Tag Archive for: surgery

Holding Knee with Arthritis

Arthroscopic Knee Surgery – Does it Even Work?

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While researching for my latest article in the Portsmouth Herald, I came across an interesting study titled: “Arthroscopy for degenerative knees – a difficult habit to break.”

The title of this study is telling.

Arthroscopic knee surgery is still one of the most common surgeries performed, despite research telling us that it’s not nearly as effective as most people are led to believe.

Furthermore, studies now indicate that people who get arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that could have been avoided.

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee.

Sounds pretty simple and harmless – right?

But over the years, research has shown that this procedure is really not necessary in most cases.

Most people can get pain relief and restore function in their knees without ever getting surgery.

One of the earliest studies from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have shown similar results. Even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment like physical therapy.

Despite all this research, surgeons are still performing these procedures more than ever.

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management and not giving therapy enough time to work.

In our office, we often see people after they’ve tried regular physical therapy first. Since we have a more specialized approach, and we’re able to spend more time with our clients, we tend to get better results and can help clients avoid surgery all together.

But not all physical therapy clinics are afforded that luxury. In those cases, people are led to believe that the physical therapy “didn’t work,” and they get scheduled for surgery.

But what’s the big deal really?

If outcomes are the same regardless of whether you get surgery or not – why not just get it? It’s quicker, and far more convenient than going to weekly therapy appointments…

But despite the term “minimally invasive,” it’s still surgery.

You will have bleeding, swelling, and recovery time. There is trauma that is caused to the soft tissue in and around your knee that has to heal. There’s also the risk of infection, which comes with a whole set of different complications.

And then of course there’s the elephant in the room that nobody likes to talk about…

I’ve seen many of these arthroscopic surgeries performed that had clients feeling WORSE than before surgery. Because it turns out the procedure wasn’t even necessary. Luckily, we’re still able to rehabilitate them. But it’s completely demoralizing and discouraging for our clients.

In general, despite how small the procedure may seem, you want to avoid surgery whenever possible.

Although small, the risks that can happen with surgery simply aren’t worth it – especially when you can get the same results from natural, conservative treatment.

For some, arthroscopic knee surgery really is necessary. But for most, it can be avoided.

If you’re currently suffering from knee pain and want to learn more about what you can do to avoid surgery and heal your knee pain naturally and on your own – DOWNLOAD our Free Guide: 7 Ways to Get rid of Knee Pain Naturally.

Considering Back Surgery? Read this First

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Approximately 500,000 Americans undergo back surgery to relieve their pain every year, and according to the Agency for Healthcare Research and Quality (AHTQ), this costs approximately $11 billion annually. The worst part — it turns out only 5 percent of these people actually need back surgery. And for many folks — the pain just ends up coming back.

So why are we spending so much money on back surgery when the majority of people don’t actually need it?

First of all, back pain is not fun. It can be excruciating, debilitating, and can have a significant impact on your life and happiness. If you’re told surgery will fix your problem (and it often does take your pain away in the short-term), why wouldn’t you choose this option? 

Well, if you knew the facts, you might be willing to hold off on a surgical “quick fix” and investigate options that are less risky. The research shows over and over that 80% of the population suffers from “non-specific low back pain,” meaning, it’s not from something structural like a tumor, broken bone, or deformity. The research also shows that non-specific low back pain does NOT benefit from surgery! The better solution for the majority of back pain sufferers is correctly prescribed movement followed by regular exercise to maintain your strength (especially your core) and postural endurance.

So again, why are we spending so much money on back surgery when the research and data clearly show it’s not the best course of action for the majority of back pain sufferers? 

There are a few reasons. First, most of the time we just don’t know any better.

Back pain is typically diagnosed with imaging (X Rays and MRI’s). Although these highly specific tests are critically beneficial after a major trauma or accident, or when you suspect something more serious is going on (like a tumor or broken bone), they are not the best way to diagnose non-specific low back pain. That’s because these tests are designed to show you everything – including all the normal, age-related changes that occur in your spine such as arthritis, degenerative discs, stenosis, and even bulging discs.

