Tag Archive for: shoulder pain

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.

Physical therapy specialist treating frozen shoulder with non-invasive therapy in Portsmouth NH

Beyond Cortisone: Healthier Options for Lasting Shoulder Pain Relief

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Shoulder pain can be one of the most frustrating problems to deal with.

At first, it’s just an annoyance. But when it starts interfering with your sleep or preventing you from doing the things you love, you can’t help but wonder if it’s time to do something more invasive – like getting a cortisone shot.

Cortisone injections can seem appealing – they’re quick, easy, and often provide relief. Anytime I see a post on Facebook asking, “What should I do about my nagging shoulder pain?” cortisone shots almost always come up as the go-to answer. But just because they’re common doesn’t mean they’re the best solution. In fact, relying on them too often could actually make your shoulder worse.

Why Cortisone Falls Short

Cortisone shots are meant to reduce inflammation – and if inflammation is truly what’s driving your shoulder pain, they can help. The problem is that in most cases, inflammation is only a symptom. The real culprit is usually mechanical: poor movement patterns, overuse, or imbalances that leave the structures in your shoulder irritated and overworked. In those situations, cortisone might give you short-term relief, but the pain will always come back until the root mechanical problem is fixed. Even worse, repeated cortisone shots can actually weaken your tendons and damage your cartilage over time.

So what do you do if you’ve got persistent shoulder pain but don’t want to rely on cortisone?

Thankfully, there are healthier and more effective options available – in the family of regenerative medicine. These treatments don’t just cover up inflammation, they actually stimulate your body’s ability to heal it – which works whether your primary problem is mechanical (secondary inflammation) or chemical (primary inflammation).

Let’s say you truly do have primary inflammation. Instead of turning to cortisone to simply wipe it out, more advanced and cutting-edge clinics are now using something called EMTT – short for extracorporeal magnetotransduction therapy. EMTT delivers high-frequency magnetic energy that penetrates deep into your joints and cells, essentially helping to “reset” them. This improved cellular activity enhances fluid exchange, allowing your body to naturally flush out the excess inflammation. What makes EMTT especially exciting is that it doesn’t just calm inflammation – it also stimulates tissue repair and regeneration. In other words, you’re not only getting relief from pain and swelling, you’re supporting long-term healing of the underlying problem.

And then there’s shockwave therapy – one of the most popular and well-studied regenerative treatments for musculoskeletal problems, including shoulder pain.

Shockwave uses sound waves to stimulate blood flow, encourage cellular repair, and break down stubborn scar tissue. It’s particularly effective for chronic tendon problems and rotator cuff injuries that just won’t heal on their own. What’s even better is when you combine shockwave therapy with EMTT. The two therapies complement each other beautifully – shockwave targets the injured tissue directly, while EMTT boosts cellular repair and helps the benefits of shockwave last longer. This combination can be especially powerful when arthritis is involved or when multiple structures in the shoulder are inflamed and irritated.

In addition to these technologies, there are also injectable regenerative therapies that are gaining more attention. PRP – short for platelet-rich plasma – is made from your own blood and concentrated into a powerful solution rich in growth factors. It’s especially helpful when your body’s natural healing process has stalled, such as with partial tears or long-standing tendon problems. In the shoulder, that might look like a stubborn rotator cuff injury that just isn’t getting better or a tear you’re hoping to avoid surgery for. Stem cell injections take things a step further, though they aren’t as widely used. These provide undifferentiated cells that can actually transform into the specific type of tissue your shoulder needs most. Stem cell therapy is typically reserved for more advanced problems – like severe arthritis or injuries that haven’t responded to other treatments. What’s exciting is that both shockwave therapy and EMTT can be used alongside PRP or stem cell injections to enhance their effectiveness, giving your shoulder an even better chance at long-term healing.

A Smarter Path to Healing

The difference between cortisone and regenerative medicine really matters. Cortisone works by suppressing inflammation, but regenerative therapies go a step further – they stimulate your body to actually repair the injured tissue. Instead of simply masking pain, these treatments target the root cause and help restore real function. While regenerative therapies aren’t usually covered by insurance, many people consider the out-of-pocket investment worth it. That’s because they encourage true healing, which leads to long-term success, rather than the short-term relief you get from cortisone.

