Before you get a Cortisone Injection – Ask these questions

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Cortisone (or steroid) injections have become increasingly popular over the years for people looking to address chronic joint pain and inflammation.

Why have they become so popular? Well, for starters, they have a reputation for getting rid of pain quickly, and they are generally considered a better alternative to something like surgery. But there can be consequences when you choose the “quick-fix” route. Before you decide on whether or not a cortisone injection is right for you – let’s look at some important considerations.

First… the benefits…

Quick Relief:

This is the main reason folks don’t think twice about getting a cortisone injection. And when you’ve been suffering for a while with something like back or knee pain – or it keeps coming back at the most inopportune times – cortisone injections are an attractive option.

Targeted Treatment:

In contrast to a pain pill – or even an oral steroid – people like the idea of a cortisone injection because you can choose exactly where it’s going to go. This makes your treatment more targeted and theoretically, more effective. Plus, a localized injection compared to an oral medication could mean smaller amounts of the drug going into your body, thus, potentially minimizing any potential side effects.

Alternative to Surgery:

I’m a huge advocate of avoiding surgery unless absolutely necessary. So if all other conservative and natural treatments have truly failed, then a cortisone injection could be a good option for you. It’s certainly better than a surgical procedure.

Now – let’s look at the risks and side effects…

Cartilage Damage and Weakening of Tendons:

Based on research and evidence, we know that repeated cortisone injections cause damage to cartilage (the cushioning material inside your joints) and weakening of tendons. This might not be an issue for you if you know you’re getting a joint replacement surgery and using cortisone to pass the time and help control pain. But otherwise, repeatedly getting cortisone injections in your joints or tendons will increase your likelihood of needing surgery down the road – so it’s an important consideration – especially if your first cortisone injection doesn’t work or doesn’t last.

Risk of Infection:

This is an important risk to consider – especially when it comes to cortisone injections in your spine. With any type of injection – you run the risk of inadvertently introducing bacteria, which could lead to serious complications. While an infection is not ideal in any area of your body, it can be especially dangerous in your spine because it could lead to things like meningitis and epidural abscesses. 

Short-term Relief:

While the quick pain relief you can get from a cortisone injection seems attractive, there are unintended consequences. First, even though joint inflammation is what’s causing you pain, it’s rarely the root cause of your problem. That’s why the relief you get from cortisone injections rarely lasts and the pain returns. The problem with this is that you’re more likely to get repeat cortisone injections which we know causes damage. Plus, once the pain is gone, you think your problem is gone, and you’re less likely to address it. 

If after all this you’re still considering a cortisone injection – at least ask these important questions first…

  • Are you absolutely sure the root cause of your issue is inflammation? Or is it a symptom of an underlying problem?

I can’t tell you how many people (even healthcare providers) get this wrong. Since 70-80% of all joint pain is mechanical in nature – meaning something in the joint isn’t moving right, and thus, irritating the surrounding structures which can lead to inflammation – it’s critical you rule this out first. Cortisone injections won’t fix an underlying mechanical problem.

  • What are the long-term side effects of repeated cortisone injections?

This can be a bit of a trick question – because we already know the answer to this. Repeated cortisone injections cause joint and tendon damage. If your doctor is not already aware of the current research, or dismisses it, they are less likely to caution you away from the procedure when there could be better, more natural alternatives. It’s always important to be well-informed and advocate for yourself when you’re working with any type of healthcare practitioner and being recommended an injection or procedure of any kind.

  • What are the alternatives?

Have you already tried quality physical therapy treatment that is designed to address your underlying problem and help you get rid of your joint inflammation naturally? Pain relief is slower with this option, and can sometimes be worse before it gets better, but it’s more likely to result in long-term relief instead of short-term. Movement and exercise are considered the best medicine when it comes to joint pain, inflammation, and arthritis. You may need some guidance so as not to overdo it, but exercises such as Pilates and Yoga are gentle on your joints, allowing you for safe movement without exacerbating your pain in most cases.

When prescribed properly, cortisone injections do work. But sadly, for most people, steroid injections are oversubscribed, not always necessary, and disappointing when they don’t work or last.

I’ve seen too many cases over the course of my career where cortisone injections provide a false sense of hope, or worse, irreversible joint damage. For all of these reasons, I highly recommend you educate yourself, and consider all the risks and possible alternatives before you get a cortisone injection. I’m a huge fan of avoiding pills, procedures, and surgery and using natural movement and exercise to get rid of most musculoskeletal problems. If you’re looking to do the same – consider talking to a mechanical pain expert who can 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].

Orthopedic dry needling

The Top Four Benefits of Orthopedic Dry Needling and Why You Should Consider it.

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Orthopedic dry needling is a modern therapeutic treatment technique that has been adopted by physical therapists and medical professionals to alleviate pain and improve muscle function. But despite its escalating popularity, I’m still surprised at how many people are unaware it even exists.

