Tag Archive for: shockwave

60 Is the New 40: Why Longevity Is the Health Trend You Can’t Ignore

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We’re living in a fascinating time.

People in their 60s and 70s aren’t settling for rocking chairs and a life confined to home anymore. They’re running marathons, hiking mountains, taking Pilates classes, and traveling the world. In fact, more and more people in their later decades are determined to feel like they did in their 40s and 50s – and thanks to advances in science and medicine – it’s becoming possible.

This desire to age differently is fueling a massive shift in how we think about health. According to the Global Wellness Institute, Americans now spend over $6,000 per person annually on wellness. This isn’t just personal choice – it reflects a booming market. The U.S. wellness industry has now surpassed $2 trillion in market size, accounting for nearly one-third of the global wellness economy.

Longevity has become the latest health trend.

But unlike quick fixes or fad diets, the focus isn’t on simply living longer – it’s about living better. The goal is to add life to your years, not just years to your life.

Why Longevity Matters

The reality is that most of the chronic conditions that plague us later in life – arthritis, diabetes, heart disease, dementia, osteoporosis – don’t appear overnight. They’re the result of decades of lifestyle habits, stress, and wear-and-tear that accumulate silently – until one day you’re suddenly facing a devastating diagnosis that could have been acted upon far sooner.

Doctors like Peter Attia, a physician and bestselling author known for his work on longevity and performance optimization, call this the difference between “Medicine 2.0” and “Medicine 3.0.” The old system waits until something goes wrong and then tries to fix it. The new approach – longevity medicine – looks at prevention, optimization, and slowing the aging process itself. It’s about maximizing your “healthspan,” the number of years you feel vibrant and capable, not just your lifespan.

Don’t Wait for Insurance to Catch Up

Here’s the catch: the very best treatments and practices that will help you feel 40 when you’re 70 aren’t covered by insurance. Insurance is designed for sick care, not health care. It will pay for a knee replacement once you can’t walk, but not for the cutting-edge therapies that could keep you from needing one in the first place.

If you want to truly thrive as you age, you must be prepared to invest in yourself.

That often means paying out of pocket for advanced testing services like Function Health or Dexascans – tools that provide powerful data so you can prevent disease and address problems before they become serious. I recently signed up for Function Health, which runs more than 100 markers and delivers insights far beyond traditional, insurance-based lab work. I was thrilled to learn that my biological age is six years younger than my actual age – and I walked away with clear recommendations to improve my diet and lifestyle. One of my Physical Therapy Specialists also invested in a Dexascan to get precise information about her bone health, muscle mass, and body composition – data she could never get from a standard doctor’s visit. She’s now using that information to guide her training, nutrition, and recovery choices, and already feels the benefits. She’ll repeat the scan in November to track progress and refine her plan.

But longevity isn’t just about data – it’s about what you do with it.

Strength training is one of the most powerful anti-aging tools we have. It preserves muscle mass and bone density, protects your joints, and helps prevent the falls and injuries that too often derail independence in later years. The problem? Pain and injuries are the number one reason people stop exercising – exactly when they need it most. That’s where “Medicine 3.0” level treatments come in: regenerative medicine to optimize the health of your joints and tissues, nutritional counseling to fine-tune your health from the inside out, and restorative practices like Yoga and Pilates to support full-body physical and mental resilience.

When you put these pieces together – advanced testing, proactive treatment, strength and mobility work, optimal nutrition, and recovery – you create a powerful longevity plan that allows you to do what most people think is impossible… Live like you’re 40 when you’re 60, 70, or beyond.

Just don’t wait for insurance to catch up – you’ll regret it. Plus – your future health is too important.

The Bottom Line

Too many people accept aging as a steady decline. But that narrative is shifting. Instead of asking: “How long can I live?” The better question is: “How long can I stay vibrant?”

That means reframing aging not as something to fear, but as something you can actively shape. Yes, it requires an investment. But what’s the real cost of not investing? Joint replacements, long-term medications, lost independence, and years of pain and limitation. Compared to that, the price of advanced testing, strength training, regenerative therapies, and restorative practices starts to look like a bargain – especially when these are the very things that keep you moving, traveling, and enjoying life. I believe in this so strongly that I’ve made it a priority in my own practice. I intentionally invest in treatments and services designed to help our clients feel like they’re 40 at any age – even when that means going against the grain of traditionally covered, insurance-based “sick care.”

Sixty truly can be the new forty – but only if you’re proactive. Longevity doesn’t happen by chance. It’s built on intentional choices, consistent habits, and a willingness to pursue therapies and treatments that insurance may not cover, but that will pay dividends in freedom, resilience, and quality of life.

So if you’re in your 60s or 70s and want to keep hiking, traveling, playing with your grandkids, and living life on your terms, don’t leave your health to chance – or to the insurance system. Longevity is within your reach. The only question to ask is: Are you ready to take the reins and make it happen?