The truth is that 60-80% of people walk around with these findings in their spine all the time and have absolutely zero pain.

That means that your back pain is likely coming from something else, typically, a bad movement pattern or habit. Poor posture and movement habits can exacerbate a bulging disc or stenosis, and this is where the confusion comes in. Surgically “fixing” your bulging disc or stenosis will not correct your poor habits. That’s why so many people suffering from back pain get surgery only to find their pain comes back several months or years later. What you need to do is find the true cause of your low back pain and attempt to address that first before ever considering something like surgery.

The second reason back surgery is so common and over-prescribed is because it does a great job at taking pain away quickly where conservative therapy often fails. Conservative therapy really can help you get rid of back pain and keep it gone – but it has to be done correctly. And sadly, there are many well-meaning therapists, trainers, and movement professionals out there that lack the expert knowledge to get it right. If you don’t get the correct conservative treatment for your back pain, you’ll assume it didn’t work, and will be more apt to get surgery.

So how do you know you’re getting correct and effective conservative treatment? Quite simply, it will work, and fairly quickly! 

Remember, 80% of all low back pain responds to the right conservative treatment. You’ll notice obvious improvement in your back pain within 2 weeks. If you fall into the 20% where conservative treatment doesn’t work as well, it will be pretty obvious to a back pain expert almost immediately. In our office, for example, we have special movement screens and tests that we perform on everyone to determine if you’re in the 80% or the 20%. If you fall into the 20%, we know right away and can send you to your doctor, or a surgeon, for one of those highly specific tests to see what’s really going on.

The take home point is this: If you currently suffer from on and off back pain, have tried every treatment you can think of, and are just tired of it because it really hurts – I completely understand why back surgery would be an attractive option for you right now.

But please consider the facts and research first before you make the decision to go under the knife. Back surgery has its risks, and there is no going back from the unimaginable happening. If you have back pain that you’re ready to solve for good — sign up for a FREE 30 minute Discovery Session with one of our specialists today! 

 

Opioid Addiction in Adults over 40: a Public Health Emergency

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The COVID-19 pandemic has been top of mind for months. We’ve all experienced some major curveballs this year, and most people have learned a lot about public health and epidemiology along the way. But why now? Why are we finally learning how viruses attack the respiratory system, what it means to be immunocompromised, and the best practices for disinfecting? Maybe it’s because of the unpredictability and common threat associated with this virus. Although some demographics have an increased risk of serious outcomes, anyone can get this novel coronavirus and anyone can become ill. 

Unfortunately, Covid isn’t the only public health crisis facing Americans in 2020.

The opioid epidemic has been in the news for years, but many of us don’t bother to take precautions or educate ourselves because we don’t think opioid addiction can happen to us.   

That couldn’t be further from the truth!

Anyone can become addicted to opioids. Many of the Americans battling addiction right now don’t have a history of drug abuse. Instead, what they have in common is something relatively routine. They deal with chronic pain or they had a surgery, and a physician prescribed them opioids.

According to the US Department of Health and Human Services, “opioid overdoses accounted for more than 42,000 deaths in 2016” and “an estimated 40% of opioid overdose deaths involved a prescription opioid.” Between 2010 and 2016, opiate prescriptions from surgeons rose by over 18 percent (UCI Health). And according to the National Institute on Drug Abuse, approximately 21 to 29 percent of patients who are prescribed opioids by physicians end up misusing them. Eight to 12 percent become addicted (NIDA). And the reality of opioid addiction is sobering. In 2017 alone, over 47,000 people in the United States overdosed on opioids and died. 

In 2017, the opioid epidemic was declared a public health emergency.