What exactly is orthopedic dry needling?

Orthopedic dry needling involves the insertion of fine, sterile acupuncture needles into myofascial trigger points (“knots”), tendons, or muscles that are typically painful, stiff, or causing discomfort. Unlike acupuncture, which aims to balance and restore the flow of energy (“chi”) in your body, dry needling focuses on restoring your muscles and soft tissue back to their optimal state. During a dry needling treatment, a needle is inserted into specific areas to encourage blood flow and homeostasis, sometimes eliciting a ‘twitch’ response in the muscles. The needles may remain in place for a short duration, or may be removed quickly, depending on the condition being treated. Dry needling is backed by scientific research and has been shown to work effectively. It’s thought to turn off trigger points, ease muscle tension, reduce inflammation, and relieve pain – all to help improve how your muscles perform and work.

Here are the top 4 benefits of orthopedic dry needling and why you should consider this treatment technique if you haven’t already:

1. Pain Relief 

Dry needling can quickly alleviate pain, which means you can get back to your regular activities sooner. While the treatment itself can sometimes be painful, and lead to residual soreness 24-48 hours after your treatment, you’ll find that the positives far outweigh the negatives. Most of my clients find that a little bit of soreness right after the treatment is well worth the pain relief they experience afterwards. Dry needling works best for pain relief when it’s performed alongside functional and integrative therapies such as corrective movement strategies – which will result in long-lasting pain relief instead of more short-term.

2. Better Mobility

Dry needling does more than just relieve pain – it helps to enhance how you move. When muscles are tight, they can restrict movement and create a lot of discomfort. By releasing tension in tight muscles, increasing blood flow, and reducing inflammation – dry needling facilitates more comfortable and more extensive range motion in your joints. This allows you to move more freely and perform your favorite activities with less pain and restriction. In conjunction with corrective exercises and stretches, dry needling can be an extremely valuable tool for enhancing and maintaining good mobility.

3. Enhanced Muscle Function

Good mobility is just one aspect required for optimal muscle function. Your muscles also need to know how to activate properly and together. Sometimes – when you’ve been suffering from pain for a while – the muscles surrounding the problem area can “fall asleep at the wheel”. While you may be able to successfully get rid of your pain in a particular area, getting rid of and correcting the problem is a different story. I often say: “just because your pain is gone – does not mean your problem is gone”. If you don’t address underlying muscular compensations, your pain will eventually come back and sometimes it’s worse. The stimulation provided by orthopedic dry needling can help get your brain to pay more attention to the affected area, thus, helping “sleepy” muscles come back to the party and work like they’re supposed to.

4. Faster Recovery

When you’re injured, your body needs all the help it can get to heal. Dry needling not only enhances blood flow to the targeted area, but helps to create an environment for muscle regeneration as well – thus – helping to speed up the recovery process of injured or damaged soft tissue. Additionally, the improved blood flow aids in the removal of metabolic waste products and the delivery of nutrients to the tissues, fostering faster healing of the injured areas and less inflammation. This accelerated recovery is particularly valuable for athletes or weekend warriors aiming to return to their sport faster, as well as anyone looking to get back to their favorite activities as quickly as possible.

Should you consider orthopedic dry needling?

When I think of orthopedic dry needling, I think of it like a helping hand to feel better, move more freely, and enhance just about any other treatment you’re using alongside it. For example, a corrective exercise is only going to work if you can execute it properly. If you’ve got stiff, painful muscles that prevent you from performing your exercise or stretch that you know you need to do to help a particular problem – dry needling can be the magic in between.

It’s important to note that dry needling is not necessary or right for everyone.  So it’s important that you know what it is and when it can be used to improve your health. If after reading this article you think orthopedic dry needling could be something that you’re missing – talk to a qualified physical therapist or health care practitioner who practices dry needling – and ask if you’re a good fit for this treatment technique.

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].

Sciatica

Battling Sciatica? Here’s what to Avoid and what you should do Instead

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Did you know that nearly four out of five people will suffer from a debilitating back pain episode at some point in their lives and that it can result in sciatica?

“Sciatica” is a term used to describe searing pain, burning, or numbness that runs from your back and down your leg, often below your knee and into your foot. It occurs because something in your lower back is irritating the nerve that sends signals to your leg. It can be caused by anything that puts pressure on and/or irritates your sciatic nerve –  such as herniated or bulging discs. 

What a lot of people don’t know is that you can have sciatic symptoms without actually having any back pain. Sciatic symptoms can occur just in one place in your leg – like your knee and/or foot – or run down the whole leg as described above. Regardless of how your sciatica is behaving – there are some general “best practices” that almost all versions of sciatica will respond to. 

