Tag Archive for: New Hampshire

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

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Nagging pain in your shoulder can be extremely annoying. But when it starts to interfere with things you love to do – you can’t help but wonder – Will a Cortisone Shot Help Your Nagging Shoulder Pain?

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast.

Just because cortisone shots are extremely routine and popular – it doesn’t mean they are the best or right thing to do.

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action.

But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom?

This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – it’s a problem if you keep getting cortisone shots when you don’t actually need them.

Why?

Well overuse of cortisone shots can cause degeneration of your tendons and joint structures. So you only want to get one when you know: 1) it’s going to help and 2) if it’s necessary.

But how do you know? The key is in understanding the source of your pain. With chemical sources of pain, the source is inflammation and a cortisone shot is a good idea. But when it comes to mechanical pain, inflammation may exist but it’s not the source of your shoulder problem. In these cases, cortisone is either not helpful – or worse – it “works” but then masks your problem, sometimes for years.  

Let’s talk about the two sources of Shoulder pain to help you understand.

 

“Chemical Pain”

Chemical pain is the result of your body’s natural inflammatory response to injury. It’s a complex chemical reaction that occurs after tissue damage that involves the releasing of chemicals from your blood and other cells to “flush out” the area and start the healing process.

A good example of this is when you fall and sprain something. The sprain causes temporary tissue damage so your body creates inflammation to heal it. Normally this process only lasts a few days, your pain subsides, and you’re back to normal in no time. But sometimes this inflammatory process lingers longer than it should.

For various reasons the accumulation of toxic chemicals sticks around and the result is constant irritation to the nerves and surrounding tissues. Constant, dull pain, even at rest, that tends to be very sensitive to any and all movement is often a tell-tale sign that you’re dealing with pain that is chemical in nature. In this case, a cortisone injection could be a good course of action for you.

“Mechanical Pain”

Mechanical pain does not need a cortisone shot and it won’t respond well to it. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. Eighty percent of all musculoskeletal problems – including shoulder pain – are mechanical in nature.

Now, the real problem is that whether or not your pain is mechanical, a cortisone shot often does take away your pain. Not only is this confusing – but many people question why they should even be concerned about this. Well – when the pain and inflammation you’re experiencing is secondary – which is often the case with mechanical pain.

 You never actually treat the true source of your shoulder pain when you “cover it up” with a cortisone shot.

For example, you might have an irritated rotator cuff tendon or arthritis that is exacerbated because of poor posture or immobility in your shoulder joint. If you inject cortisone into your tendon or joint, the pain will likely be relieved. But this will only be temporary. It’s only a matter of time before your poor posture and movement habits cause irritation and pain again. This is the vicious cycle I see a lot of folks get themselves into. You risk never fixing the real problem. And irreversible damage to your tendon that might eventually need to be fixed surgically. 

Moral of this story… don’t rush to get a cortisone shot just because you’ve been told you have inflammation.

You must figure out the source of your inflammation first. Cortisone shots are not necessary if your pain is mechanical in nature. And it might actually prolong your problem. If your pain comes and goes, or you have good days and bad days, this is a classic sign that your pain is likely coming from a mechanical source.

Your best course of action is to work with someone who understands and specializes in this. I’ve seen many cases where getting a cortisone shot provides a false sense of hope, and as a consequence, delays quality treatment that you should be getting instead. 

Are you local to Portsmouth, NH?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

If you can’t wait for the call  – get our free guide to neck and shoulder pain now. 

This totally free guide – written by leading back pain specialist, physical therapist, and movement expert, Dr. Carrie Jose – reveals seven easy ways (plus a bonus section!) that are PROVEN to help you ease neck and shoulder pain quickly – without pain medication, procedures, or surgery.

Click here to download the guide!

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] or call 603-605-0402

Neck Pain

Tech neck: What it is and How to Cure it

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Tech neck – also known as text neck – is a commonly used term to describe neck pain that results from overuse of various electronic devices. If you’re looking down at your cell phone or iPad too much, or sitting in front of your computer too long – and you feel pain in your neck – you are likely suffering from tech neck.

So what’s the big deal? Is this even a real syndrome?

I’ll be honest. I had my doubts at first. I’ve been a physical therapist for 20 years and when I first heard this term I thought it was a joke. But over the last 12-15 years I’ve seen more and more cases pop up and I can tell you with certainty that tech neck is, indeed, a real problem for people.

Tech neck – when allowed to go unaddressed – can result in headaches, tension into your upper shoulders, or even pain and tingling into your arms and hands.

The good news – it’s not only entirely possible to get rid of it – but you can learn how to prevent it all together.

So what can you do about tech neck? Here are three simple tips:

1. Be mindful of your posture

When you’re constantly looking down or hunching forward – it eventually wreaks havoc on your neck. Being mindful of your posture is not only the number one way to cure tech neck – but it’s the best way to prevent it.