A public health emergency is just that — public! The emergent status of this crisis is not limited to one demographic or “type” of person. Although media attention through TV and movies tends to focus on heroin and young people getting high, data from the Substance Abuse and Mental Health Services Administration tells us that 63.4% of the adults who misused prescription opioids in 2015 did so to relieve legitimate physical pain. Chances are, we’ve all felt pain at one time or another that ibuprofen or tylenol alone couldn’t get rid of. Everyone is at risk for opioid addiction because anyone could get in a car accident, or require surgery, or develop arthritis. 

Pain-relieving drugs like Oxycodone, Oxycontin, Vicodin, Percocet, and others can be extremely helpful in some circumstances. But unfortunately, they are often overprescribed thanks to aggressive incentivising and pressure from drug manufacturers. The fact that opioids are so often prescribed after surgery and for patients with chronic pain means that middle aged and older adults are at a higher risk for drug addiction than ever before. In 2016, 14.4 million adults on Medicare (age  65+) had at least one opioid prescription (Consumer Voice). Older adults are also more sensitive to the physical effects of opioids. Side effects such as respiratory depression and cognitive impairment increase in severity as the patient’s age increases, often leading to hospitalizations and even deaths. 

So many clients in our practice fall into this at-risk demographic.

We have countless clients coming to us with severe chronic pain. Some have already had surgeries or been told that surgery is their only route to a pain-free life. Many have considered opioids to treat their back pain. And we are so grateful that we’ve been able to help hundreds of individuals recover from their injuries AND chronic pain without resorting to drugs, surgery, or both!

We promote both physical therapy and Pilates as alternatives to surgery and for preventing painful musculoskeletal problems because they truly work.

We recognize that most knee, back, and other injuries occur because the surrounding muscles are too weak to support those joints and systems properly — and we have the expertise to retrain your body in correct movement. You may think that your regular exercise and stretching is enough, but oftentimes working specific muscle groups leaves others underdeveloped and your body unbalanced as a whole. Our team of specialists is trained to create individualized solutions for your particular needs, because we believe that movement is medicine — when it’s prescribed properly! The idea of a quick fix is tempting — but a quick fix can easily turn into long term opioid addiction, illness, and even death. Taking the time to teach your body how to heal itself is so much more rewarding in the long run.

Want to learn more about how we can work with you to determine the safest, strongest, most effective route to recovery? Just click here to sign up for a FREE Discovery Session with one of our specialists.

 

This article was authored by Katya Engalichev. Katya is a pharmacy technician, EMT, and graduate student who writes for CJ Physical Therapy & Pilates. 

Carrie working on a client's shoulder

Shoulder Pain not Going Away? This could be why…

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Whether it’s shoulder pain, neck pain, back pain, or knee pain that you’re dealing with — if you have a nagging pain or injury that just won’t go away no matter what you try, it’s a clue that you’re missing something.

We see this ALL the time in our office with shoulders.

Folks just like you come to us wondering why their shoulder still hurts after trying ice, heat, rest, physical therapy, massage, and every possible shoulder exercise you could imagine.

The pain either goes away temporarily, or sometimes it gets WORSE!

When it comes to shoulder pain, it’s critical that you know for certain if the pain is actually coming from your shoulder, or somewhere else. If not, you risk trying to fix the wrong problem… and that explains EXACTLY why your shoulder pain isn’t going away.

So… if your shoulder pain isn’t caused by your shoulder — where is it coming from?

The most common culprit is actually your NECK. Below are a few key signs to help you figure out if that’s the case…

(PS – we’re doing an online workshop on this topic in just a few weeks.)

Where is your pain?

When your pain is coming from your shoulder, the pain will always be localized to your shoulder alone. True shoulder pain is felt directly in front of your shoulder, directly on top, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm… but it will never go below your elbow.

If the pain goes past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area), or if you feel it deep inside of your shoulder blade in your mid-back, odds are pretty good that you’re dealing with a neck problem and not just a shoulder problem. This could be the reason why your shoulder pain isn’t going away.