Here’s what you should avoid when you’re battling sciatica – as well as what to do instead:

What to Avoid:

1. Soft beds and couches 

While it may feel better in the moment – lying in soft beds or couches will ultimately aggravate your sciatica. When you lie in soft beds or couches – it forces you into a slouched posture – which puts unwanted pressure on your already irritated nerves. What’s tricky is that you often won’t notice the aggravation while you’re in the slouched position. It won’t be until later, perhaps when you get up to walk or move around, that you’ll feel worse. Because of this, people mistakenly attribute the aggravation of their sciatica to the activity they just did instead of the prolonged, slouched position they were assuming perhaps just minutes or hours before.

2. Child’s pose and stretching forward.

Just because a stretch feels good, doesn’t mean it is good – another big misconception when it comes to sciatica. Since sciatica is often caused by a bulging or herniated disc that is putting pressure on your nerve – you want to avoid anything that is going to increase that pressure. When you stretch forward – like in child’s pose – you’re opening up the space in between your vertebrae (intervertebral space). In between each vertebrae lies your discs. Although it feels good “in the moment” when you’re stretching forward – and may even temporarily relieve your sciatica – this relief won’t last. By opening up your intervertebral space – you’re making it easier for your discs to protrude out and irritate your nerves – unknowingly prolonging or worsening your sciatica.

3. Letting your MRI dictate treatment.

As already mentioned, sciatica often involves bulging discs – and an MRI will typically confirm this. But here’s what you might not know… Research has shown us that lots of folks (more than 60%) have bulging discs showing up on their MRI’s, but they don’t all have back pain or sciatic symptoms. What that means is that while sciatica is often caused by a bulging disc, a bulging disc doesn’t always guarantee you’ll have sciatica. Why is this important? Because when you allow your MRI findings to dictate your treatment plan, you’re more likely to undergo a procedure or surgery that might not be necessary. Removing the bulging disc material or fusing your spine together might take the pressure off the nerve temporarily, but if the underlying issue is a movement or mechanical problem, and it’s not addressed, it’s only a matter of time before your problem comes back and/or shows up in a different area of your spine.

What to Do:

1. Go for Walks. 

Walking is one of the best things you can do for back pain – even though it may seem counterintuitive to do so when you’ve got pain running down your leg. Walking is an upright activity that is generally good for sciatica versus the slouched, curved posture you have when sitting. When you walk, pay close attention to what happens in your leg. Do your symptoms worsen or start to get better? If they worsen, certainly stop and seek professional guidance. But if your leg starts feeling better – then the walking is likely good for your sciatica.

2. Pay attention to your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. When your sciatic nerve is irritated, it becomes highly sensitive to postural changes in your lower back (especially slouched postures). Whether you’re sitting or standing – you want to maintain the natural S-curve of your spine as best as you can. I recommend to my clients they use a lumbar roll whenever they are sitting to make maintaining this posture easier. Correcting your posture alone is often not enough to get rid of your sciatica, but it can keep you from getting worse, and prevent it from coming back if you’ve successfully eliminated your sciatic symptoms.

3. Talk to a Mechanical Pain Specialist.

Did you know that 70-80% of all musculoskeletal pain is mechanical in nature? Both back pain and sciatica can fall into this “mechanical pain” category – which is caused by slowly developing movement problems or habits that eventually result in stiffness and mobility restrictions in your spine. These restrictions can lead to irritated structures, such as nerves. So if your sciatica is due to a mechanical problem – it’s not going to permanently improve with pills, procedures or surgery. You’ll need to find a mechanical pain specialist who can help correct and restore your movement patterns for a long-term solution you can maintain on your own.

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

6 Reasons Your Back Surgery Failed

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Back surgery, often viewed as a last resort for those suffering from debilitating back pain, has become increasingly common in the last 15 years.

A quick Google search reveals that an estimated 1.5 million spinal fusions are performed annually in the United States alone. When you consider that 70-80% of all back pain is considered “non-specific” and does not require surgery – that number is staggering. Additionally, it’s been well documented that 20-40% of all back surgeries fail, resulting in what we call “Failed Back Surgery Syndrome”. So why then – do we continue to operate?

If you or a loved one is considering back surgery – I highly recommend you do your due diligence and research first.

To give you a head start – here are 6 reasons why back surgery often fails:

1. Incorrect Diagnosis

If the wrong diagnosis leads you to an unnecessary surgery – then your back surgery is going to fail. How does this happen? All too often we blame aging structures in the spine as the main source of our pain. But what many fail to understand is that arthritis and degenerating discs (for example) are a normal part of aging. Everyone has it – but not everyone has back pain. An aging spine is not a reason to get back surgery – so be cautious anytime someone blames arthritis or disc degeneration for your pain. It’s typically not the full story.

