spine checked by a mechanical pain expert when your knee hurts. It will help you avoid years of mis-guided knee treatment, and could save you from an unnecessary knee replacement.

3. How stiff is your knee?

Typically, with severe or advanced OA of the knee, you’re going to have pretty restricted mobility. And any efforts to improve that mobility will be minimally effective and likely make your knee worse. But if your knee is not consistently stiff, only seems to get tight in certain situations, or perhaps it feels better after you stretch and mobilize it – you may want to think twice before getting it replaced. That’s because sometimes mobility restrictions in your knee can be caused by something other than arthritis – like a small tear in your tissue that gets “caught” in your joint. If you know how to move your knee joint in just the right way – you can actually remove this restriction. Not only will your knee move normally again, but your pain will go away too. This is really hard to figure out on your own. It even gets missed by a lot of medical professionals if they aren’t expertly trained in diagnosing mechanical pain. And it definitely doesn’t get picked up by an X-ray or MRI.

If your knee is not terribly stiff 100% of the time, and you’re tolerating most of your favorite activities – the best thing to do is get a second opinion from a trained mechanical pain expert. Because what you might be missing is highly specialized and specific mobility treatment for your knee. Once your knee mobility is fully and properly restored, you might find you no longer need a knee replacement, or at the very least can put it off another 10 years.

To be clear, I’m not saying you shouldn’t get a knee replacement.

I’m saying there’s a chance you don’t need one and it’s important to explore that. I’ve seen so many cases over the course of my career where people didn’t need a knee replacement – but got one because the X-ray or MRI “said so” – and then continued to suffer for years afterwards.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

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