 

 

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.

plantar fasciitis

Foot and Heel Pain: How to Move Beyond Short-Term Relief

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If you’ve ever stepped out of bed and felt a stabbing pain in your heel, there’s a good chance you were experiencing plantar fasciitis – one of the most common causes of heel pain in adults.

More than two million Americans struggle with it each year. Cortisone shots, orthotics, and rest are often prescribed, but these strategies usually provide only temporary relief – and in some cases, can even prolong the problem.

Recovering from plantar fasciitis starts with understanding why it happens in the first place. Once you know the root cause, the path forward becomes clearer – and today there are modern, natural options that focus on healing rather than simply masking pain. That’s the aim of this article. 

So let’s dive in: how do you move past short-term relief and get back to doing the activities you love, without heel pain holding you back?

What is Plantar Fasciitis?

The plantar fascia is a thick band of tissue running along the bottom of your foot, connecting your heel bone to your toes. Its job is to support your arch and absorb shock when you walk, run, or jump. When this tissue is overloaded, it can become irritated – and if that continues, the fascia begins to degenerate. The result is plantar fasciitis, marked by pain at the base of the heel, especially during the first few steps in the morning or after long periods of sitting.

Many assume plantar fasciitis is an inflammatory condition, but that isn’t the full picture. It’s more accurately a degenerative process, where the collagen fibers of the fascia weaken and lose their ability to tolerate load. This helps explain why treatments aimed only at reducing inflammation, such as cortisone shots, rarely provide lasting relief.

Why Traditional Treatments Fall Short

Cortisone injections have long been a standard treatment for heel pain. While they may reduce pain briefly, research shows the benefit is temporary – often only a few weeks or months. Repeated injections also carry risks. Cortisone does not repair the damaged fascia – in fact – it can weaken collagen and allow the problem to persist. Worse, by masking pain, injections often encourage continued activity that aggravates degeneration.

Custom orthotics are another common approach. These shoe inserts, often prescribed by podiatrists, can redistribute pressure and provide comfort in the short term. But research shows little difference between costly custom orthotics and high-quality prefabricated ones. More importantly, they do not address the underlying weakness or tissue degeneration. Once the initial benefit wears off, the pain often returns – and relying on orthotics indefinitely is impractical and prevents restoration of natural foot strength.

Both cortisone and orthotics may play a role in daily function. But if the goal is to truly heal the fascia and return to full activity, more is needed.

Stimulating Healing – Don’t Mask It

Instead of suppressing symptoms, you want to encourage true healing and pair it with corrective strengthening to keep the tissue healthy. Modern treatments such as shockwave therapy, EMTT, and PRP aim to jump-start your body’s own repair mechanisms instead of impeding them.

A good place to start is extracorporeal shockwave therapy, or ESWT. This non-invasive treatment sends acoustic waves into the fascia to create controlled “microtrauma,” which stimulates collagen regeneration and promotes tissue recovery.

An important complement is Extracorporeal Magnetotransduction Therapy, or EMTT. A 2022 multicenter study in the Journal of Clinical Medicine found that 80 percent of patients with chronic musculoskeletal conditions improved after EMTT, with more than 75 percent maintaining benefits six to twelve months later. In practice, EMTT appears to extend and amplify the positive effects of shockwave therapy by sustaining cellular activity long after treatment sessions.

For those needing an additional boost, platelet-rich plasma (PRP) injections are another option. Though invasive, PRP delivers concentrated growth factors directly into damaged tissue, enhancing the body’s natural healing. A 2023 randomized trial in BMC Musculoskeletal Disorders reported that PRP outperformed corticosteroid injections at reducing pain, improving function, and thinning the plantar fascia at six months. Case reports in the German Journal of Sports Medicine also show excellent outcomes when ESWT and PRP are combined, including full return to sport in runners who had failed other treatments.

Taken together, these therapies form a layered strategy: shockwave jump-starts the healing cascade, EMTT helps sustain it, and PRP provides an extra regenerative boost (if needed). When combined with a structured rehabilitation program, this approach offers a pathway to lasting recovery rather than temporary relief.

Beyond the Foot: Make the Healing Last

What many don’t realize is that chronic plantar fasciitis can also be linked to dysfunction higher up the chain. The pelvic floor, deep core muscles, and hip stabilizers all influence how forces travel through the legs and feet. If these areas are weak or poorly coordinated, the plantar fascia often absorbs stress it wasn’t designed to handle.

Clinical experience shows that individuals with weak core and pelvic floor control often develop altered gait mechanics, leading to excessive strain on the heel with each step. In these cases, treating only the fascia leaves the root cause unaddressed.

A comprehensive plan should therefore include strengthening of the core and pelvic floor, along with intrinsic foot training, alongside regenerative therapy. When these muscles are retrained to provide stability and load-sharing, the fascia is no longer forced to work alone. Over time, this reduces reinjury risk and creates a long-term fix. In essence, regenerative therapy jump-starts tissue healing, while strengthening ensures the fascia remains supported once it recovers.