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 – and could be due to a bulging disc or a restricted/faulty movement pattern that is irritating nerve roots in your neck. An isolated shoulder problem typically does NOT involve nerve root compression or irritation. This is much more common in a problem related to your neck, and if that’s what’s happening, you will feel symptoms into your shoulder, shoulder blade, or even down into your arm. What’s particularly misleading is that it’s entirely possible to feel all these nerve symptoms and not actually feel anything localized to your neck. This is a big reason why shoulder pain caused by a neck issue gets missed by so many health practitioners.

Have you lost mobility or range of motion?

Lack of mobility and stiffness are common symptoms associated with a rotator cuff injury or the dreaded “frozen shoulder.” If your neck moves well and is pain free, but your shoulder is stiff and immobile, odds are good that the problem is actually in your shoulder and you just haven’t found the right treatment approach yet. BUT… if you have a stiff and painful neck, and you lack mobility in your shoulder, then it’s absolutely imperative that you investigate your neck. If your care provider only focuses on stretching and improving your shoulder mobility, and never bothers to look at your neck, it’s possible you could be missing a key component to full recovery… and that’s why your shoulder pain keeps coming back.

 

How Stress Leads to Pain

Three Ways Stress Can Cause Back Pain

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In our fast-paced world, stress has become an almost unavoidable part of daily life.

From work pressures to personal challenges, it can be quite overwhelming at times. But while stress is often thought of as a mental or emotional issue, its impact on the body can be profound. One of the most common physical complaints associated with stress is back pain. Whether it’s a dull ache or sharp discomfort, the connection between stress and back pain is real – and understanding why this happens is the first step toward finding relief.

Here are three ways that stress can lead to back pain:

1. Social conditioning: 

Many of us are taught from a young age that expressing emotions, particularly negative emotions, is “bad” or “unacceptable.” The result is that you may have learned to hold stress inside your body when faced with a stressful situation. Researchers who study this believe that the muscle tension we develop is the result of “unspoken social beliefs” that we adopted as children in order to feel accepted or liked. This pattern carries into adulthood and becomes embedded into our subconscious systems, i.e. our nervous system. Later on, when faced with certain types of stress, our muscles react based on how we’ve taught our nervous system to respond – which is typically to tense up. If you grew up learning to bury emotions and tension in your back muscles, your back can react in a painful way when you’re under stress .

2. Trauma Response: 

Trauma is often associated with a singular, catastrophic event like a car accident or a severe fall – but trauma can also occur in the form of cumulative “micro-traumas.” These micro-traumas are more subtle, often emotional or psychological in nature, and can go unnoticed for years. Research shows that the body can actually store memories of trauma – whether it was large or small – as part of the brain-body connection. And your body can remember this physical response for a very long time – even years after the event has passed. Our nervous systems (particularly the autonomic portion) can be triggered by emotional stress, and may reactivate old trauma responses that your body has stored.

This explains why for some people – physical symptoms of back pain can resurface any time their body perceives stress – especially if that’s where their trauma response occurred initially.

3. Environmental Stressors and Habits:

Your physical and postural habits have a huge impact not only in how your body feels from day to day, but in how well it recovers from pain or injury. For example, sitting too much is a number one cause of persistent and chronic back pain. And stress can play a role in this. When you’re stressed, it’s often accompanied by less motivation, and you may opt for unhealthy coping mechanisms, such as more TV and couch time. If being a homebody is how you react to stress – versus getting out for a walk or exercise – you’re  more likely to experience back pain when you’re stressed out.

Movement can Help:

Regardless of how or why stress impacts your body – there is one thing I know for certain – and it’s that movement helps. Physical activity helps to release tension stored in muscles, improves circulation, and promotes the release of endorphins which are your body’s natural pain killers and mood elevators. But movement also helps to break up the fight or flight response that can often occur in your nervous system when it’s under stress.

If you’ve got back pain and are wondering if stress could be part of it – consider talking to a mental health professional who can help uncover the source of your stress. 