The biggest problem with poor posture is that you don’t know it’s a problem until it’s too late. Postural problems take a lot of time to reveal themselves. The changes in your soft tissue and the wear and tear on your spinal joints that occur from being positioned poorly and repeatedly don’t happen overnight – and you rarely notice them when they are first happening.

Truth be told, “bad posture” on occasion is not bad for you and should not cause you any major problems. Poor posture all the time is where you get in trouble. That’s why simply being mindful of how you’re positioned when using your favorite electronic devices can go a long way.

2. Use headphones

Our spines crave movement but also alignment. But we don’t want alignment at the expense of other joints – namely – our shoulders. It’s not always comfortable to hold your phone or iPad in front of your face – which is what you need to do if you want to maintain optimal neck alignment when using your device. While great for your neck – this position can cause strain and tension in your upper shoulders.

For this reason I highly recommend using headphones. Especially wireless headphones. This allows you to keep your phone or iPad on your desk while freely sitting upright and talking. Headphones also allow you to use the speak to text feature quite easily so you don’t have to strain your thumbs or shoulders when talking to your friends, kids, or grandkids.

3. Interrupt your sitting and standing

Prolonged posture in any form is not great for you. Our bodies – especially our spines – crave movement. We hear a lot about the detrimental effects of sitting all the time – but standing all the time isn’t great either. When it comes to sitting, your lower back tends to hunch over time which forces your neck into that “forward head” posture when you’ve been sitting for more than 20 min or so. When you add an electronic device to the mix the effects are even worse.

Because of this – standing desks have become much more common over the past few years. But I see folks having problems from standing too long also. If you don’t have great core engagement, for example, which is important when you’re standing for prolonged periods, you might hold tension in your jaw or neck to compensate. This can create unwanted tension and stiffness in your neck muscles.

How do you combat all this?

Simply interrupt your position. Try not to stay sitting – or standing – longer than 30 min at one time. Your body – and especially your neck – will thank you.

Recognizing tech neck early is crucial and if you catch it in time – it’s very easy to cure on your own.

The problem is that it’s something that tends to creep up over time and not addressed until it’s too late. If you’re suffering from chronic headaches, or symptoms down your arms or into your hands – the tips I’ve given you here may not be enough to address the problem.

Don’t worry – you can still get help with these symptoms naturally and without pills and procedures – you will likely need some expert help.

Talk to someone who understands posture and the importance of healthy movement in your spine – they are the best people to help you cure and prevent tech neck.

Local to Portsmouth, NH?

Consider talking to one of our specialists free. They’ll let you know if you’re a good fit for what we do and get you on our schedule as quickly as possible! CLICK HERE to request a free Discovery Call with someone from my client success team.

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

tendinosis

The Number One Reason your Shoulder Pain isn’t Going Away

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Statistics show that shoulder pain impacts approximately 15.4% of men and 24.9% of women. The prevalence of shoulder pain also tends to increase and become more severe as we age, especially for folks in their 50’s.

There are many reasons why we get shoulder pain. It’s the most mobile joint in your body, making it more susceptible to injury. But why – for some – does it seem to just linger and not go away?

The number one reason is mis-diagnosis. Here are a few examples of what that looks like.

  • Your MRI says you have a rotator cuff tear – so you get surgery – yet the pain comes back or doesn’t fully resolve like they told you it would.
  • You’re told you have impingement syndrome – so you get arthroscopic decompression surgery – no success.
  • Perhaps you’ve been told you have tendonitis in your shoulder and need a cortisone shot – followed by physical therapy. Nope, that didn’t work either.

When it comes to shoulder pain, it’s critical that you know for certain the pain in your shoulder is actually coming from your shoulder. If not, you’re going to waste your time fixing the wrong problem and are more likely to get an unnecessary procedure or surgery. 

So – if your shoulder pain isn’t coming from your shoulder – then where is it coming from? 

The most common culprit is your neck or mid-back. In fact, studies have shown that 40% of the time extremity pain (including shoulder pain) comes from a source in your spine – even when you don’t feel any pain in your spine. 

Here are a few key signs and considerations to help you figure out if your shoulder pain has been misdiagnosed:

1. Where is your pain located?

When your pain is coming from your shoulder, the pain will be localized to your shoulder joint. True shoulder pain is felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But 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 pain deep inside of your shoulder blade into your mid-back – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem. 

2. 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 something like a bulging disc – or a restricted/faulty movement pattern that is irritating nerve roots in your neck. You might feel symptoms in 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 in your shoulder or arm – and not actually feel anything in your neck. If you’ve got more pain in your arm than you do your shoulder, be sure to get your neck fully checked out. This is a huge area of mis-diagnosis for those suffering with long-standing shoulder pain.