The Bottom Line

Foot and heel pain can be stubborn, and plantar fasciitis in particular has a reputation for lingering. Cortisone shots and orthotics may provide temporary relief, but they do not restore the health of the fascia or solve the underlying problem. Regenerative therapies, especially shockwave, are supported by strong evidence for reducing pain and improving function in people with chronic plantar fasciitis. When combined with mobility, strength training, and – critically – core and pelvic floor retraining, they provide a durable solution that not only relieves pain but helps prevent it from coming back.

If your heel pain has been persisting for months, it’s worth considering a plan that goes beyond masking symptoms. Lasting relief comes when you treat both the tissue that hurts and the movement system that created the overload in the first place.

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.

Plantar Fasciitis

How to Survive Flip-Flop Season Without Wrecking Your Feet

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Flip-flop season is here – which means sunshine, beach days, and pool time. But it can also mean extra foot pain. And every summer around this time, we see an influx of people dealing with aching arches and stabbing heel pain – most commonly known as “plantar fasciitis”

What is Plantar Fasciitis?

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

How Do Flip-Flops Contribute?

Footwear can either “protect” your arch or cause it to overwork. Technically, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. However, due to prolonged sitting and limited barefoot walking, the bottoms of our feet are not as conditioned as they should be. This is the real problem – not so much what you put on your feet. If you’re used to wearing supportive and cushioned shoes and then suddenly switch to flatter, less supportive flip-flops, it can shock your foot. And if you’re already prone to plantar fasciitis, it will flare up easily and quickly.

What Can You Do?

The good news is you don’t have to give up your favorite summer footwear entirely – you just need to be smart about how you wear them and how you care for your feet. Here are five simple tips and strategies to help you get through flip-flop season without completely wrecking your feet.

1. Choose Supportive Styles

Not all flip-flops are created equal. Those flat, flimsy styles you can pick up at the drugstore for five bucks? Probably not doing your feet any favors. They offer little to no support, and if your foot mechanics aren’t perfect, you’re asking a lot of your plantar fascia every time you take a step. A better choice is a flip-flop that gives you a bit of arch support and structure. Look for ones with a cushioned sole, some contouring through the arch, and even a slight heel cup to help stabilize your foot and keep it from sliding around. The right pair makes a big difference – a key factor for enjoying flip-flops pain-free.

2. Save Them for Short Distances

Even the most supportive flip-flop has its limits. They’re not designed for long walks, hours of standing, or sightseeing on vacation. Think of them like you would a slipper – something you wear for convenience or comfort in short bursts, not as your all-day shoe. If you’re going out for a full day of walking, or standing at an outdoor event, it’s better to switch to something more structured that supports your foot and ankle. Use your flip-flops strategically – around the house, to and from the pool, or for short errands. Giving your feet the right support when it matters most can go a long way in keeping them pain-free.

3. Strengthen Your Feet (and Your Core)

One of the best ways to prevent plantar fasciitis – or keep it from coming back – is to strengthen the muscles that support your arch and stabilize your entire lower body. Most people don’t think about exercising their feet, but they absolutely should. Working on things like toe strength, arch activation, ankle mobility, and balance helps condition your feet so they can handle different surfaces and demands. But don’t stop at your feet – your core matters too. The way your pelvis and deep abdominal muscles function has a direct impact on how forces move through your body when you walk. A weak or poorly functioning core can lead to poor movement patterns that put extra stress on your feet. Strengthening both your feet and your core can transform the way you move – and reduce the load on your plantar fascia dramatically.

4. Stretch and Massage Regularly

One of the most underrated things you can do to prevent or treat plantar fasciitis is to stretch and massage your feet on a regular basis. Tight calves, stiff ankles, and tension through the soles of your feet can all contribute to pain and inflammation. A few minutes of daily stretching – focusing on your calves and toes – combined with massage using your hands, a lacrosse ball, or a mobility tool, can make a huge difference. This kind of soft tissue work helps relieve tension, improves circulation, and keeps your plantar fascia mobile and healthy. 

5. Don’t Ignore Persistent Pain – Treat It Early

If you’re already feeling pain in your heel or arch that just won’t go away, don’t wait around hoping it gets better on its own. Plantar fasciitis becomes harder to treat the longer it sticks around, and it can quickly go from annoying to chronic. When that happens, exercise and stretching might not be enough to get you out of pain – and that’s where regenerative therapy comes in. Shockwave therapy (EPAT) is a non-invasive treatment that uses high-energy sound waves to stimulate blood flow and break up tight, inflamed tissue. It helps jumpstart healing in a way that rest and stretching can’t. EMTT (Extracorporeal Magnetotransduction Therapy) takes this even further. It uses pulsed magnetic fields to penetrate deeper into tissues and promote healing at the cellular level. Together, shockwave and EMTT are incredibly effective at reducing pain, accelerating recovery, and allowing you to tolerate the exercises and movement you need to fully resolve your plantar fascitis.