2. Surgical Complications

Surgical complications are a risk when you undergo any type of surgery – even when it’s coined “minimally invasive”. From anesthesia reactions, to accidentally nicking a nerve, to the possibility of infection – complications can occur – and some of them irreversible. Conservative therapy and natural treatments involving movement and exercise come with virtually no risk – and have better outcomes than surgery according to research. You want to make absolutely certain that a back surgery is warranted before you put yourself at risk for complications.

3. Scar Tissue

Scar tissue is an unavoidable consequence of any surgery and a necessary part of the healing process – but its impact is significantly underestimated. For some, scarring can get out of control and be excessive, manifesting itself similar to an auto-immune condition. For others, they simply have no clue that scars need to be managed and mobilized. Unmanaged scar tissue will become adhesive and may cause problems with your nerves, fascia, and general mobility. While there are treatments such as Shockwave therapy that can help regenerate damaged soft tissue from scarring – unmanaged scar tissue can be one reason your pain doesn’t resolve after back surgery

4. False Expectations

A lot of folks go into back surgery with false expectations. They think they’ll be out of pain and back to their activities in no time. But proper healing from back surgery is deceivingly long. While most incisions will technically heal in about 2 weeks – your body has a different timeline. Most people grossly underestimate the impact their condition prior to surgery will have on their recovery. Your pain may be gone after surgery, but all of the underlying, compensatory problems that developed leading up to your surgery have not magically disappeared. For example, it takes a minimum of 6-8 weeks to build and retrain muscle. If you had nerve impingement that was inhibiting a muscle from performing properly, it’s going to take several months to get that strength back. When this is not considered, and you jump back into activities too soon, you’re asking for trouble. False or mismanaged expectations about recovery after back surgery is a big reason for poor outcomes.|

5. Images are Misleading

X-rays and MRI’s do not tell the full story when it comes to back pain. And in most cases, they are misleading and can result in an incorrect diagnosis. For example, I already mentioned to you that most things you see in your images – such as arthritis, degenerative disc disease, and even bulging discs – occur naturally as you age. But they don’t always lead to back pain. Studies have shown that 60% of folks in their 50’s will have bulging discs on X-ray and 80% will have disc degeneration – regardless of whether back pain is present or not. These statistics only increase with age. If you allow your imaging alone to dictate your decision to get back surgery – you’re increasing your risk of it failing because it may not have been necessary in the first place.

6. Back Surgery Makes Money

At the end of the day, healthcare is a business. And back surgeries are among the most lucrative procedures in the medical industry. According to studies and statistical data, common back surgeries like lumbar fusion cost anywhere from $50,000 to $90,000. But it only costs hospitals a fraction of that amount to actually administer. Plus, despite its unethical nature, some surgeons have been reported to receive kickbacks for using certain medical devices and performing more surgeries. While this is an indirect reason for your back surgery failing, it’s not something you can ignore. The profitability of back surgery naturally lends itself to being overutilized when there could be better, natural solutions instead.


After all this, I hope you can see that back surgery isn’t a decision you should take lightly, and a good outcome should not be assumed.

Consider the statistics. Anywhere from 20-40% of all back surgeries fail and it could be due to any of the reasons we just looked at. Most back pain (70-80% to be exact) is considered non-specific and mechanical in nature, and can be resolved naturally with prescriptive exercises, lifestyle changes, and corrective movement strategies. It’s worth exhausting all of these options first before jumping into a surgical procedure that has a good chance of failing you.

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

How Back MRI’s Lead to more Invasive Treatments and Surgery

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If you’ve ever suffered from acute or long-standing back pain, you’ve likely wanted to “see inside” and know what’s going on. If this is you – you’re not alone in your thinking – and many medical doctors agree with this approach. However, evidence suggests that unwarranted MRI’s on your back can lead to unnecessary invasive treatments and surgeries, which often result in more harm than good in the long-term.

Let’s take a look at the research.

As part of their International Choose Wisely Campaign, the BMJ (British Journal of Medicine) published findings of a 2020 study that investigated what happens when back pain sufferers get MRI’s done too early (defined as less than 6 weeks into an episode and absent of any red flags). In more than 400,000 patients, those who received early MRI’s on their back were more likely to undergo back surgery and be prescribed opioids. And worse – they had higher pain scores at 1-year follow-up than those that didn’t get an MRI. This is not an isolated study. There is mounting evidence that indicates when MRI’s are done too early or unnecessarily – it leads to more surgery, more invasive treatments, more negative perceptions and catastrophization of spinal conditions, and overall – poorer outcomes.

So when is a back MRI needed? 

When you’ve got any alarming symptoms (known as “red flags”) you should absolutely get an MRI. These include signs of cancer, infection, inflammatory disease, possibility of fracture, or severe neurological deficit. Qualified health care practitioners are trained to identify these red flags. However, they are seen in only about 5-10% of all back pain cases. For context, in my two decades of treating patients with back pain, only three had these serious symptoms. This isn’t to downplay severe back pain cases, but to emphasize that most back pain patients don’t need an MRI for a proper diagnosis and treatment plan. And if you get an MRI when you don’t need one – you might end up with unnecessary treatments or surgeries, be prescribed opioids, and are likely to feel generally worse about your back pain.