3. How is your posture?

Poor posture can wreak havoc on your shoulder joint – without you even knowing it. If you’ve got a really curved middle back, combined with a “forward head” posture, you’re just setting your shoulder up for failure. Chronic, poor posture will crowd the tendons and structures in your shoulder joint over time. Every time you raise your arm overhead, or try to lift something with an outstretched arm – there will be implications if you’ve got poor posture.

The tricky part about this scenario is that you really will have pain in your shoulder. You’ll have wear and tear of your rotator cuff, and you’re more likely to have degeneration in your shoulder joint that might cause it to feel weak. The confusion here is that the shoulder “problems” are actually symptoms. The real cause is your posture and it’s either been missed or not addressed. The good news is that if you address your posture, most of these “wear and tear” shoulder problems will go away naturally, and you can avoid unnecessary procedures and surgery. This problem flies so under the radar that it’s overlooked all the time.

If you’ve got a true shoulder problem and it’s been diagnosed correctly – it should go away with proper treatment.

If that’s not happening, it’s worth considering that the true source of your shoulder pain has been missed. Start by getting a thorough check of your spine.

Don’t know where to start?

You can request a free Discovery Call with someone from my client success team. They’ll let you know if we can help – tell you if you’re a good fit for what we do – and get you on your way to living pain free. CLICK HERE to request a free Discovery Call.

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Traveling

4 Tips to Avoid Neck and Back Pain When Traveling

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4 Tips to Avoid Neck and Back Pain When Traveling

Memorial Day weekend is the “unofficial” start of summer – and AAA estimates that 39.2 million people will travel this weekend. That’s 8.3% more than last year, and it’s going to mean the exacerbation of neck and back pain for a lot of folks out there – especially the over 40 crowd.

So why does traveling wreak such havoc on our spines? 

Road trips, planes and trains typically involve lots of sitting and driving, which necks and backs just don’t like when done frequently and for prolonged periods. You’re typically off your routine when you travel, and sleep on surfaces you’re not accustomed to.  Any one of these things – but especially when combined together – can flare up old patterns of neck and back pain.

The good news is there are lots of things you can do when traveling to ease neck and back pain. Here are 4 of my top tips:

 

1. Use the 30 Min. Rule

The biggest strain on your body while traveling is undoubtedly the prolonged periods of sitting – often in cramped spaces. Our bodies are made to move continuously throughout the day. Whenever possible, getting out of your seat often is critical for keeping your neck and back healthy and mobile. Motion is lotion. And one of the best things you can do for your neck and back is to interrupt any prolonged posture – especially sitting – once every 30 min. If you’re unable to actually stand for a few seconds, then try arching your back or stretching your arms up over your head while sitting. Do a few neck rolls and chin tucks to stretch your spine. The more you move, the better your spine is going to feel.

2. Use a Lumbar Roll

Our spine is made up of distinct curves for a very good reason. They are designed to balance forces and sustain shock – and it’s best if you can maintain them. When you sit, the curve in your lower back (lumbar spine) decreases, or sometimes disappears all together, when not supported. While it’s perfectly acceptable to sit like this for small increments of time, it will start to cause problems after several hours. Prolonged curvature of your low back puts unwanted stress on the discs, ligaments, and muscles in your spine.

Your neck also responds to this posture by assuming a position we call “forward head”. This can give you headaches, neck pain, and cause extra tension to occur in your mid back and upper shoulders. One of the best things you can do is use a cylindrical lumbar roll to help maintain the natural curve in your low back. If you’re driving, the lumbar support in your seat usually isn’t enough. Take a small towel roll, sweatshirt, or pillow and place it at the small of your back any time you’re sitting. You’ll find it’s easier to maintain the natural curves in your spine – and you’ll have a lot less strain on your neck and back.

3. Bring your own pillow

Sleeping on surfaces we’re not accustomed to can not only ruin a vacation but set us up for unwanted neck and back pain. If possible – bring your favorite pillow from home – or ask for extra pillows wherever you’re staying. If a mattress is too firm for you – you can use pillows to cushion areas of your body like hips and shoulders so that you don’t wake up sore. Conversely, if a mattress is too soft, you can use extra pillows to build up the surface under your waist if you’re a side sleeper, under the small of your back if you’re a back sleeper, and under your belly if you’re a stomach sleeper.

Lastly, if a pillow is too fluffy or too flat – your neck will end up paying for it. When you’re sleeping – the goal is to position yourself in a way that allows your spine to stay in neutral alignment. You don’t want your head tilted down or up – it’s the fastest way to stir up an old neck injury or wake up with a tension headache.

4. Extend instead of bend

Did you know that the average person bends or flexes forward between three and five thousand times per day? When you’re traveling – you’re going to be on the upper end of that metric. Our spines crave balance. And because of the disproportionate amount of time we spend bent over – we need to make a concerted effort to move our spines in the opposite direction. When you’re traveling – look for opportunities to be upright and mobile.