If you’ve been struggling with nagging shoulder pain, it’s worth doing your research and asking the right questions. Is your pain chemical-driven by runaway inflammation? If so, cortisone might help, but EMTT could be a healthier and more effective option. Or is your inflammation secondary and rooted in a mechanical cause? In that case, you’ll want treatment that doesn’t just mask pain but instead works with your body’s natural ability to heal – without compromising the integrity of your tissues, which ultimately need to be loaded and strengthened. Too often, people resort to cortisone shots without asking these questions first, and it leads them down a road of temporary fixes and long-term problems.

In the end, the right approach depends on identifying the true cause of your shoulder pain.

When you choose solutions that promote healing rather than simply cover up symptoms, you give yourself the best chance for lasting relief and healthier shoulders for years to come.

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.

Frozen Shoulder: Why the “Quick Fix” May Set You Back

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If you’ve ever suffered from a “frozen shoulder,” you know firsthand how debilitating it can be.

The shoulder pain and stiffness make it hard to reach into cabinets, fasten a seatbelt, or even sleep comfortably – and this condition can hijack your life for months, sometimes even years. The bigger problem is that the usual advice – to just “wait it out,” get a cortisone shot, or let a surgeon force the shoulder to move under anesthesia – can often do more harm than good. But there is a better way forward, and it involves working with your body instead of against it.

What exactly is frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, occurs when the capsule around your shoulder joint becomes inflamed and tightens. It affects more women than men, most often between the ages of 40 and 60. Metabolic health plays a major role as well. Conditions like diabetes, obesity, high blood sugar, and elevated lipids significantly increase the risk, likely because they contribute to inflammation and tissue changes in the shoulder capsule. As the capsule thickens and stiffens, motion becomes restricted and pain increases. Frozen shoulder usually progresses through three stages: the painful phase, the frozen (or stiff) phase, and finally, the thawing phase. The good news is that most cases resolve on their own. The bad news is that “on their own” can mean two to three years without the right care – and that’s a long time to put your life on hold.

Why “quick fixes” don’t work

One of the most common interventions people get pushed toward is manipulation under anesthesia. On paper, it sounds appealing: you go under anesthesia with a stiff shoulder and wake up with more motion. But the reality is more complicated. A large review reported that about 14 percent of people needed a second procedure, and the overall evidence base was weak, with most studies lacking proper control groups.

Complications, though not frequent, can be serious. Tears of the capsule, labrum injuries, rotator cuff damage, bone bruising, fractures, and even nerve injury have all been reported. For a problem that often improves with proper conservative management, exposing yourself to those risks doesn’t make sense. Manipulation might have a place for rare cases that fail everything else, but it should never be your first option.

Cortisone injections are another common recommendation. While these can provide short-term pain relief, they come with a big catch. Cortisone is not a healing agent – it simply suppresses inflammation. Multiple studies have shown that repeated cortisone injections can weaken tendons and joint tissue, which may actually slow long-term healing and set you back. Frozen shoulder already has a natural life cycle, and while cortisone can blunt pain temporarily, it does not change the overall course of the disease. Worse, relying on injections can delay the real solution: restoring mobility through movement and proper rehab.

Do you have the correct diagnosis?

Another important point often overlooked is that a doctor’s diagnosis of “frozen shoulder” may not always tell the whole story. Adhesive capsulitis is commonly misdiagnosed, because many shoulder problems can look and feel like frozen shoulder in the early stages. Stiffness and pain are not unique to adhesive capsulitis – rotator cuff injuries, labral issues, arthritis, and even postural or mechanical problems can mimic it.

A 2016 case study published in the International Journal of Sports Physical Therapy highlights this problem. A patient was referred with a diagnosis of adhesive capsulitis. But when evaluated using Mechanical Diagnosis and Therapy (a form of specialized mechanical therapy), the presentation was actually consistent with what’s known as a “shoulder derangement.” Instead of requiring the long and difficult course typically associated with frozen shoulder, the patient responded quickly to specific corrective movements – achieving full pain relief and restoration of motion within just a few visits. This underscores why it’s so important not to take a frozen shoulder diagnosis at face value. The right examination makes all the difference, and sometimes what looks like frozen shoulder is actually a mechanical problem that can be resolved much faster.