The problem with relying on back MRI’s

When you get an MRI of your back – the problem is it shows you everything.

You’ll see a comprehensive view of bulging discs, arthritis, stenosis, and degenerative discs – which are all common findings – but also a normal part of aging. Everybody gets them whether you have back pain or not. But because we haven’t done a good enough job of normalizing these findings – they often get blamed for your back pain when seen on an MRI. But the research shows you can’t reliably correlate your MRI findings to the true cause of your back pain. In fact, they’ve compared MRI’s of people with and without back pain and found they can share almost identical results. In a set of publications known as the Lancet series, Martin Underwood, MD, co-author and professor at Warwick Medical School, said: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Confused? I don’t blame you.

The truth is, about 70-80% of all back problems, even sciatica, are considered what we call “mechanical” in nature. Your pain will come and go, you’ll have good days and bad days, and you’ll often feel better with movement. Mechanical back pain cannot be diagnosed by an MRI – it’s diagnosed via repeated movement testing to see what triggers and relieves your back pain. And it’s treated with corrective movement strategies designed to get rid of your pain and keep it gone. If you undergo an MRI for what’s essentially mechanical pain, you risk receiving treatments that are not only unnecessary, but can exacerbate the problem. Remember, you can’t reverse a back surgery. And complications related to back surgery are complicated to treat. You owe it to yourself to exhaust all possible conservative treatments.

If you’ve been suffering with back pain for years, I know it’s frustrating.

Consider speaking to a mechanical back pain expert who can help you accurately determine the root cause of your back pain with corrective movement strategies instead of a back MRI.

Give yourself a chance to resolve your back pain naturally instead of resorting to invasive treatments or procedures.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request a seat in her upcoming Masterclass for Back Pain & Sciatica – visit her website www.cjphysicaltherapy.com or call 603-605-0402

work out

5 Ways Working Out Can Aggravate Your Back

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The research continues to show that the best “treatment” for back pain is exercise. But for some, a work out is what actually aggravates their back. This is a common frustration I hear from clients. They know that strengthening their core and working out is good for their back. But when they do – they suffer. 

Here are five ways your work out is aggravating your back:

1. Misguided Exercise Choice

While the research isn’t wrong about exercising and back pain – not all exercises are appropriate depending on the type and severity of back pain you’re experiencing. For example, walking is considered one of the best activities for back pain sufferers, but for some, it’s excruciating. Strength training and lifting weights should be an essential part of back pain rehabilitation (and prevention). But if it’s done haphazardly, you’re going to have problems and likely aggravate your back. “Exercise” is not what causes problems for most people – it’s exercise choice. And when you make the wrong choice and aggravate your back, you tend to do the worst thing possible – rest and avoid exercise altogether. There is a middle ground when it comes to exercise and back pain. Working with an expert who understands this is essential.

2. Premature Stability Training

Stability training is an important part of back pain recovery – but I often see it introduced too soon. “Mobility before stability” is my mantra. If you don’t have full mobility in your spine, there is a reason, and it must be explored. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You don’t want to stabilize this scenario. You want to restore proper mobility first and then stabilize your spine. I can’t tell you how often I see people making this mistake. When it comes to back pain and working out, mobility-first is a must. If you’ve got a stiff back but have been trying to stabilize it – this could be why your back is getting aggravated when you work out. Stability work has been introduced too soon.

3. Poor Core Activation

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your “6-pack abs” are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or when performing complicated, coordinated movements such as tennis or golf – you’re setting yourself up for injury. The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. If you’re constantly having back pain every time you work-out or exercise, it could be that you lack the ability to activate your core properly – and/or when you need it.

4. Poor (or non-existent) breathing technique

Not breathing properly – or not breathing at all – can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, deep back muscles, pelvic floor musculature, and your diaphragm. Your diaphragm is what controls your breathing. Let’s say you hold your breath when you exercise. This means your diaphragm isn’t expanding or contracting, which impacts the other four muscle groups in your deep core. All four muscle groups must work together in order for your core to be functional and strong. Plus – when your diaphragm – or any other muscle group in your deep core can’t work like it should – you get unnecessary pressure and strain on your back muscles. If you’re constantly aggravating your back every time you work out – make sure you’re breathing properly. Or at the very least, not holding your breath.

5. Improper form

Perhaps the most common reason working out aggravates your back is because you’re not using proper form. There’s a lot of people out there who think posture and form don’t really matter. But they do. When you lift weights, for example, you’re adding load to your spine. It’s essential you have good form and technique when your spine is under load or stress. The tricky thing about form, however, is that you can get away with poor form for a time. It might not hurt the first time you lift with improper form – or the fourth – but by your 100th rep – your back will start talking to you. Same goes for body weight exercises. Just because you aren’t adding load to your spine in the form of an external weight, doesn’t mean you can’t still aggravate it by doing the same movement over and over poorly. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture. Otherwise – if you haven’t aggravated your back yet – it’s only a matter of time.