Bottom Line

Flip-flops don’t have to be the enemy. But if you’re not taking care of your feet, wearing them can easily lead to pain and frustration. By choosing the right styles, wearing them in moderation, and taking the time to strengthen and care for your feet – you can enjoy them all summer long without paying the price. And if foot pain does creep in, don’t ignore it. Get the right help early. Treatments like shockwave and EMTT, combined with expert-guided movement and strengthening, could be exactly what you need to survive flip-flop season pain-free – and keep your feet happy long after summer ends.

Knee Pain Causes

PRP for Knee Pain? What You Need to Know Before You Try

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If you’ve been dealing with knee pain that just won’t go away – chances are you’ve come across Platelet-Rich Plasma injections – also known as “PRP.”

Although PRP has been around for decades, it gained popularity in the early 2000s when high-profile athletes began using it to accelerate healing. More recently, it’s become more well-known thanks to the “longevity craze” – where people are actively searching for natural solutions and cutting-edge technologies to improve healing and avoid procedures, surgery, or medication.

Like other regenerative therapies, I appreciate PRP because it works with your body’s own healing abilities. It offers a healthier alternative to cortisone injections and medications, which can damage joints and organs over time. In some cases, PRP has even helped people avoid major surgery – an option that carries its own risks. PRP treatment involves taking a small blood sample, spinning it in a centrifuge to isolate the platelets, and injecting the concentrated solution into the knee joint. Platelets are rich in growth factors that support tissue repair – which is why proponents believe PRP can accelerate healing.

But despite its benefits, the real question is: “Is PRP the best first course of action for my knee pain?” It’s expensive, it’s invasive, and results can take months to appear. Let’s take a closer look at the pros and cons so you can make the best decision for yourself.

PRP outcomes aren’t always predictable.

Some people experience relief and improved function, while others feel little to no difference. A 2023 meta-analysis published in Annals of Medicine and Surgery found that PRP outperformed both corticosteroid and hyaluronic acid injections at the six-month mark. But that relief was not immediate. PRP is a waiting game. Results can take several months, and in some cases, may never fully arrive. This delayed response and unpredictability often pushes people toward cortisone shots for their fast – though temporary – relief. Ultimately, PRP success varies widely depending on your condition, the protocol used, and the provider’s skill.

Another factor to consider with PRP is cost.

Most regenerative therapies aren’t covered by insurance. One PRP injection can range from $500 to $2,000, and many protocols recommend two or three injections. Add in the long waiting period for results, and it may be wise to explore other options first. One of the biggest complaints I hear from patients is that they jumped to PRP too fast, spent the money, and either stayed in pain or the pain came back a few years later.

The good news is that the growing interest in longevity has brought other effective technologies to market. When people ask me about PRP – I often say it’s a great treatment – but if you haven’t yet explored some of the precursors to PRP – it might be worthwhile. Regenerative therapies like shockwave (high-pressure soundwaves) and EMTT (extracorporeal magnetotransduction therapy, using high-frequency magnetic energy) stimulate blood flow, activate tissue repair, and reduce inflammation. Like PRP, these treatments are natural and enhance your body’s ability to heal. But unlike PRP, they’re non-invasive, require no downtime, and often deliver results more quickly. I typically recommend trying these options first. For many people, they’re enough to get healing and moving again – fast – so you’ll know whether you even need PRP.

While relatively new to the market, both shockwave and EMTT have shown promising results – especially when compared to more invasive options like PRP.

A 2024 meta-analysis published in Scientific Reports found that shockwave therapy significantly reduced pain and improved function in patients with mild-to-moderate knee osteoarthritis. And unlike PRP – which can take months to show results – shockwave and EMTT often begin working within just a few sessions, sometimes as quickly as two to four weeks. Studies comparing shockwave to cortisone have also found that while cortisone may provide faster short-term relief, shockwave offers better long-term outcomes – typically within one to three months – but without the harmful side effects. Even more encouraging is emerging evidence that combining shockwave with EMTT yields even better outcomes than using shockwave alone.

Though research on knee pain is still developing, early studies and clinical experience suggest the two therapies work synergistically to accelerate healing, reduce pain and inflammation more effectively, and help people return to activity faster. For many, this combination offers a more efficient, less invasive alternative to PRP – in both outcome and timeline.

Cost is another important consideration. While shockwave and EMTT aren’t necessarily “cheap,” they’re generally more affordable and lower-risk than PRP. A full course of treatment typically costs around $2,000, and most people notice improvement within a few weeks. Compare that to PRP – where the total cost may be similar or higher – but you’re waiting months just to know if it worked. This is why shockwave and EMTT are often a smarter first step. You get faster feedback and, in many cases, relief without needles or downtime.