And incorporate more movement and exercise in your left – which will help address both the mental and physical aspects of back pain. Now, if your back pain is so severe that movement or exercise is not an option – then seek the help of a mechanical pain/movement specialist who understands back pain. They will prescribe you healthy, corrective movement strategies designed to relieve your back pain – and likely some of your stress – since the two can be so linked.

Dr. Carrie Jose, Physical Therapist and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or to request a copy of her free guide for back pain – CLICK HERE.

tight hips

The Big Reason why Back Pain Keeps Coming Back

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If you’re reading this and you’re over the age of 40, odds are pretty good that you’ve experienced back pain at some point in your life. The odds are also pretty good that you’ve experienced back pain more than once.

Every few months or maybe once per year – your back “acts up”. You get rid of it – but it ALWAYS comes back.

Sound familiar?

Well… you’re not alone. Four out of five people are impacted by back pain, and for many, it’s a constant back-and-forth year after year.

But why? Why does back pain always seem to come back?

There are essentially two main reasons:

  1. Back pain is primarily addressed with “quick-fixes” and passive modalities
  2. You (or your doctor) let MRIs make the decisions about your treatment

Quick fixes and passive modalities…

This is the most common way people tend to address their back pain. And it’s the number one reason why it always comes back.

What is a passive modality? It’s something that is done TO you. It’s where you walk in somewhere, lay on a table, and you receive some kind of treatment. This could be chiropractic care, massage, craniosacral therapy, acupuncture, even injections and surgery. You have no active role in the process — it’s completely passive.

Now, I’m not saying there is anything wrong with these treatments. They are GREAT for getting rid or your back pain — and quite often quickly. And they are also great for helping you with other problems, such a stress relief. (I LOVE getting my massage once per month!)

But when your back pain keeps coming back, it’s a big sign something is missing. These treatments are only addressing your symptoms – for example – tight muscles, tension in your nerves, stiff or out of place joints. These things are all the result of your back problem – not the cause.

And it’s the number one reason why your back problem keeps coming back – because the root cause – the thing that is causing you to have tight muscles or stiff joints – is never addressed.

When MRI’s make the decision…

Traditionally, the medical community diagnoses your back pain with images. They use X-rays and MRI’s to see what’s going on inside your spine, and from there, they make a determination of what your treatment should be.

This is a big problem, because what shows up in your MRI isn’t always the reason for your pain. For example, your MRI might show a herniated or bulging disc in your spine. Your doctor will immediately blame that for your pain. And depending on how “bad” it looks, they may suggest injections or surgery. But the truth is, another person could have the exact same visual results as you on their MRI and have no back pain at all.

So why is it that one person can have a bulging disc with no back pain, and another person can have a bulging disc with excruciating back pain?

It’s because the root cause of back pain is more complicated than your anatomy. Research has shown time and time again that 80% of all back pain is primarily influenced by your habits and the way you move, not by what’s going on structurally in your spine.

So you can go in and cut out the disc, but if you don’t identify and correct your poor movement habits that led to that bulging disc in the first place — it’s either going to come back or bulge somewhere else. It’s why surgery only has a 50% success rate for helping people keep back pain away for the long-term.

If you’re confused right now – I don’t blame you.

It’s why so many people suffer from back pain!

It’s also why we offer the opportunity for you to come talk to us for FREE if you’re tired of suffering from back pain with no real answers.

Click here to request a FREE Discovery Session with on of my specialists.

You can also download this FREE GUIDE on how taking care of back pain on your own. It was written especially with the recent quarantine in mind – where so many people have been stuck at home and off their routines.

Either way, you should know that if you want your back pain to stop coming back — it IS possible. You just might have the wrong approach and could benefit from some specialist care to finally get you going in the right direction.

Noticing More Knee Pain during Quarantine?

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Aside from back pain, the second most common complaint bringing people into our office these days is knee pain, and lately, I’ve seen a little surge.

Here’s why…

People are sitting a lot more, which leads to increased stiffness in your knees. And a lot of us are doing different kinds of activities than we did 6 weeks ago, which for some, is exposing knee problems they never knew they had.