If you’re always hurting your back when you work out – it’s likely due to one of these five reasons.

Get expert help to figure out which one it might be – because at the end of the day – exercise is good for your back – and you don’t want to avoid it or dismiss it when there could be a perfectly reasonable explanation

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

Consider speaking with one of my specialists – we will ask you all about what’s been going on with you and see if we would be a good fit to help! 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 request one of her free guides for getting rid of back pain – visit her website www.cjphysicaltherapy.com or call 603-605-0402

Osteoporosis

5 Ways Pilates can help Manage Osteoporosis

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Osteoporosis is a “silent” disease of the bones that makes them weaker and far more susceptible to breaking.

The Bone Health & Osteoporosis Foundation estimates that approximately 10 million Americans suffer from this disease, and another 44 million have low bone density. Osteoporosis affects one in two women and one in four men. A woman’s risk of breaking a bone when she has osteoporosis is equal to her combined risk of breast, uterine and ovarian cancer. For men, they are more likely to break a bone than get prostate cancer. Hip fractures are common with osteoporosis, and of the nearly 300,000 folks who fall and break their hips, 25% end up in nursing homes and never get back to their previous function.

If these statistics don’t scare you, they should. But the good news is there are plenty of things you can do – starting right now – to help protect yourself from this condition. When you research osteoporosis, diet and exercise consistently come up as key prevention strategies. When it comes to exercise, you want to make sure it focuses on healthy resistance exercises, mobility, flexibility, and balance. 

Well… there happens to be one exercise system that accomplished all of this. It’s called Pilates.

Here are 5 Ways Pilates can help manage your Osteoporosis:



1. It’s a weight bearing exercise

One of the primary recommendations for preventing and managing osteoporosis is to engage in weight-bearing exercises. Well here’s the amazing thing about Pilates – the entire exercise system is based on bearing your own weight through various movements. Pilates gradually progresses you through postures of lying, kneeling, and standing – on both hands and feet – allowing you to bear weight through multiple planes and postures. This makes Pilates an excellent choice for those wanting to better manage their osteoporosis.


2. It improves muscle strength

You might be wondering… how does improving muscle strength help with bone strength? As your muscles become stronger, they pull harder on your bones, which helps improve the inherent strength of your bone. Plus, stronger muscles provide more support to your skeletal system as a whole, putting you at less risk of a fracture. Pilates in particular focuses on core strength – which is key for providing support to all your other muscles. And when you use the Pilates equipment to enhance your practice, you’ve got the resistance of springs putting special focus on all your tiny muscles, which helps strengthen areas of your body that might be inaccessible via traditional strength training methods.

3. It enhances flexibility and range of motion

It’s quite common for your joints to get stiffer and your flexibility to be impacted when you’ve got osteoporosis. You may think this is inconsequential – but stiffness and immobility can actually create more stress on your bones – which is what we’re trying to avoid. Pilates exercises emphasize the stretching and elongation of muscles, which inherently improves your range of motion. This will not only make you feel better – but makes doing everyday tasks a lot easier and they’ll feel less stressful on your body – which is important when you’re dealing with osteoporosis.


4. It encourages proper alignment and posture

Over time, osteoporosis can lead to unwanted changes in your spine, such as a stooped or kyphotic posture. Not only will these changes make it more difficult and uncomfortable to sit upright and move around, but they can make the bones (vertebrae) in these deformed areas of your spine more susceptible to damage. Pilates can help prevent and reverse these changes. Pilates emphasizes lengthened and proper spinal alignment and helps you to become more aware of your posture during the day. If you want to avoid (or even reverse) a slumped and kyphotic posture – with or without osteoporosis – Pilates can help.

5. It helps improve your balance and stability

Fall prevention is critical for those living with osteoporosis. And one of the best ways to prevent falls is to work on your balance. One might not think of Pilates as playing a key factor in this, however, Pilates is an exercise system that not only focuses on your core, but your feet as well. Everyone knows that a stronger core is going to make your whole body feel more stable. But when you’ve got feet that are more mobile and more in-tune with the ground – it dramatically improves your balance – making Pilates a safe and healthy way to not only improve your balance but decrease your risk of falling.

The best management of osteoporosis requires a multifaceted approach – and factors such as diet, nutrition, and exercise modifications must all be considered. Pilates is just one factor in the mix. But I like it because it hits on so many areas that are critical for the successful management of osteoporosis. If you’ve never tried Pilates before, I’d highly recommend giving it a whirl.