But what if you’ve already had PRP and didn’t get the results you hoped for?

A 2023 study published in Cureus compared PRP alone to PRP combined with shockwave in patients with chronic patellar tendinopathy. The group that received both had significantly better outcomes, especially in the first month. This suggests that even if PRP is part of your treatment plan, combining it with shockwave – and potentially EMTT – can improve your outcome and shorten recovery time.

Of course, no treatment works for everyone. The right solution depends on your condition, goals, and how much time and money you’re willing to invest. But when weighing your options, it often makes sense to start with less invasive, more affordable treatments. Shockwave and EMTT cost less than PRP, involve no injections, and carry far fewer risks. They also pair well with movement-based therapy or rehab – helping address not just your knee pain – but also its root cause (typically underlying mechanical joint dysfunction).

In the end, PRP injections may be helpful for some – especially those with mild joint degeneration who have exhausted other options. But they shouldn’t be the first thing you try. Evidence shows that non-invasive regenerative therapies like shockwave and EMTT are not only safe and effective, but may work faster and at a lower cost. And unlike PRP, they can be part of a broader plan that restores whole-body movement and function – so your knees stay strong and pain-free long after treatment ends.

If you’re considering PRP for knee pain, make sure you understand the full picture – what it costs, how long it takes, what the science says, and whether less invasive options could help you feel better sooner. Because when it comes to staying active and mobile as you age, getting the right diagnosis – and choosing the right first step – makes all the difference.

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.

Plantar Fasciitis

Enjoy Flip-Flop Season: Strategies to Prevent and Treat Foot Pain

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Flip-flop season is officially here – but unfortunately – that also means we are about to see an influx of foot pain – otherwise known as “plantar fasciitis”.

Here’s a question someone asked me just the other day… “I’ve been wearing my flip-flops for the past week and notice that the pain in my arch and heel has acted up. Is there anything I can do? Or do I need to just not wear flip-flops anymore?”
While wearing more supportive shoes would certainly help, staying on top of your plantar fasciitis and/or preventing it altogether means flip-flops don’t have to be an issue, and you can continue enjoying them all season long.

First – What is Plantar Fasciitis?

Quite simply, it’s inflammation of your plantar fascia—the tissue that makes up the arch (bottom) of your foot. Your plantar fascia runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot, enabling you to propel yourself during walking and running. When you land on your foot, your arch falls or flattens—this is called pronation. In response, your foot then stiffens or supinates, providing the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked, leading to what we call “plantar fasciitis”.

How Do Flip-Flops Contribute?

Footwear can either “protect” your arch or cause it to overwork. Technically, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. However, due to prolonged sitting and limited barefoot walking, the bottoms of our feet are not as conditioned as they should be. This is the real problem—not so much what you put on your feet. If you’re used to wearing supportive and cushioned shoes and then suddenly switch to flatter, less supportive flip-flops, it can shock your foot. And if you’re already prone to plantar fasciitis, it will flare up easily and quickly.

What Can You Do?

The best way to prevent and treat plantar fasciitis is to not neglect your feet. Consistent mobility exercises for your toes and ankles are key, as is conditioning for the strength and stability of your arch. Balance exercises, toe exercises, and plyometric (jumping) exercises are all important. Additionally, make it a point to walk around without shoes as often as possible. Incorporating pelvic floor and core training exercises is also beneficial because the function of your deep core has an impact on your foot mechanics.

When Your Pain is Too Severe

If your plantar fasciitis is too painful, jumping into exercises may not help and could even aggravate it more. One effective treatment modality for particularly painful cases is something called Shockwave Therapy (Extracorporeal Pulse Activation Technology or EPAT). During a shockwave treatment, high-pressure sound waves are delivered directly to the affected tissue, bringing blood flow and accelerated healing to the injured and inflamed area (in this case, your plantar fascia and surrounding muscles). The treatment is non-invasive and penetrates deeply. Pain reduction can be seen in as little as one shockwave session, but research shows it to be most effective after a minimum of six. Shockwave therapy can significantly reduce pain and swelling from plantar fasciitis in the short term, allowing you to tolerate the exercises required to keep your plantar fasciitis at bay in the long term.

When addressed correctly, plantar fasciitis doesn’t have to be chronic, and it doesn’t have to dictate your footwear selection. If you’ve tried various treatments already for your plantar fasciitis without success, consider working with an expert who can accurately identify where your plantar fasciitis is coming from. They can also help you decide if incorporating something like shockwave therapy – in addition to the necessary exercises – is what’s needed to finally resolve your plantar fasciitis and get back to enjoying your flip-flops again.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or inquire further about Shockwave Therapy – CLICK HERE.

plantar fasciitis

Best Treatments for Persistent Plantar Fasciitis – According to Science

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Ever had nagging foot and heel pain that’s so bad it feels like you’re walking around on glass? Yep – that’s called plantar fasciitis – and it impacts over 2 million individuals in the United States every year. 