Walking is an excellent, therapeutic activity for your spine – plus – it’s a great way to see the sights wherever you’re going. When you’re practicing the 30 min rule, give your back and neck a nice stretch backwards each time you stand to interrupt your sitting. But probably more important than what you do during travel is what you do when you’re back home. Be cautious when jumping back into your typical gym or exercise routine. All the sitting and bending that comes with travel makes your spine vulnerable for injury. It’s very common to get injured a week or two after you’re home – seemingly “out of nowhere”.

 

Looking for more help with your neck and back pain?

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you get rid of your neck and back pain for good.

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

5 Summer Activities on the Seacoast to Keep You Active, Healthy, and Mobile!

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With the weather getting warmer, it’s time to start appreciating all the amazing assets that the Portsmouth area has to offer for summer fun! The best way to prevent back pain and all-around stiffness or soreness is to stay moving as much as possible, and what better way to do so than out in nature?

Here are some of our favorite places to walk, bike, and otherwise enjoy the outdoors!

 

1. Great Bay National Wildlife Refuge

The Great Bay National Wildlife Refuge includes more than 1,000 acres of protected land in Newington, NH. Its two main trails are open to both hiking and biking and offer a close look at the flora and fauna of the Great Bay area. While visiting the reserve, you might see bald eagles, foxes, otters, turtles, deer, and a huge variety of songbirds. There are two main trails for the public to explore this unique and largely untouched area. The half mile Upper Peverly Pond path is a boardwalk trail, meaning it is fully wheelchair accessible and inviting for both young children and seniors! The William Furber Ferry Way trail is a more ambitious, yet not intimidating, two miles that delves deeper into the forest and features a beaver pond and old orchard.

NH Wetlands

2. Picnic by the Sea at New Castle

New Castle’s Great Island Common is a perfect destination for a relaxed, yet active day spent outdoors. You can spend the morning kayaking, an excellent core and upper body workout, and then kick back with a picnic on the beach or lawn. The park area also offers a large playground if you’re accompanied by young children. No matter where you stand, you’ll have a breathtaking view of the ocean, multiple lighthouses, and boats entering and leaving the harbor.

3.  Take a bike ride around Portsmouth

Get some exercise in while riding along all of the scenic views that the Seacoast area has to offer! Port City Bike Tours brings groups on historic and coastal bike tours with 5 different routes to chose from for a private or public tour. All of the tour guides are local to the area and have a love for New Hampshire history and historic preservation!

4. Odiorne State Park

Odiorne is the ocean lover’s ideal hike- gorgeous views of the rocky coastline, twisting trails through the woods that open up onto a salt marsh, and a paved bike path all in one place. Odiorne is comprised of about 330 acres of protected land, and is open year round to walkers and explorers! In the summer, you can even go tidepooling while you walk along the shore. You might find sea stars, snails, minnows, crabs, and more! And you will undoubtedly see seagulls throughout the entire coastline walk. On the wooded trails, you could come across deer, songbirds, chipmunks, and squirrels. Odiorne is a great place to stretch your legs and get some fresh air while enjoying the seacoast at its best!

5. Try Stand-Up Paddleboarding

Stand-Up Paddleboarding is a perfect way to get a core workout in while enjoying the ocean! This low-impact outdoor activity has gained popularity over recent years not only for being great exercise, but also because standing at your full height above the water gives you a unique view of your surroundings – which are beautiful at any location along the Seacoast! The balance and core stability that goes into paddleboarding is something we focus on with our Pilates program as well. In fact, Pilates and paddleboarding would be great activities to pair this summer!

Is pain getting in the way of you doing your favorite summer activities?  CLICK HERE for a free discovery visit with one of our specialists to see how we can help!

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Hip Flexors Always Tight? Maybe stop stretching.

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When it comes to chronically stiff muscles – tight hip flexors are the second most common complaint I hear after tight hamstrings. Tight hip flexors are annoying, achy, and they often contribute to lower back pain. When your hips are always tight, it can interfere with your ability to enjoy walking, running, golfing, and just exercise in general.

Typically – the recommended treatment for tight hip flexors is to stretch – right along with advice to foam roll and massage. But what do you do when none of that works? What if no matter how often you stretch, the tightness just keeps coming back?

First, you need to make sure that the tightness you feel in your hips is actually due to tight hip flexors. Just because your muscles feel tight – doesn’t mean they are tight. 

Let me explain.

Your hip flexors (or any muscle for that matter) can feel tight for different reasons. They can literally be shortened and constricted – in which case – they need stretching – and lots of it. But they can also feel tight due to weakness or being overworked. If your hip flexors are weak, they are going to feel strained when you use them, which can create a sensation of tightness. If your hip flexors are compensating for another underperforming muscle group – say your deep core – then a sensation of tightness may occur because they are simply tired and overworked.