But be sure to get approval from your doctor first, and enlist the help of a movement specialist who understands how to work with someone suffering with osteoporosis.

Local to Portsmouth, NH? Consider speaking with one of my specialists 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 enroll in her upcoming OsteoCore Strong Bones Program – visit her website www.cjphysicaltherapy.com or call 603-605-0402

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Using Exercise as Medicine. A Natural Alternative to Pain Pills.

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Using Exercise as Medicine. A Natural Alternative to Pain Pills.

We are inherently designed for motion from the moment we are born. But if you look around – we simply don’t move enough. Compared to our ancestors, our modern lives have us sitting (on average) for more than half our day. Fit bits and smart watches help combat this by alerting you to stand and get more steps in – but it still doesn’t seem to be enough. 

In today’s sedentary world, physical inactivity has become a significant health concern. In fact, the World Health Organization identifies physical inactivity as the fourth leading risk factor for global mortality. Lack of movement and exercise has many adverse effects but most notably – more musculoskeletal problems and pain.

While over-the-counter pain pills and prescription medications are the standard go-to for pain management – research increasingly indicates that regular exercise as medicine is just as effective – and certainly healthier.

Let’s explore how exercise can be used as medicine – so you don’t have to rely on pain pills next time you experience something like back, knee, neck, or shoulder pain.

Exercise Mediates Pain

The way we perceive pain is complex. Many assume it’s a direct response to physical damage or injury – but it’s not that simple. The perception of pain involves numerous physiological and psychological factors that the brain must interpret. Depending on your general health, past experiences, and mental health condition, this can vary quite drastically from person to person. In other words – it’s your brain that decides how much or how little pain you experience.

Because of this complexity, external factors like exercise (and also pain medication) can alter how we perceive these signals. When we exercise, our bodies exhibit an increased tolerance towards pain, and a lower perception of pain intensity. This phenomenon is called “exercise-induced hypoalgesia” – and it works by closing down the gateways that allow pain signals to enter the brain. Certain medications can do this too, but when you exercise, you’re doing it naturally.

Exercise Helps Inflammation

Inflammation is a normal part of your body’s healing process, and it occurs when inflammatory cells travel to a place of injury. However, if inflammatory cells stick around too long, it can result in chronic pain and irritation. This is where exercise can really help. 

When you exercise, your body experiences minor physiological stress, which triggers your body’s natural inflammatory reaction. During the inflammatory process, certain proteins called anti-inflammatory cytokines are produced. These protein chemicals help to modulate the body’s inflammatory response – ultimately reducing the level of inflammation associated with your pain. Inflammation can be both good and bad. When you exercise, you are creating “good” inflammation, which will naturally ease your pain.

Exercise Stimulates Endorphins

Every wonder why a quick walk outside, or a strenuous gym workout just magically makes you feel better? It’s not your imagination. It’s something called endorphins – neurotransmitters released by your brain to alleviate pain and promote pleasure. 

Endorphins are considered your body’s natural “opioids” – because they interact with the same pain-inhibiting receptors in your brain that drugs like morphine would. But unlike morphine, endorphins are triggered naturally and don’t come with all the harmful side effects. Exercise stimulates the production of endorphins – and ultimately – your very own stash of natural and healthy painkillers.

Exercise Improves your Mental Health

Ever heard of the phrase “mind body exercise”? It’s coined from the fact that exercise and mental health share a powerful connection. It’s virtually impossible to influence one without the other.

Regular exercise stimulates the production of various mood-boosting chemicals such as our new friends, endorphins – along with serotonin and norepinephrine. Aside from helping to control pain, endorphins are also considered a “feel-good hormone”. They trigger feelings of positivity that, once again, are similar to morphine. Serotonin and norepinephrine are instrumental in alleviating symptoms of depression and anxiety. Therefore – when you exercise – it’s virtually impossible not to feel better. And since we know that pain is controlled by your brian – anything that improves mental health is going to be beneficial in your relationship to pain.

Exercise as a Prescription

OK – so we’ve discussed the multitude of positive effects that exercise has on pain perception, inflammation, and mental health. But what if you’re currently suffering from an injury? Is it possible to still use exercise as a pain reliever? The short answer is yes. But it’s challenging to do on your own. You can’t just google “best exercises for back pain” and expect good results.

When it comes to using movement or exercise to rehab an already existing injury – it needs to be carefully prescribed. 

For all the reasons already discussed, physical activity will still help you modulate pain – but you must consider the role exercise is going to have on any potential tissue damage. With weakened or damaged tissue, exercise is still an effective pain reliever, but it has to be prescribed or you risk worsening your injury.

For these reasons, I always recommend working with a movement expert who truly understands the nature of musculoskeletal pain and tissue healing. If you start a general exercise routine because you want to feel better  – I applaud you – just make sure you’re getting your desired result.