Plantar fasciitis occurs when you have inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot.

Your plantar fascia is responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you suffer from plantar fasciitis – it’s not only annoying and painful – but can be quite debilitating. It keeps runners from running, walkers from walking, and eventually will cause problems up the kinetic chain (think knees and hips) when left untreated. Typical treatments for plantar fasciitis include everything from rest, ice, cortisone shots, orthotics, braces, exercise, and stretching. 

But which treatments are best? 

Depending on who you ask – you’ll get a lot of different answers – so let’s see what the science and research says. 

Cortisone Shots:

While there is plenty of evidence to support the use of cortisone shots for reducing pain and inflammation – it’s important to consider the consequences of how cortisone works. When you’ve got damaged, painful tissue from overuse or overstretching – such as what can occur with plantar fasciitis. The cells in your tissue respond by releasing certain factors designed to recruit blood vessels, stem cells, and healing factors. The inrush of these fluids causes temporary swelling and pain, but it also stimulates the laying down of new collagen. Collagen, a naturally occurring protein in your body that helps tissue to heal and become strong again. Cortisone works by shutting down this cellular process. Which is great because it stops the swelling and pain from occurring. But by doing so – it inhibits your body’s natural healing process.

This can result in weakened tissue that stays in a weakened state. Leaving you susceptible to repeated and sometimes permanent damage over time, especially if you keep getting cortisone shots. So while cortisone injections may appear to be the miracle quick-fix you’re looking for – it’s crucial you consider the long-term consequences that inhibited tissue healing could cause.

Regenerative Shockwave Therapy:

Unlike cortisone shots, this therapy aids in the tissue-healing process instead of inhibiting it. And there is good research and evidence to support its use with plantar fasciitis specifically. While it’s been successfully used in Europe for decades, it didn’t surface in the United States until around the year 2000. Shockwave Therapy uses acoustic sound waves to stimulate the same natural healing process described above. This can be especially useful in tissue that has already experienced damage. What I like about Shockwave Therapy – is that it’s completely non-invasive – compared to something like platelet-rich plasma (PRP) injections (another popular treatment for plantar fasciitis). With injections, there is always a risk of infection. You don’t have to worry about that with Shockwave Therapy. That, combined with promising evidence for significant pain reduction in as few as six sessions, makes this a wise treatment choice for plantar fasciitis.

Stretching and Strengthening Exercises:

For most musculoskeletal injuries (plantar fasciitis included) the research overwhelmingly supports the use of stretching and strengthening as an effective and long-lasting means of treatment. So why does this approach fail so often? And make us quick to resort to injections, surgery and other types of medical procedures to resolve musculoskeletal-related pain? The biggest problem I see is not with the stretches and exercises themselves, but with exercise prescription. That’s why you can’t just go to Google or YouTube and look for “the best exercises for plantar fasciitis”. Finding great and appropriate exercises isn’t the issue.

The problem is that you won’t know when and how to perform them – and you risk making your plantar fasciitis worse or resorting too quickly to a more invasive treatment option because you think the exercises just didn’t work. With plantar fasciitis specifically, the type of stretching and exercise you choose has to match the stage of tissue healing. You have to load the tissue just enough to cause the appropriate amount of tissue damage that will elicit remodeling of tissue fibers – but not so much that you elicit an inflammatory cycle, which will disrupt the remodeling process. The only way plantar fasciitis truly heals is through remodeling the damaged tissue. And this requires a perfectly prescribed stretching and exercise protocol – which can take up to 7-9 months to work.

So be cautious of the quick fixes, work with an expert, and be patient in this process – because stretching and strengthening really do work when done correctly for Plantar Fasciitis.

In the battle against plantar fasciitis, a prescribed combination of stretching and strengthening exercises, along with non-invasive passive modalities that work to enhance your body’s natural healing process tend to be the most effective. Stay away from ice, rest, and other invasive procedures that disrupt healing or interfere with tissue remodeling.  If your plantar fasciitis is chronic, understand that there’s still hope, but it may take some time. My advice is to talk with an expert who is up to date on the latest research, and who has a good understanding of tissue healing and remodeling.

Because ultimately – the best treatment for plantar fasciitis must involve a combination of these two things. 

Local to Portsmouth, NH? Discover how regenerative shockwave therapy can help! CLICK HERE to learn more and start your journey of pain relief.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or to inquire further about Shockwave Treatment, CLICK HERE to talk to one of our specialists or call 603-605-0402

Shockwave Therapy

What is Regenerative Shockwave Therapy and Should You Consider it?

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What is Regenerative Shockwave Therapy and Should You Consider it?