So the first and most important thing you need to figure out is what is causing the sensation of tightness in your hips. Are they actually short and tight? Are they weak? Or do they simply need a break?

Let’s do a quick anatomy review of your hip flexors to help you figure this out…

Your hip flexors consist of the muscle group located in the front of your hip and groin. They are responsible for bending (flexing) your thigh up and toward your chest. But they also play a role in stabilizing your pelvis and lower back – and this is where I see a lot of problems and confusion. The rectus femoris, part of your quadriceps muscle group, and your psoas, part of your deep abdominal muscle group, are the two major hip flexors. Your rectus muscle is the one primarily responsible for lifting (flexing) your thigh. When you are walking or running, and repetitively flexing your leg, this is the muscle primarily at play. Your psoas, on the other hand, is much shorter and has a connection to your lower back. Because of this, it has more of a stability role. When functioning properly, it will assist in exercises like the crunch or sit up, and also work alongside your deep abdominals and glute muscles to help you have good upright posture when you’re sitting or standing.

Let’s talk about the psoas for a moment, because this is where many folks I speak with are misinformed. The psoas gets blamed for a lot of things – most notably – tilting your pelvis forward and being the cause of low back pain. The theory is that if you stretch, massage, and “release” your psoas muscle, then you will balance out your pelvis and your back pain will disappear. Sadly, this is rarely the case. Most of the time, your psoas feels tight because it’s either too weak and not able to keep up with what it’s being tasked to do, or it’s overworking to compensate for your deep abdominals not working properly. Either way, the result will be an angry psoas that retaliates against you by feeling tight and achy. And stretching it over and over again will simply not work.

Now sometimes your hip flexors – particularly your rectus femoris – can get deconditioned from not being used enough – and this can result in actual constriction of your muscle tissue. This typically happens slowly over time, and is more likely to occur if you sit too much and aren’t very active. In this case, you actually do need stretching to fix the problem – but one of the reasons it doesn’t work – is because you aren’t doing it properly. When your muscle tissue is actually constricted – it requires a very specific stretching protocol to work. The days of holding a stretch for 30 sec and repeating it 3x are long over. If your muscle fibers have actually become constricted – the only way for them to improve their length is to remodel. They need a lot of stress to remodel (aka get longer) and the only way to accomplish this is to stretch repeatedly and often.

At the end of the day, if you’ve got chronically tight hip flexors and you’re stretching all the time, you’re either doing it wrong or shouldn’t be doing it at all. Perhaps you need to strengthen your hip flexors so they don’t feel so tense all the time? Or maybe your core isn’t kicking in and you need to strengthen that instead? Don’t stress yourself trying to figure it out on your own.

Talk to an expert who gets this.

Stretching a muscle that feels tight isn’t always your answer, and you’ll know this because stretching over and over just isn’t fixing the problem. 

Request to speak to one of my specialists to see if we are the right fit to help get to the root cause of your tight hip flexors. CLICK HERE to request a Free Discovery.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Shoulder Pain

Neck Pain Not Going Away? 3 Reasons Why

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Over 30% of people report they have neck pain, and of those, 50% will continue to have problems without any real answers or solutions. The last 2 years of the pandemic saw people becoming generally less active, falling off their routines, and working from home in less than optimal “work stations”. It’s no surprise that people are suffering from more neck pain than usual.

Having been a mechanical spine pain specialist for the last 10 years – and a physical therapist for just over 20 – I can tell you that resolving neck pain is trickier than resolving back pain.

And there are some good reasons for that. Your neck is the most mobile area of your spine – which makes it more complicated to manage – and the muscles in your neck are a bit more fragile than some of the bigger muscles in your lower back. The way you strengthen muscles in your neck can’t be approached in the same manner you might tackle your lower back – for example.

While there are several reasons for your neck pain not going away – the biggest culprit I have found is inaccurate diagnosis. Without an accurate diagnosis – your neck pain treatment fails – and it’s more likely you’ll be prescribed injections or pills to relieve your neck pain and get stuck with this treatment regimen for the long-term.

Here are three reasons why the root cause of your neck pain might be getting missed – and why your neck pain just isn’t going away:

 

1. Your neck problem is disguised as shoulder pain:

Shoulder problems are confused with neck problems more often than you would think. If this happens – you risk spending weeks (or months) trying to resolve shoulder pain that is actually a neck problem. Not only will your shoulder pain not fully resolve – your neck pain won’t either – and could actually become worse. Because your neck is so mobile, it’s easy for nerves in your neck to get irritated and refer pain into the middle of your shoulder blade, top of your shoulder, or down the side of your arm. When you consider this, it makes sense why neck problems are so easily mis-diagnosed as shoulder problems. It’s a very common scenario that not only results in neck pain not going away – but persistent shoulder problems too. My general rule of thumb – if you’ve been working on a particular problem persistently and consistently for 2-3 weeks or more without significant improvement – something is missing. You’re either treating the wrong thing or have the wrong treatment approach. It happens a lot with neck pain so be sure to pay attention to this common error – especially if you’ve got coinciding shoulder pain.