What should you do?

But let’s say you do, indeed, have frozen shoulder. While it’s true that in most cases you have to let it “thaw out” and get through the freezing stage, there are natural treatments that can speed this up. Non-invasive technologies like Extracorporeal Shock Wave Therapy (ESWT) and Extracorporeal Magnetotransduction Therapy (EMTT) give your body’s natural healing mechanisms a boost to aid in both pain relief and mobility.

Shockwave therapy uses acoustic waves to stimulate healing, increase blood flow, and help tissues remodel, while EMTT uses high-energy pulsed electromagnetic fields to influence cells at the microscopic level and calm inflammation. On their own, each has been shown in recent studies to reduce pain, restore motion, and improve function. But when used together, the results are even more powerful. Shockwave helps loosen the capsule and ease pain so movement becomes possible, while EMTT supports the healing process at the cellular level. This combination accelerates recovery, making it easier to progress with the stretching and strengthening that ultimately restore long-term shoulder health.

The real power of these therapies is how they fit into a bigger plan. Specific stretching techniques, corrective mobility drills, and later, strengthening exercises are still the foundation of recovery. But when you can reduce pain and inflammation more quickly with shockwave and EMTT, you unlock the ability to move sooner and with less fear. That means you don’t just get better – you get better faster.

Final thoughts

Frozen shoulder does not require surgery, force, or repeated cortisone injections. In fact, those approaches can cause setbacks or complications that make recovery even harder. A smarter path is to combine natural, non-invasive therapies like shockwave and EMTT with guided, progressive movement from a specialist. Research is showing us that these tools can help people reduce pain, improve range of motion, and shorten recovery time – all without exposing you to unnecessary risk.

If you’ve been told to “wait it out” or to sign up for an aggressive procedure, it may be time to get a second opinion. Frozen shoulder is tough, but it is not unbeatable. With the right plan, the right tools, and the right guidance, you can move past the pain and stiffness – and get your life back.

Sound like you?

Consider speaking to one of our specialists in Downtown Portsmouth, NH. Click here to request a free discovery visit.

golf injuries

How to Stay Injury-Free on the Golf Course This Season

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Golf is a favorite pastime for millions – and now that the season is in full swing here in New England – many players are eager to hit the course as often as possible. But when back, knee, elbow, or shoulder pain creeps in – those 18 holes can quickly lose their appeal – and even become depressing. Pain doesn’t just interfere with your swing. It can drain the joy right out of your game.

The good news? Many of the injuries that golfers suffer from are preventable. With a bit of foresight, the right kind of movement, and smart preparation – you can keep your body strong and your game on point all season long.

Here are five of the most common injuries I see golfers facing – and what you can do to avoid or recover from them quickly:

1. Back Pain

This is by far the most frequent complaint among golfers. The constant bending, twisting, and rotational force of a golf swing can wreak havoc on your spine – especially if your back is stiff or you spend a lot of time sitting during the week.

The best way to keep your back pain-free? Focus on improving your spinal mobility – particularly extension and rotation. Even perfect swing mechanics can’t make up for a back that lacks movement. Try adding daily backward stretching and limit prolonged sitting – especially on the days you know you’ll be golfing. These small changes can make a big difference in keeping your spine mobile and resilient throughout the season.

2. Golfer’s Elbow (Medial Epicondylitis)

This injury happens when the tendons on the inside of your elbow become irritated – often due to repetitive swinging. But the root problem, however, frequently lies elsewhere. Weakness in your shoulder girdle or stiffness in your wrist can force your elbow to overcompensate.

To prevent and heal golfer’s elbow – don’t just focus on the elbow itself. Work on improving shoulder stability and wrist mobility as part of your regular conditioning. In more stubborn cases – regenerative therapies like Shockwave Therapy or EMTT can speed up healing and reduce inflammation – helping you stay on the course without resorting to cortisone shots or any downtime.