If you’ve been reading my articles for awhile – you’ll know that I’m generally not a huge fan of passive modalities – especially when used in isolation. However, every now and then one comes along that grabs my attention. A few months ago – Shockwave Therapy treatment did just that – so I started doing my research…

Shockwave Therapy is a revolutionary, non-invasive treatment protocol that utilizes high-energy acoustic (sound) waves to treat chronic musculoskeletal pain conditions, as well as soft tissue/sports-related injuries. To give you an idea of how powerful it is – it was initially used by urologists to treat and break up kidney stones. Over the last few years, the orthopedics and sports medicine practitioners have started to apply the technology in their respective fields, and are happy with the results.

So what is Regenerative Shockwave Therapy and how does it work?

Shockwave therapy – otherwise known by its technical name of Extracorporeal Shock Wave Therapy (ESWT) – utilizes high-energy “shock waves”. These Sound-waves promote and accelerate the body’s own natural healing process. When the shockwave treatment is applied, there is a transference of energy from the shockwaves into the targeted tissue area. This triggers a biological response that helps to aid and accelerate the healing process. The biological responses include stimulation of cell regeneration, improved blood flow, and formulation of new blood vessels (neovascularization). All are designed to speed up soft tissue healing and provide relief from pain. Some folks feel pain relief right away, for others it takes a few sessions. 

Research is still being done to evaluate the full effectiveness of shockwave therapy – but so far we are seeing really good results for persistent, chronic conditions such as plantar fasciitis, tennis elbow, patellar tendonitis (runner’s knee), and shoulder tendonitis. Anytime you have a chronic condition involving tendonitis, the treatment protocol required to get true healing and rehabilitation is highly specific and generally takes 7-9 months. You also want to avoid things like ice and anti-inflammatories because it impedes the healing process. This can be hard for a lot of folks since chronic tendonitis tends to be painful. This is one of the reasons I love Shockwave Therapy. It not only enhances the healing process of tendons and other soft tissue – but it helps to relieve pain at the same time.

Ok – now that you know a little bit more about Regenerative Shockwave Therapy. Is this a treatment you should consider for yourself?

Have you been suffering from a chronic or persistent soft tissue injury or tendonitis? Are the treatments you’re currently trying not quite getting you back to 100% as fast as you’d like? Then this might be something valuable to add into the mix. It could very well be the missing link needed to give your soft tissue healing the boost required to get you over the hump you’re currently at.

Another great reason to consider trying Shockwave Therapy is that it’s very safe and completely non-invasive. It doesn’t require any kind of incision, use of  anesthesia, or needle punctures such as with steroid injections. This significantly reduces the risk of any type of infection or complication after your treatment. Plus, the treatments are short. They only last about 15-20 min to get significant pain relief and powerful tissue healing.

The last thing I’ll say about Shockwave Therapy is that although it’s very safe and designed to reduce pain, there can be some short-term pain and discomfort associated with this treatment. As well as temporary skin redness and minor swelling. For those with extremely low pain tolerance, this treatment can take some getting used to. Shockwave Therapy is also very noisy. The treatment is administered through a handheld device that pulses and makes a noise throughout the duration of your session. That – combined with potential temporary pain/discomfort – causes some to shy away from giving Shockwave Therapy treatment a try. But luckily the treatments are short, so it makes these minor adverse side effects more tolerable.

So, if you haven’t yet heard of Regenerative Shockwave Therapy, hopefully this helps you have a better understanding of what it is.

And most importantly, decide for yourself if it’s something worth considering. Especially if you’ve been suffering with a persistent soft tissue or tendon injury for quite some time. While it’s not a miracle cure by any means, I have seen fantastic results since beginning to incorporate this technology into my own practice. I like it because there’s a lot of scientific evidence to support its efficacy. Plus it’s a safe, non-invasive alternative to so many other pain-relief techniques that is designed to leverage the body’s own natural healing response.

Are you a local to Portsmouth,NH? CLICK HERE to learn more about the benefits of Regenerative Shockwave Therapy and how it can support your overall well-being.

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 learn more about Shockwave Therapy, CLICK HERE to talk to one of our specialist or call 603-605-0402.

Plantar Fasciitis

Don’t let Plantar Fasciitis Ruin Flip Flop Season

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Good weather is on its way and if you haven’t already broken out your flip flops – it’s only a matter of time before you do. The only unfortunate thing about flip flop season is the coinciding rise in plantar fasciitis that typically comes with it.

Someone I was speaking with the other day recently asked:

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

This is a great question.

While yes, wearing more supportive shoes would certainly help. Ideally, if you can stay on top of your plantar fasciitis and/or prevent it all together, flip flops don’t have to be an issue at all and you can continue enjoying them all season long.

First – what is plantar fasciitis?

Quite simply, it’s inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot. Your plantar fascia runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you land on your foot your arch falls or flattens – this is called pronation.

The response to this action is that your foot then stiffens or supinates. This is where your foot gets the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked. This leads to inflammation/plantar fasciitis.

What causes your plantar fascia to become inflamed?

