Category Archives: Musculoskeletal Health

Muscle in focus: Hamstrings

The hamstrings

I know I call this ‘muscle in focus’ but the hamstrings is really a group of muscles, three to be precise. At the back of the thigh, between the hip and the knee, semimembranosus, semitendinosus and biceps femoris all have two main actions, extension of the hip and flexion of the knee. They play a crucial role in standing up, walking, running, jumping… and are the major antagonist of the quadraceps. [1]

They are also the most injured muscles in the body.

Hamstring muscle injury is a common athletic injury, particularly for runners, running & jumping athletes like footballers, long & high jumpers, and dancers.

The most common cause of a muscle or tendon strain is overuse, which weakens the tissue fibers. Muscles and joints may also be forced to perform movements for which they are not prepared or designed, over stretching and potentially damaging the surrounding muscle or tendon. An injury can occur from a single stressful incident, or it may gradually arise after many repetitions of a motion. [2]

The word “ham” is derived from the Old English ham or hom meaning the hollow or bend of the knee, from a Germanic base where it meant “crooked”. … String refers to tendons, and thus, the hamstrings are the string-like tendons felt on either side of the back of the knee.

Injuries to the hamstring group of muscles can range from a minor strain to a major rupture. A minor or grade I tear to a hamstring will most likely heal with a small amount of physical therapy, such as massage and dry needling. A major, grade III tear or full rupture could be a major disruption to an athletes sporting career and may require surgery.

World Athletics Championships, 2017

Even someone at an Olympic level like sprinter Usain Bolt is not immune to injury, tearing his hamstring in the World Athletics Championships earlier this year.

How do they happen?

At the knee, these muscles act to slow down your leg as it swings forward very quickly during in preparation for footstrike. It’s this action that commonly leads to injuries because the muscle is trying to shorten and contract, but the knee is extending very quickly, which pulls on the hamstring and creates a tremendous amount of strain.

At the hip, these powerful muscles generate force just prior to the foot coming off of the ground as they extend the hip backwards. Injuries can occur at this point of the running cycle because these muscles are generating tremendous amounts of force to maintain, or increase, forward running velocity. [3]

What are the symptoms?

You don’t have to be an elite athlete to injure the hamstring. Over use, misuse and lack of stretching or massage can put you at risk. Even tight quadraceps can contribute to tight hamstrings.

Symptoms of a strained or torn hamstring could include sudden and severe pain during exercise, along with a snapping or popping feeling in the area, pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over; tenderness; bruising in the area. [4]

In severe cases, you can tear your hamstring from its point of origin on the ischial tuberosity (sit bones). This is called a hamstring origin avulsion. In extreme cases, an avulsion fracture will occur where the hamstring muscle tears the bone where it attaches off your pelvis. This happens after a sudden and forceful eccentric contraction of your hamstrings with your hip flexed, for example, when hurdling or performing the splits. When this occurs, it is necessary to undergo surgery in order to reattach the bones.  [5]

How is it treated?

If you feel you have strained or torn a hamstring muscle, the first thing to do is R.I.C.E.R. – Rest, Ice, Compression, Elevate and Refer, as in refer to a health care practitioner.

The risk of hamstring injury can be reduced with a regular stretching program and exercises. However, a strained or torn hamstring will need soft tissue therapy, some biomechanical assessment to find the cause of the injury, heat & ice therapy and stretching. Once the pain has eased, the muscle will benefit from gentle exercise and a strengthening program.

Static hamstring stretch

Straight leg hamstring stretch

Lying on your back, raise your leg straight up until you feel the tug of the muscle. Don’t over stretch or force the stretch. If you feel numbness in your foot, ease the stretch off a fraction until the numbness subsides.

Breathe deeply and hold the stretch for 30 seconds. Lower the leg and rest for 10 seconds. Repeat each leg 3 times.

If you need to support the leg, use a towel or belt looped around the arch of the foot.

 

To increase flexibility

Lie on the floor in a doorway or close to a corner of a wall.

Place one leg up against the wall, the other is straight on the floor and your buttock is as close as possible to the door frame or wall.

Extend the elevated leg and pull your toe own as much as possible until you feel a stretch behind your thigh.

Hold the stretch for between 10 and 30 seconds.

Active Stretch

If you’re a particularly flexible person, but still have tight hamstrings, you could benefit from an active stretch.