I spoke to one gentleman last week (we’ll call him “Jack”) who had started walking every day, and running a little bit, because his gym had closed. After about 4 weeks of this, he began experiencing pain in the front of his knee. He put some ice on it, took a break from his daily walks and running, and also resumed some stretches that a former physical therapist had told him to do. This seemed to help, so he resumed his walks and running again. Three days into it… bam… his knee pain returned.

Our specialist team has opened up our schedules to answer people’s questions about what they can do at home right now to take care of any aches or pains.

So Jack took us up on that, because he wanted to know if his knee pain was something to worry about. Did he need to see a doctor? Did he need to let it rest some more? Were there specific exercises he could do?

He did NOT want to stop his walking and running routine, but he definitely didn’t want his knee to get so bad that it would keep him from returning to the gym when it opened back up. He’s 55 years old and staying active and mobile is VERY important to him. We spoke for about 20 minutes and I knew immediately that rest wasn’t going to work, and that X-rays or medication from a doctor wouldn’t do anything either. Those things would only mask the problem. They would take care of the pain in his knee – but wouldn’t correct the source of his problem.

Ironically, the truth about knee problems is that they’re often not actually knee problems!  

With most knee pain, we can trace the underlying issues to a locality directly below the knee (the ankle or foot) or directly above it (the pelvis, hips, core, and low back). If you don’t engage your core throughout your daily movement, it actually puts a huge amount of strain on your knees. As your legs swing and rotate, the torque that should be occurring through your pelvis and hips gets overloaded onto your knees. So as we age, we may start feeling a sense of wear and tear or weakness in our knees that actually comes from a lifetime of improper movement.

The mainstream medical model is focused largely on treating symptoms rather than identifying the root cause of WHY the problem is occuring in the first place.

Pain pills, injections, and even surgery are often recommended before more conservative and natural treatments! And because these quick fixes are merely addressing the symptoms, the physical problems return for the majority of affected individuals. That’s because those knee issues actually stemmed from a different part of the body, and the knee will continue to be overloaded until those biomechanical problems are addressed directly!

Yes – we were able to figure ALL of this out from a FREE phone session.

The next step for Jack was an evaluation with our knee specialist. We scheduled a virtual session over Zoom, she was able to confirm the source of the problem. Turns out the muscles in his hips weren’t firing like they should and it was causing his knees to compensate and work harder than they needed to, which resulted in pain. So we got him doing the correct stretches and specific exercises that would train his hip and pelvis to work like they are supposed to.

In no time, Jack will be back to his walking and running routine, but he will ALSO be in better shape to return to the gym. One of his frustrations before was not being able to do as many squats as he wanted – because they hurt his knees. He had no idea that the problem was actually coming from his hips! So he is pretty excited to try his squats again once his gym opens back up.

If Jack’s story sounds familiar to you, schedule a call with us.

There is no point in sitting at home worrying, or scouring Google for what you should do to fix your pain. We can figure out what’s going on with you over the phone and I’ll let you know if you need to schedule a session with us, see a doctor, or if it’s something you can take care of on your own.

How you actually CAN recover from chronic back pain

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There’s nothing more discouraging than being in pain and feeling that there’s no way out of it. Back pain is such a common issue, and unfortunately, many people hold onto the mistaken belief that if you have a “bad back” you’re stuck with it for life. Not true!!

It is totally possible to recover from chronic back pain and return to the activities you used to love.

Great news, right? Let’s talk HOW. 

First of all, keep moving.

There are people in healthcare who will tell you to just avoid anything that irritates your back and accept that you can’t be as active as you once were. But what if basically everything triggers back pain? What if your job requires you to be on your feet or you simply want to tie your own shoes or pick up your grandkids? You don’t have to resign yourself to sedentary days spent popping ibuprofen every four hours and missing out on life. Don’t listen to the people who tell you to avoid movement — because in fact, the solution is the exact opposite. Consistent, correct movement heals your body and keeps it from shutting down. If you’re suffering from back pain, it may be a sign that your movement habits are off. You could benefit from working with a specialist physical therapist to retrain your body in how to move properly throughout your day, thus eliminating unnecessary stress on your spine.  