2. Your core is weak:

Lack of core strength is commonly associated with back problems – but believe it or not – it can have a lot to do with neck pain too. Most people are familiar with how muscles and joints are connected – but did you know your muscles and organs are connected as well? They’re connected by a web of tissue called fascia – and this connection is often referred to as myofascial. “Myofascially speaking” – your deep neck muscles are connected to your core. If your core isn’t functioning properly – your neck will try to compensate and it will result in neck pain. Do you consistently feel neck pain or tightness every time you do a core workout? This could be a sign that your neck is compensating for your core – and there’s a good chance proper core strengthening is what’s missing. It could explain why your neck pain isn’t going away no matter how aggressively you treat it.

3. Not working with an expert:

The anatomy of your neck, more so than the rest of your spine, is fairly intricate and quite mobile. Not only does this require special care and accuracy when it comes to examining your neck, it makes it easy for someone who is not expertly trained to miss things. For example, one of the most common things I see is someone thinking that full range of motion has been restored in your neck when it hasn’t. If you start strengthening your neck when it doesn’t have full mobility, you can run into problems later on that result in persistent pain. Additionally, strengthening the muscles in your neck, especially in a neck that hurts, needs to be done carefully. The muscles in your neck were designed for stability – which is very different from say – the muscles in your legs – which are designed for power. You can’t approach strengthening them in the same way. All too often I see neck strengthening exercises that are too aggressive for the small muscles in your neck. This results in unnecessary neck tension – and delayed resolution of neck pain.

Generally speaking – if you’ve been suffering from neck pain for a while now – and despite trying lots of different treatments you’re still having problems – there’s a really good chance you’ve got the wrong treatment approach because you’ve been misdiagnosed. Don’t settle for relying on pills or injections for the rest of your life. And don’t undergo any kind of surgery or procedure until you’ve truly exhausted all possible causes of your neck pain. Ideally, find a neck pain expert and work with them, particularly one who prioritizes natural, movement-based solutions over pills and procedures. If diagnosed properly, it’s not only possible to get rid of your neck pain naturally, but learn to keep it gone all on your own.

 

Ready to get rid of your neck pain?

Check out this totally free guide on 7 Easy Ways to Get rid of Neck & Shoulder Pain to learn easy tips that are PROVEN to help your neck and shoulder pain – without pills, procedure, or surgery. CLICK HERE to get the free guide.

 Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Back Pain

Is it Safe to Push Through Pain?

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“No pain no gain” is a common phrase we hear but is it accurate? Not always. And it’s important to know when it’s safe – and not safe – to push through your pain. While unpleasant – pain provides us with important information that when understood – can be extremely valuable.

But first, what is pain exactly?

Britannica.com defines pain as “a complex experience consisting of a physiological response to a noxious stimulus”. Say what? In simpler terms – pain is our warning mechanism. It’s designed to alert us of harmful stimuli that are primarily associated with injury or threat of injury. The key word here is threat. Not all stimuli are harmful, even if it elicits pain. And that is where our cognitive brain must kick in to interpret the signal of pain and decide… should or shouldn’t you push through pain?

So how does your brain decide?

Well, your brain learns how to deal with pain from experience. And how those experiences are shaped is important. For example, if your brain is conditioned to think that all pain signals are “bad” or harmful – it’s going to always trigger you to withdraw or freeze. While this might be the safest option from a glance, it’s not always the most effective, and it can cause you more problems down the line. In fact, this is how a lot of chronic pain problems are formed. Your body becomes hypersensitive to pain signals because your brain never learns how to interpret them properly. For some suffering from chronic pain – it’s because your brain has been conditioned to think all pain is dangerous and your body – in turn – will reject any attempt to rectify it.

The best response to pain is to examine how it behaves versus judging it at first glance. There are some instances where pain and damage are synonymous and obvious – such as burns, trauma, broken bones, etc. But for most musculoskeletal aches and pains – it’s not so clear. How your pain behaves in specific situations and over time is what’s most important and it’s how your brain learns what to do.

Does it get worse? Does your pain move around? Does it come and go? Does it get better and stay better the more you move? Or does it worsen the more you move? Understanding how your pain behaves is the first and most important thing to look at when it comes to pushing through your pain or holding back.

For example, let’s look at an acute back pain episode.