3. Knee Pain

Walking the course and rotating through your swing can put a lot of pressure on your knees – especially if you lack strength in your core and hips – or have unstable feet and ankles. Your knees aren’t designed to power your swing, but they often get overworked if other areas aren’t pulling their weight.

Most knee pain in golfers is mechanical, not structural. Meaning, it’s caused by faulty movement patterns rather than actual damage, even when imaging shows said “damage”. The good news? With the right strengthening and stabilization exercises, you can typically resolve your knee pain naturally – no injections or surgery required.

4. Rotator Cuff (Shoulder) Injuries

The rotator cuff is responsible for stabilizing your shoulder, and it’s highly involved during your golf swing. If it’s weak – or if your mid-back and core aren’t supporting it – your rotator cuff can easily become inflamed or irritated.

To prevent this, build strength not only in your shoulders, but also in your mid-back, lats, and core. These “powerhouse” muscles provide a solid foundation and reduce the strain on your shoulders. If your shoulder pain is persistent, regenerative Shockwave Therapy and EMTT (like in the case of golfer’s elbow) can be an excellent way to accelerate healing and reduce the need for medication, rest, or downtime.

5. Wrist and Hand Injuries

Sprains, strains, and other wrist or hand injuries are common in golf – often due to grip issues or poorly fitted equipment. But one commonly overlooked factor is your neck. Research shows that nearly half of all upper extremity pain can be traced back to the cervical spine – even if you don’t feel any neck pain.

If nerve irritation or stiffness in your neck is the true culprit – no amount of wrist strengthening will help – because the root cause has been missed. If your wrist or hand symptoms persist despite traditional mobility, strength and even manual work, it may be time for a full-body assessment by a mechanical pain specialist who can identify whether the issue is actually coming from somewhere else.

Final Thoughts

Golf injuries can be frustrating – but they’re often preventable and highly treatable when you know what to do or where to turn for the right help. By addressing problems early, using targeted movement strategies, and supporting your body with proper mechanics – you can keep playing pain-free all season long.

And when more advanced treatment is needed – especially for tendon or joint inflammation – non-invasive regenerative therapies like Shockwave Therapy and EMTT can offer fast, effective relief and accelerate recovery.

As a physical therapist who specializes in mechanical pain and movement dysfunction, I’ve helped countless golfers who thought their playing days were over – only to return to the course stronger and better than before. The key is addressing the true source of pain, not just masking the symptoms.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH and writes for Seacoast Media Group. To request one of her free guides for back or knee pain – visit her website: cjphysicaltherapy.com – or call 603-380-7902

Shockwave Therapy

How Regenerative Therapy Speeds Healing After Injury and Surgery

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As we age, our bodies naturally experience wear and tear.

Degenerative conditions, arthritis, and the aftermath of surgeries can all make it challenging to stay active. Many people assume this means they have to give up their favorite activities, but nothing could be further from the truth. With the right approach, including proper hydration, nutritious food, regular movement, and now advanced therapies like Regenerative Shockwave Therapy (RSWT) and Extracorporeal Magnetotransduction Therapy (EMTT), staying active and vibrant well into your later years is entirely possible.

While both therapies use cutting-edge technology, the real story is about the benefits they provide—helping clients heal faster, reduce pain, and regain mobility so they can get back to doing the things they love.

Pain Relief That Gets You Moving Again

Pain is one of the biggest barriers to recovery and activity. Both RSWT and EMTT work synergistically to target pain at its source. RSWT uses sound waves to stimulate deep tissue healing, while EMTT employs high-energy magnetic pulses to reduce inflammation and promote cellular repair. Together, they accelerate the body’s natural healing processes, reducing discomfort and giving clients the confidence to move freely again.

Enhanced Mobility and Flexibility

Stiffness and restricted movement can become significant problems, particularly after surgery. Shockwave therapy enhances collagen production, while EMTT helps improve tissue elasticity and overall function. By addressing the root causes of stiffness and encouraging healthy tissue regeneration, these therapies ensure you can move more freely and avoid the compensatory patterns that often lead to further issues.