Along the same lines, make sure you educate yourself.

We offer a FREE workshop at our Portsmouth office every month to answer questions from our community, and our next topic is back pain and sciatica! You may feel like surgery and medication are the only options out there for recovery, but in reality they are just two of the less effective strategies for treating back pain. One of our clients, Sean, was dealing with multiple herniated discs and spoke with us on this exact topic. 

“I was considering back surgery until I found CJ Physical Therapy. I walked out of 

therapy with such relief that the thought of surgery was no longer an option. Therapy 

worked so much better than the steroid injection just a few months earlier, that it gave 

me hope of actually being able to feel like I did before the injury a year earlier.”

Nobody wants to get surgery, but if you haven’t been told about any noninvasive therapeutic routes to remedy your pain, surgery may seem like the only option. But time and time again, we have clients come to us with severe back pain and injuries that are often prescribed surgery — and time and time again, they have FULLY recovered through an individually customized program of physical therapy. 

If you’re dealing with chronic back pain, don’t be afraid to reach out.

We understand if you’re not yet ready to commit to PT — that’s why we offer FREE Discovery Sessions for potential clients. This 30 minute session is a chance for you to speak with one of our specialists and determine for yourself if we’re the best people to help you. It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health — whether that’s working with us or not! 

Questions About Your Shoulder Pain? Here are Some Real Answers.

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Often when clients come to us with shoulder pain, they’ve already tried several approaches without success. But the real issue is that everyone they’ve seen up to that point has failed to give them an accurate diagnosis.

Without an accurate diagnosis, treatment fails.

It’s not surprising. The true cause of shoulder pain is missed by many and can actually be difficult to diagnose. Sometimes it really is your shoulder, but in other cases the pain is actually caused by a problem in your neck. If there is irritation or inflammation in your neck, but someone is aggressively treating your shoulder, guess what? You aren’t going to see results and your pain may even worsen.

Here are a few questions to ask if you’re wondering if really have a shoulder problem… or if you should be getting help for your neck instead.

Where is your pain?

 When you have an actual shoulder problem, the pain is always going to be just in your shoulder. The most common areas to experience pain are directly in front of your shoulder, directly on top of your shoulder, or in a more involved shoulder problem – like a rotator cuff injury – you might feel achiness on the side of your shoulder and down into the side of your arm a little. If the pain goes past your elbow, is above your shoulder and into your neck (the upper trap area), deep inside of your shoulder, or in the back into the shoulder blade, it’s entirely possible (and maybe even likely) that your neck is involved or totally responsible for your “shoulder pain.”

Do you have numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening in your neck – say due to a bulging disc or restricted/faulty movement patterns that irritate your nerve roots – you can feel it into your shoulder, shoulder blade, or even down into your arm.

What’s particularly misleading is that all of this nerve difficulty in the neck will only be felt in your shoulder or arm.

When do you feel stiff?

Lack of mobility and stiffness are common symptoms associated with a rotator cuff injury or the dreaded “frozen shoulder.” If your neck moves well, is pain free, and your shoulder is stiff, odds are that the problem is in your shoulder. Now, let’s say you’ve got stiffness in your neck as well as your shoulder. It’s possible the neck stiffness is a result of your shoulder not moving properly. However, you’ll never know for sure without a proper assessment. If there is even a hint of a neck issue being fully or partially responsible for your shoulder problem, it must be addressed or you will never achieve full recovery.

I do everything I’m told, why won’t my shoulder get better?