But if you start exercising to help with pain and don’t experience any noticeable improvement – or you catch yourself modifying to work around your pain – then it’s time to enlist the help of an expert. Otherwise, you risk ending up on pain pills, which is exactly what we want to avoid.

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 a copy of one of her free guides to back or knee pain, visit her website www.cjphysicaltherapy.com or call 603-605-0402

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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].

Running Over 50: Top 3 Injuries and What you can Do

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If you love to run, then you’re probably no stranger to running injuries.

But if you love to run and you’re over 50, not only are you more likely to suffer a running-related injury compared to runners half your age, but you’ll tend to suffer from different categories of injuries as well. In older runners, we tend to see more soft-tissue related injuries versus problems with joints and stress fractures. Part of this is due to the fact that older runners may have been running longer. This predisposes them to more long-term wear and tear that is typically associated with soft tissue injuries like tendinopathy and plantar fasciitis. Older runners also are more likely to have altered their running mechanics over time, another factor that leads to injury. Either way, the good news is that once you know what to look for, you can take proactive measures to prevent these common running injuries as well as treat them naturally.

Here are the top 3 running injuries I see in people over 50 and what you can do:

1. Plantar Fasciitis

Plantar fasciitis is a condition characterized by a sharp, stabbing pain in your heel or bottom of your foot. It often worsens with the first steps in the morning or after long periods of rest. This discomfort comes from inflammation in your plantar fascia, a thick band of tissue running across the bottom of your foot from your heel to your toes. Factors such as overuse, improper footwear, high arches, flat feet, and tight calf muscles can all contribute to the development of plantar fasciitis, whether you’re a runner or not.

Prevention measures for plantar fasciitis include incorporating regular stretching and self-massaging of your plantar fascia and calf muscles before and after running. Balance exercises that focus on strengthening the intrinsic muscles of your foot, along with maintaining a healthy weight can also help – as it will allow you to better control and manage the load that gets transmitted through your plantar fascia. But what if you’re already suffering from pain due to plantar fasciitis? Don’t just resort to rest and ice, which has been known to impede healing. Plantar fasciitis requires prescriptive loading of your muscles in order to remodel the damaged tissue. This, along with non-invasive treatments such as Shockwave Therapy designed to enhance blood flow to the tissue, can aid in accelerating your healing.

2. Runner’s Knee (Patellofemoral Pain Syndrome)

Runner’s knee is a term used to describe a variety of conditions that cause pain around the kneecap (patella) – and is often synonymous with patellar tendonitis. You’ll notice your runner’s knee most during activities that require knee bending, walking downhill, or descending stairs. Overuse of your quadriceps muscles, poor tracking of your patella, and any other muscle or joint imbalance that results in increased load to the front of your knee can all result in runner’s knee. 

Regular and balanced strength training of the muscles around your knee – particularly of the quadriceps, hamstrings, and hip muscles – is a key prevention strategy. Making sure you have good ankle and foot mobility is also important. Because if your foot doesn’t move well when you run, unwanted forces move up the chain into your knee, eventually leading to runner’s knee. If you’re already suffering from runner’s knee, then you’ll want to first mitigate your pain. Similar to plantar fasciitis – rest and ice won’t do much for you. Getting blood flow to the area – followed by carefully prescribed exercises designed to restore your mechanics and properly load your patella tendon – is what’s going to heal the irritated tissue in and around your knee and make it stronger.

3. Achilles Tendinitis

Achilles tendinitis presents as pain and swelling in the back of your heel or lower calf. Right where your Achilles tendon connects your calf muscles to your heel bone. Your Achilles pain will typically be most prominent during or after running. It may be accompanied by stiffness when flexing your foot. While the causes of Achilles tendinitis are very similar to that of plantar fasciitis, we see this occur most often with sudden increases in intensity or duration of training. Particularly, this happens when your body is not adequately prepared.

A gradual increase in training load, regular calf strengthening and stretching exercises, and proper warm-up and cool-down regimens can go a long way in preventing Achilles tendinitis. Be cautious of your footwear as well. Minimalist running shoes have become extremely popular. But, if you move into them too quickly, your Achilles tendon could become irritated due to the sudden change in load and force. If you’re already suffering from Achilles tendinitis, the treatment is quite similar to that of plantar fasciitis. The exception is that when it comes to tissue loading, you’ll want to focus more on your lower calf and Achilles tendon, versus the plantar fascia.

With all of these conditions, keeping yourself healthy and in good shape is crucial for prevention.

Enlisting the help of a running coach is also a good idea. They can address any potential issues with your running mechanics that may have occurred over the years. If you’re picking up running for the first time, or returning to it later in life, take it slow and easy. Consider talking to a movement expert who can detect and analyze any imbalances in your body. They can ensure that you’re moving and exercising correctly. Imbalances will cause you to compensate. This is not something that will be immediately obvious to you – until it’s too late.