It’s typically debilitating, and the last thing you want to do is move. If you rest, your pain will eventually subside, but you’ve taught your brain that doing nothing is the best response, until you hurt your back again. This strategy will only get you so far. Eventually, rest doesn’t work anymore and you’re at a loss. Movement is almost always the best solution for back pain – even when it’s scary. The first time you try to move after a debilitating back pain episode is typically terrible. But the secret to movement is in its repetition.

You want to evaluate how your back pain responds to any given movement over time versus just once. Does it get better and stay better the more you move or stretch a certain way? Or does it only get better temporarily? The response you’re looking for is getting and staying better. This is the kind of experience that reinforces your brain to take an active approach to pain and appropriately push through it. When you have the opposite response, then you know to stop.

I like to think of pain’s behavior like a traffic signal.

When you move in a specific way more often and it feels better – green light – keep going. When you perform a specific movement and it feels worse – stop – that’s a red light. Yellow lights are murky and where you need to decide whether or not it’s wise to push through pain. If pain is not changing and staying the same – or you consistently have good days and bad days – then you might want to “push”. You’ll find yourself at either a green light or red light. This is where you get valuable and reliable information about your pain and know exactly what to do.

Pain is a complicated concept that even those in the medical field have difficulty understanding and managing well. I’m not a fan of managing pain via medication. While it might be a successful strategy for getting rid of pain quickly – it tells you nothing and gives you the best chance of it coming back again or living a life hooked on that medication. Eighty percent of the time the best “medicine” for pain is movement. Use these guidelines to help you figure out if you’re on the right track or not – but the best advice when it comes to getting rid of musculoskeletal pain is to talk to an expert who understands how pain behaves and can help you figure out how to manage it on your own.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Common Pickleball Injuries and what to do

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If you haven’t heard of pickleball yet, odds are good you will very soon. Pickleball is quickly becoming one of the most popular recreational sports in the US, especially in the over 50 crowd, and especially in Portsmouth and all around the Seacoast of New Hampshire. It’s essentially a cross between tennis, racket ball, and ping pong. The court is smaller than in tennis and the net is set lower. People love pickleball because it’s a great way to not only get exercise – but to socialize and meet new friends.

But like any other sport, injuries happen. And because injuries become more significant and harder to rehabilitate as you get older – it’s important to have an awareness about the common injuries that tend to occur in pickleball players and what you can do to prevent them.

Here are four of the most common injuries I see in Pickleball and what you can do:

 

1. Rotator cuff strains

Your rotator cuff is a group of muscles in your shoulder that play a critical role in both stability and mobility of your shoulder joint. Because pickleball involves repetitive swinging – your shoulder is at risk for overuse injuries and strains. To help minimize the risk of rotator cuff injury, it’s important to ensure that you have good mobility in your shoulder joint, and good mid-back or scapular strength. Your scapula is also called your shoulder blade – if your scapular muscles are weak – then your rotator cuff might be tasked with extra work or strain. The more mobile your shoulder is, and the more balanced the strength around your shoulder joint is, the more effective your rotator cuff will be when playing a repetitive sport like pickleball.

2. “Pickleball” elbow

This is pretty much identical to tennis elbow – known medically as lateral epicondylitis. It causes pain and tenderness on the side of your elbow or forearm – and happens due to overuse of your forearm muscles – typically due to poor mechanics above, below, or in the elbow itself. To prevent this, you want to make sure the areas above and below your elbow joint are strong and stable. Your shoulder needs to be both strong and mobile for when you swing – otherwise your elbow will compensate and try to help out. Your wrist needs to be stable when holding the racket – or your elbow will need to kick in and try to help. The ligaments and muscles around your elbow aren’t designed to do the job of both your shoulder and your wrist – so if you don’t give these areas some love – you could end up with pickleball elbow.

3. Ankle sprains

Because there is a lot of pivoting and starting/stopping directions during pickleball – it’s easy to sprain your ankle if you’re not careful. Most ankle sprains occur from rolling on the outside of your ankle. This results in bruising, pain and swelling of the ligaments along the side of your ankle. While this injury does heal over time, it can often result in chronic weakening or scarring of those ligaments as well as tightness in your ankle joint – which only makes you susceptible to future ankle sprains. It’s best to make sure you have a good warm-up before you play. One that conditions your ankle and feet for quick stepping and flexibility. You also want to make sure you have strong hip muscles. If your side hip muscles aren’t strong and helping you stay stable in your pelvis – your ankle will take the brunt – and you’ll be more likely to sprain it.