Basically, it can be anything that impacts or disrupts the natural mechanics of your foot to pronate and supinate. Most commonly, poor mobility in either your ankle or 1st toe is the culprit. Even tight hips and weak glutes can cause problems all the way down to your foot. Anything that impacts the way your foot hits the ground has an opportunity to influence the level of force and energy transmitted through your plantar fascia when you walk.

When the natural pronation/supination mechanism is disrupted, your plantar fascia will attempt to compensate. If this goes on uncorrected, your plantar fascia eventually becomes angry and irritated – resulting in a very painful case of plantar fasciitis.

So what do flip flops have to do with this?

Footwear can either “protect” your arch, or cause it to overwork. If your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. But because of how much we sit, and how little we walk around barefoot, the bottoms of our feet are simply not as conditioned as they should be.

This is really the problem – not so much what you put on your feet. If you’re accustomed to wearing supportive and cushioned shoes all the time, and then suddenly switch to flatter, less supportive flip flops, it’s going to be a shock to your foot. And if you’re prone to plantar fasciitis already, it will flare up easily and quickly.

What can you do?

The best thing you can do to prevent and treat plantar fasciitis is to not neglect your feet. Performing consistent mobility exercises for your toes and ankles is key, as well as conditioning for the strength and stability of your arch.

Balance exercises, toe exercises, and plyometric (jumping) exercises are all important. Also, making it a point to walk around without shoes as often as you can. Along with all of this, it’s a good idea to incorporate pelvic floor and core training exercises. The function of your pelvis can have a significant impact on your foot mechanics.

But what if your plantar fasciitis is too painful?

If this is the case, jumping into exercises may not help, and could even aggravate your plantar fasciitis.

But one treatment modality that is known to be effective for particularly painful cases is something called Shockwave Therapy (Extracorporeal Pulse Activation Technology or EPAT).

During a shockwave treatment, high pressure sound waves are delivered directly to the affected tissue to bring blood flow and accelerated healing to the injured and inflamed area (in this case your plantar fascia and surrounding muscles).

The treatment is non-invasive and gets very deep. Pain reduction can be seen in as little as one shockwave session, but the research shows the most effectiveness after six.

Shockwave therapy can help to significantly reduce your pain – and even swelling – from plantar fasciitis in the short-term. It will allow you to tolerate the exercises required to keep your plantar fasciitis gone for the long-term.

When addressed correctly, plantar fasciitis doesn’t have to be chronic and it doesn’t have to dictate your footwear selection.

Are you local to Portsmouth, NH?

CLICK HERE to learn more about our Shockwave Therapy treatment – one of my specialists will reach out to you and see if you would be a good fit.

If you’ve already tried a lot of different treatments for your plantar fasciitis and they haven’t helped – consider working with an expert. They can incorporate something like shockwave therapy. This combined with the exercises you need will make a difference and get you back to enjoying your flip flops again.

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].

Tendonisis

Tendonitis vs. Tendinosis – The BIG difference and why it matters

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If you’ve ever suffered from tendonitis or tendinosis – then you know that it can last anywhere from a few weeks to several months!

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon. Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably, they couldn’t be more different. When tendonitis isn’t caught early enough or treated properly it can turn into tendinosis. The treatment for acute tendonitis is very different from chronic tendinosis.

Let me explain…

Tendonitis is an acute condition. The best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

When you don’t manage tendonitis properly, and it goes on longer than a few months, it can result in tendinosis. Tendinosis is a very different condition where the fibers in your tendon actually start to break down. The first thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you. I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again.

Passive treatments like ice, rest, and medicine will not help tendinosis. They might help to relieve any pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area. In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis. Making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right? Well technically it is, but the biggest problem is that this process takes time – up to 9 months in many cases. And most patients I come across simply don’t have the patience for this. Or they simply aren’t told about it.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time. You have to put just the right amount of stress to cause a little bit of pain. However, not so much stress that your tendon gets inflamed again. A properly trained physical therapist that is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time. The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry. So is half the medical community.

The take home points to remember are these:

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks. Treatment for this should involve passive modalities like ice and rest. The focus should be on what causes the tendon to get irritated innitially.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies. These will properly re-organize the tendon so that it can be strong again! This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

Luckily – we’ve introduced a brand new treatment modality in our office. It accelerates the healing of soft tissue and tendon injuries.

It’s called Shockwave Therapy and we are currently accepting new patients for this service. If you’re already a client – you will get this service at no charge. Just ask your specialist next time you’re in and see if you’d be a good fit for this treatment.

But if you’re not a current client – and are currently suffering from something like plantar fasciitis, tendonitis, or some other soft tissue strain or injury – you could be perfect for this treatment! Studies have shown about 70% reduction in symptoms in as little as 6 sessions.

While this won’t completely “fix” your tendon or soft tissue problem – it can have a significant reduction on your pain which will allow you to more easily do the work that WILL fix your problem.

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