Accelerated Healing with Better Blood Flow

Healthy circulation is critical for recovery. Shockwave therapy promotes vasodilation, increasing blood flow and delivering essential nutrients to injured areas. EMTT complements this by stimulating cellular activity, speeding up the repair of both soft tissues and bones. For individuals recovering from surgery, this combination can significantly shorten the healing timeline, allowing for a faster return to normal activities.

Tackling Scar Tissue and Restoring Function

Post-surgical scars can cause long-term discomfort and mobility issues if not properly managed. RSWT breaks down dense scar tissue, while EMTT encourages the formation of new, healthy tissue. This duo not only improves the appearance of scars but also restores functionality to the affected area, preventing complications and ensuring you’re back on your feet sooner.

A Recovery Companion for Every Stage of Healing

One of the most exciting aspects of combining RSWT and EMTT is how they support healing at every stage. Whether you’re preparing for surgery, recovering immediately afterward, or dealing with lingering issues months later, these therapies adapt to your needs. They amplify your body’s natural ability to heal, making them a perfect companion to any rehabilitation program.

Get Back to the Activities You Love Faster

If you’ve been struggling with pain, stiffness, or prolonged recovery after surgery, RSWT and EMTT might be the missing pieces in your healing journey. These innovative therapies not only accelerate recovery but also improve overall quality of life by reducing pain, improving mobility, and restoring functionality. With these tools, you can confidently reclaim the activities you love and enjoy a fuller, more active lifestyle.

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.

Physical therapy specialist treating frozen shoulder with non-invasive therapy in Portsmouth NH

Why Your Nagging Shoulder Blade Pain isn’t Going Away

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

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

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

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

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

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

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

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

1. Location of your pain?

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

2. Do you experience numbness, tingling or burning?

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

3. Does posture affect your pain?

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

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

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Are Cortisone Shots the Best Option for Chronic Shoulder Pain?

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Nagging shoulder pain can be extremely annoying.

But when it starts to interfere with things you love to do – you can’t help but wonder – is it time to get a cortisone shot? 

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast. Just because cortisone shots for shoulders are routine, popular, and often effective at getting rid of pain – it doesn’t mean they are the best or right thing to do.

What is a cortisone shot and how does it work?

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action. But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom? This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – you put yourself at risk for irreversible damage to your joints and tendons if you keep getting cortisone shots when you don’t actually need them. 

So how do you know if a cortisone shot is best for your shoulder pain?

Step one is making sure you’ve correctly identified the root source of your shoulder pain. Is it a chemical source – where the inflammatory process to heal something injured within your shoulder has gone haywire? Or is it a mechanical source – meaning the source of your pain is due to poor movement habits and imbalances in your body.  The difference matters – and will determine whether or not a cortisone shot is, indeed, the best option for your chronic shoulder pain.  Let’s look at the differences between the two sources of pain to help you figure out when a cortisone shot is best for your shoulder pain – versus when you should hold off.

“Chemical pain”

Chemical pain is normal (until it isn’t) – and it’s the result of your body’s natural inflammatory response to injury. When your body is trying to heal from an acute injury or tissue damage, a complex chemical reaction occurs between your blood and other cells that involves the releasing of chemicals to “flush out” the injured area and start the healing process. A good example of this is when you fall and sprain something. The sprain causes tissue damage – so your body creates inflammation to heal it. Normally this process has a start and an end. As your pain subsides, so does this chemical process called inflammation. But sometimes this inflammatory process can get out of control for various reasons. And the accumulation of toxic chemicals sticks around (they don’t ever flush out or go away). The result is constant irritation to your nerve endings and surrounding tissues. You’ll experience constant, dull pain (even at rest) that will appear extremely sensitive to any and all movements. There will be no reliability as to what makes your shoulder feel better – or worse. As you’ll read below – the presentation of shoulder pain due to an underlying chemical cause behaves quite differently from shoulder pain due to a mechanical cause. When it’s chemical – a cortisone shot is often necessary – and the best option for your shoulder pain 