4. Achilles tendonitis

Your Achilles tendon is a very strong, thick tendon that connects your calf muscle to your heel. It’s responsible for generating a lot of power to help you spring off your foot and jump. Its power is generated from its ability to stretch and then contract. Therefore, your ankle needs to have good mobility in order for your Achilles tendon to do its job. If your ankle is stiff and tight, you could be at risk for developing Achilles tendonitis. One other consideration is the strength of your glutes (or butt). Calf muscles love to compensate for weak gluteal muscles. If that happens over and over, they become tight and can put extra strain on your Achilles tendon – since they are connected. So make sure your butt is strong and your ankle is mobile in order to help prevent this common pickleball injury.

If you’re a pickleball lover – or perhaps wanting to get into this popular sport for the first time – I hope these tips help you to become more aware of what you can do to protect yourself from injury.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH. 

 

morning neck pain

Neck Pain During Crunches? 3 Reasons why and what you can do.

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Abdominal crunches are one of the most popular “ab exercises” around. It’s a move that emphasizes your upper abdominal strength more so than your lower. You start by lying on your back – typically hands behind your head and knees bent – then lift your head and chest off the floor – “crunching” your upper body into a C-shaped curve. 

Over the years, many healthcare and fitness professionals have dismissed this exercise entirely claiming its ineffectiveness for working the core. While I agree that it shouldn’t be the only core exercise you do – the abdominal crunch does have its place. When done correctly, mastering this move can help you get up from the floor, and sit up out of bed with more ease and less risk of injury. And of course, you see this move a lot in exercise classes, so it’s important to know how to do this move correctly without hurting your neck. 

If you’re feeling crunches in your neck instead of your abs – here are the biggest problems I see and why they might be hurting you.

     1. You’re not using your abs. 

This sounds pretty obvious, right? Of course you use your abs when you crunch. Anatomically-speaking – it would be impossible for you to perform this move without some form of engagement with your abs. But many people don’t engage their abs enough or in the right way. And this can result in neck pain.

Here’s what happens. 

If you don’t engage your abs enough or in the right way during a crunch – your neck will often kick in to try and help. Eventually your neck gets sore from this because your neck muscles aren’t designed to be the primary mover during a crunch. One easy tip to try next time you do a crunch is to make sure you inhale deeply – and then exhale as you begin to crunch. At the same time, check in with your neck. Make sure you can easily turn and wiggle it side to side. If that is challenging – then you are likely using your neck to help you crunch and your abdominal engagement could use some work.

    2. Your neck is in the wrong position. 

When you’re doing an abdominal crunch your neck position is critical. There is an illusion that your neck moves during the crunch but it should actually stay pretty stationary. The ideal position for your neck is to begin with a slight nod of the chin (like you’re nodding “yes”) and then keep it there. The rest of the curling motion will come from contracting your abdominals to move your trunk. As you curl up, you want to keep a nice C-shaped curve of your upper body – and keep a tennis ball’s distance between your chin and chest. 

Most people either curl their neck too much, or not enough. If your chin is touching your chest you’re curled too much – and you’ll experience strain behind your neck. And if you keep your neck too straight you’ll experience strain in the front of your neck. Another common mistake with neck positioning during a crunch is jutting your head forward. This will put strain in your upper neck right behind your head. While any of these positions will cause temporary discomfort in your neck – they could lead to more long-standing problems down the line if not corrected. 

     3. You have an underlying neck problem. 

Sometimes you will get all of the above right – and still have neck pain when you perform an abdominal crunch. This could be a sign that you have an underlying neck problem – and doing a lot of crunches has just exposed it.

Let me explain.

Let’s say you have a small bulging disc in your neck that you weren’t aware of, or you thought was “fixed”. The curled position of your neck during a crunch can exacerbate this problem, even if you are using your abs correctly and following every tip I just mentioned above. 

Pay attention to what you feel during and after performing an abdominal crunch. If you notice pain that shoots into your shoulder blade, or any numbness or tingling down your arm (especially if past your elbow) – these are clues you could have an underlying neck problem that is being aggravated by crunching. You might experience these symptoms during your crunches, or even up to several hours after. Either way, symptoms like this could be a sign there is more to your neck pain than simply incorrect crunch-technique or weakness in your abs. And it would be important to talk to an expert about this.

If you’re experiencing neck pain during abdominal crunches – hopefully these tips give you a better understanding why – but most importantly – please know this is a very common issue and you’re not alone.

It’s partly why I created Pilates 101: Get [Your] Back to Health™

Although this program is primarily geared toward helping folks who’s back pain is keeping them from strengthening their core and exercising the way they want to…

We actually talk quite about about the relationship between your abdominals and your neck – and teach you how to “crunch” safely and correctly.

I’ve been personally teaching this program for the past 4 years – and previously – you could only do it live with me 1-2x per year…

But NOW – I’m excited to tell you that we’ve opened it up to the entire world!

We’ve had people signing up from all across the country right now – people who’ve been wanting to get help from me but couldn’t because of where they were located.

This program is not for everyone – but if you want to learn more and see if it might be for you – CLICK HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilatesin Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.