This is probably the number one sign that your shoulder problem is not really a shoulder problem at all. If you’ve had pain for months, or if you fix your pain but it keeps coming back, then there is a very good chance someone has missed something. Quite possibly, it’s a hidden neck problem. I can’t tell you how many times I’ve seen this happen. I’ve seen people try three different therapists who’ve prescribed the best rotator cuff exercises on the planet. I’ve seen people get multiple cortisone injections in their shoulder. And worse, I’ve seen people get surgery – only for their shoulder to problem return months or years later. If this sounds like you, then someone has missed the boat and your shoulder problem may not be a shoulder problem at all. You need to find a physical therapist who is a specialist and can properly assess you. They’ll know the right questions to ask, take their time doing a thorough and proper assessment, and get you on the right track to getting better. 

Do You Really Need an MRI?

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Do you really need an MRI for that?

This is probably the number one question we get from clients  – especially those who suffer from back or neck pain.  Believe me, I get it! When you have pain that won’t go away, and it’s shooting down your arm or leg, often causing numbness and tingling – it’s scary! Why wouldn’t you want an MRI?  An MRI tells you everything and then you know exactly what to do to fix the problem, right?

Not necessarily….

Don’t get me wrong – MRI’s are an amazing advancement in medical technology.

MRIs can easily detect abnormalities in your brain and spinal cord. They can find tumors, cysts and other abnormal growths in various parts of your body. They can even detect certain heart problems and liver disease.  When you don’t know exactly what’s wrong, but you are showing signs that something is not right, an MRI is an amazing tool to help doctors detect the source of the problem.

The problem isn’t with MRI’s – they do their job magnificently.  The problem is with the way they are being used and prescribed.

Let me explain.

When it comes to neck and back problems, for example, what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature.  That means that your problem has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – because it takes a while for bad movement patterns or bad postural habits to take their toll.  The best way to figure out a movement problem is with… well… movement!

But how do you know that it’s a mechanical problem and not something more serious?

The easiest way to find out is to ask a physical therapist (we’ll get to that later). But the most common sign is that the problem comes and goes.  Some days you feel great, and then other days you’ll be experiencing severe pain that interferes with your routine and activities.  When the pain comes and goes like that, it is usually NOT due to something serious.  A tumor, or a growth, or a broken bone doesn’t go away. If you feel the pain or discomfort constantly and nothing – not even medication – changes your symptoms very much, that’s an indicator that you should see a doctor and may need an MRI.  But remember what I said – 70-80% of all musculoskeletal problems are mechanical in nature and NOT the result of a significant injury or dangerous growth. To sum it all up – MRIs are not needed as often as they are prescribed.

So what’s the big deal about getting an MRI?  Isn’t it good just to be extra-cautious?

In theory – yes.  But here’s what actually happens.  MRI’s are super powerful and amazing tools.  Because of this, they see everything – including normal age-related changes, such as arthritis, stenosis, degeneration of joints, and even bulging discs. These typical and often unrelated imperfections show up in the MRI and are frequently blamed for the movement problem.

So back to our original question:  Do I really need an MRI?

If you’ve had a bad accident, fall, or trauma – then you’ll want to seek immediate medical attention and an MRI is probably a good idea. But if you are dealing with chronic, long-standing aches and pains that have come and gone over the years and have recently gotten worse – there is a 70-80% chance that it is a movement problem that has finally caught up to you.  It’s best to see a movement expert for this.  A professional and specially trained movement expert (like a specialist physical therapist) knows how to tell if the issue is NOT a movement problem and can send you to a doctor if necessary.  But when you automatically assume that you need an MRI first, you end up spending a lot of money (the average cost of an MRI is $150,000 and you have to pay a portion of this), and often get prescribed unnecessary surgery or procedures for those normal effects of aging that show up in the MRI and get blamed for your problem.

If this story sounds all too familiar, or you’ve been told that you have to get an MRI, get in touch!  We are a specialized physical therapy practice that is well-known for helping people with this exact dilemma and we know how to tell if you need an MRI or not.

Or – download our FREE guide to back pain, written by Dr. Carrie Jose, Portsmouth’s leading back pain specialist and physical therapist. This guide contains her BEST tips – the ones she gives to clients – that will help you get rid of back pain WITHOUT things like pain pills, procedures, and of course MRI’s.