“Mechanical pain”

Mechanical pain is responsible for 80% of all shoulder pain. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. You’ll find, for example, that your shoulder pain eases with exercise, movement, and certain positions – while other times it seems to have a mind of its own and will hurt constantly. But typically, you’ll have some sense about things you can do to ease and/or aggravate your shoulder pain. And this is what makes mechanical pain so confusing  – because when you’ve aggravated it – your shoulder will feel inflamed. But the presentation is different from that I’ve just described above, namely, your pain comes and goes. This type of inflammation is a symptom – and not the root cause of your shoulder pain. A cortisone shot may work temporarily to abolish this type of shoulder pain, but it’s going to keep coming back until you address the root mechanical reason that is causing the shoulder inflammation. What you risk here is getting repeated cortisone shots in your shoulder because you think they are working – when they are only serving as bandaids. 

The verdict?

For chemical pain, a cortisone shot is likely the best option for getting rid of your shoulder pain. But for mechanical pain – it’s not. For shoulder pain that is mechanical, you fix it naturally, with specialized and corrective movement strategies. The tricky part here is distinguishing between primary inflammation that’s gone haywire versus secondary inflammation that is responding to activities, overdoing it, or simply the way you move. Don’t try to figure it out yourself – let a mechanical pain expert do that for you.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists for FREE by clicking HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or reserve a seat in her upcoming free Masterclass for headaches, neck & shoulder pain – email [email protected] or call 603-380-7902

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].

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Treat the cause not symptoms

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Have you ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge?  Or place grocery bags on the counter?  You were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade.

This can occur for a number of reasons…

You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder. If this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation. You may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions.

This is more commonly known as shoulder impingement.

With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally.

The tempting and easy fix is to get a cortisone shot to calm the inflammation.

But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good.

The cortisone will temporarily mask your problem. It will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better. But, unless you address the reason for the crowded space, your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back.

For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned.

With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time. Or, more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.

Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury. The result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back FIRST.

If there are poor postural habits there, your shoulder will undoubtedly be impacted.

If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon).

Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it.

None of these solutions will give you the long-term solution you’re looking for.

The very last thing you want to do is choose passive treatment interventions or procedures. These either mask the pain or prolong the problem because they only address symptoms.

You want to do everything possible to preserve the integrity of your tendon. The best way to do that is by optimizing the mobility and strength around your shoulder joint first. Do this before resorting to more aggressive measures like cortisone or surgery.

Are you currently suffering from shoulder pain (or anything else) that is keeping you from doing things you love?

Are you contemplating surgery or a cortisone shot because you have been told it’s your best and only option?

Let me know and let us help!

We’re happy to provide a second opinion for you.

We will examine your shoulder and see how it responds to certain movement tests. Then we’ll be able to tell you – and show you – if your problem can be resolved naturally with movement instead of a procedure like a cortisone shot or surgery.

Our patients find that if they end up needing a procedure (which is rare) – they do so with peace of mind. This is because they’ve exhausted a natural, movement-based solution with us FIRST.

If you want to talk to us and see if what we do is right for you – CLICK HERE to request a Discovery Call with my client success team.

They’ll let you know if we can help and get you on our schedule as quickly as possible!

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

Shoulder Pain

Persistent Shoulder Pain could mean Misdiagnosis

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Persistent Shoulder Pain could mean Misdiagnosis

We’ve been hearing a lot of complaints lately about shoulder pain. Your shoulder joint is one of the most complex and mobile joints in your body. It’s made up and supported by an intricate structure of bones, tendons, ligaments, muscles and connective tissue. They all work in unison to keep it functional.

You’ve got the head of your shoulder joint (looks like a round ball) inserting into a socket within your shoulder blade (your “wing”). This makes up your shoulder joint and is supported by a joint capsule, ligaments, and your rotator cuff muscles.

Surrounding and supporting your shoulder blade and shoulder joint is your cervical and thoracic spine. (neck and upper back). This has both large and small muscles helping to support your ability to push, pull, reach, and raise your arms overhead.

Intertwined within all of that is a delicate web of nerves and blood vessels… No wonder shoulder pain can be a challenge to treat – never mind diagnose.

If you see your doctor about shoulder pain, they will typically want to take a closer look via X-rays and/or MRI’s. X-rays will show you all the bony parts of your joint – to see if anything is broken and check for arthritis. MRI’s will see if anything is torn or worn away, such as rotator cuff or labral tears.

Relying on imaging to diagnose your shoulder pain can be tough. Or any joint pain for that matter.  It’s entirely possible to have arthritis, a torn rotator cuff, or torn labrum – and still have a perfectly functioning shoulder. The problem is we only get things looked at when we are in pain. So, there is no way to know for sure if you’ve had these “abnormalities” already, and if they are the true reason for your shoulder pain.

For example, it’s estimated that between 20-50% of people over aged 50 have “asymptomatic rotator tears”. Meaning – they walk around with a torn rotator cuff and have zero pain in their shoulder. Just because an X-ray or MRI says so – doesn’t mean it is so. And it’s a big reason why so many folks suffer unnecessarily with persistent shoulder pain.

If I meet someone with shoulder pain that hasn’t gone away – the first thing I question is whether or not we have the correct diagnosis. With shoulders, misdiagnosis is all too common given the complex nature of the joint and surrounding structures.

Here are some clues to help you figure out if your persistent shoulder pain has been misdiagnosed:

 

Where is your pain?

When pain is coming from the shoulder, the pain will typically be felt directly in three places. In front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) down the side of your upper arm. But it will never go below your elbow. If the pain goes past your elbow and into your forearm or hand – radiates above your shoulder into your neck (the upper trap area) – or deep inside your shoulder blade or middle back – odds are pretty good you’re dealing with a neck problem – and not just a shoulder problem.

If you don’t address your neck, your shoulder pain will continue to persist. I can’t tell you how many people I’ve seen get unnecessary rotator cuff surgery because of this misdiagnosis.

Have you lost mobility in your shoulder?

Lack of mobility is a common symptom associated with a rotator cuff injury or the dreaded “frozen shoulder.” These are, indeed, shoulder problems. So if your pain is persisting, you probably have the correct diagnosis, just the wrong treatment approach.

However, one overlooked area when it comes to shoulder stiffness is your middle back (thoracic spine). If your thoracic spine has mobility restrictions – or even weakness that leads to stiffness (our joints stiffen up to compensate for weakness/instability) – it will impact your shoulder joint. Stiffness in your thoracic spine can inhibit your shoulder mobility. Over time, this lack of mobility will irritate structures within your shoulder joint, causing pain.

If you’ve got persistent shoulder pain and feel like you’ve tried everything, get your middle back checked out. This could be your misdiagnosis.

Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening – it’s likely coming from your neck or upper portion of your middle back (cervicothoracic junction). It could be due to a bulging disc or a restricted/faulty movement pattern that is irritating nerve roots (or discs) in your spine. An isolated shoulder problem typically does not involve nerve root compression or irritation. Sometimes certain trigger points in your rotator cuff muscles can refer pain. But this usually feels quite different from what I’m referring to.

Do you consistently feel pain, numbness, tingling or burning in your shoulder blade, middle back, or down your arm? Especially if it seems to move around during the day? Then it’s likely not a shoulder problem. In the medical world we call this presentation “cervical radiculopathy”. If you continue to experience persistent shoulder pain and you’ve got any of the symptoms I just mentioned, this is probably your misdiagnosis.

Confused? I don’t blame you.

The moral of this story is that if you’ve got persistent shoulder pain and given treatment your best shot, then you’ve likely been misdiagnosed. Shoulder pain loves to disguise itself as a spine problem (neck and/or middle back) even when you don’t feel pain in your spine.

Whatever you do, don’t resort to any surgery or major procedures until you’ve thoroughly explored these areas with a mechanical pain expert who knows where to look.

If you are local to Portsmouth, NH…

Consider reaching out to one of my specialists by requesting a free discovery visit HERE. They will ask you all about what’s been going on – and see if we would be the best fit to help you.

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