Lie face up with a theraband around the arch of the foot to be stretched. Bend this knee. Hold the stretch theraband in one hand, arm straight. Stabilize the thigh with the other hand.

Exhale, straighten the knee while lifting up on the theraband, until extended.

Lower the leg and repeat 5 times. Finish with a static stretch.

Foam rolling

Place a foam roller on the floor and sit on the floor supporting yourself with your hands.

Place the back of one thigh over the foam roller and the other leg on the floor for support. Support your core and have proper low back posture during the exercise.

Magnesium: what is it & what does it do for you?

I regularly recommend my clients use magnesium, either in the form of a supplement, topical cream or oil, or as salts dissolved in a warm bath.

But what is magnesium, and what does it do for our body?

The Science

Magnesium

Magnesium is a chemical element. It is the fourth most common element on Earth, and the third most common dissolved in seawater. Magnesium is the eleventh most abundant element by mass in the human body and is essential to all cells and some 300 enzymes.

The important interaction between phosphate and magnesium ions makes magnesium essential to the basic nucleic acid chemistry of all cells of all known living organisms. More than 300 enzymes require magnesium ions for their catalytic action, including all enzymes using or synthesizing adenosine triphosphate (ATP).

Now I don’t want this to turn into a boring chemistry lecture, but ATP is a complex organic chemical that participates in many processes, including providing energy for nearly all of the body’s metabolic processes and muscular contraction. 20% of the body’s magnesium is for skeletal muscle function.[1]

Magnesium is also an imperative part in;

  • Nerve conduction
  • The production of energy from carbohydrates and fats
  • The production and maintenance of healthy bones, including the synthesis of bone matrix, bone mineral metabolism and the maintenance of bone density
  • Maintenance of healthy heart function and normal heart rhythm.[2]

Where can we source magnesium?

The Source

Nuts, Greens, Cocoa & Spices

Spices, nuts & seeds, cereals, cocoa (W00T!) and leafy green vegetables are rich sources of magnesium. [3]

Thankfully, if we are not getting enough magnesium in our diet, or are experiencing symptoms of magnesium deficiency alternative methods for magnesium intake is readily available.

Bath salts

Magnesium chloride

Magnesium chloride is extracted from seawater and is more readily absorbed through the skin than other forms of magnesium, so it’s perfect for bath salts. It is not for ingestion.

Magnesium sulfate

Magnesium sulfate is more commonly known as Epsom salts. A great source of magnesium and available in most supermarkets and chemists, Epsom salts have been popular since it was discovered in the British town it was named after, in the 17th century. [4]

Topical creams and oils

As both magnesium chloride and sulfate are absorbed through the skin, they make great topical applications and are available in creams and oils that can be rubbed directly on the sore or cramping muscle. Great for carrying in your sports or travel bag and cant get to a bath.

Topical spray, supplements, bath salts

Supplements

Magnesium itself cannot be absorbed and needs to be bonded to another molecule to be absorbed. The most common bonding agents are oxide, citrate, glycinate, sulphate or amino acid chelate.

This is the least absorbed form, but also has one of the highest percentages of elemental magnesium per dose so it still may be the  highest absorbed dose per mg. This is a great general purpose magnesium if really Mg is all you need.  It makes a simple muscle relaxer, nerve tonic and laxative if you take a high dose.

This is one of the most common forms of Mg on the commercial market. This is Mg bonded to citric acid, which increases the rate of absorption. Citrate is a larger molecule than the simple oxygen of oxide, so there is less magnesium by weight than in the oxide form. This is the most commonly used form in laxative preparations.

In this form, Mg is bonded to the amino acid glycine. Glycine itself is a relaxing neurotransmitter and so enhances magnesium’s natural relaxation properties. This could be the best form if you’re using it for mental calm and relaxation.

Magnesium amino acid chelate is usually bonded to a variety of amino acids. In this form there is less magnesium by weight but the individual amino acids could all be beneficial for different things. Every formula is different so if you need both Mg and a particular amino acid, then this could be the way to go. [5]

Recommended daily intake of magnesium is;

  • 400 mg/day for men aged 19-30 years, increasing to 420 mg/day for those aged 31 and above,
  • For women aged 19-30 years, the RDI is 310 mg/day, increasing to 320 mg over the age of 30,
  • Depending on their age, the RDI for adult women who are pregnant is 350-360 mg/day.
  • The RDI for breastfeeding for those who are breastfeeding is 310-320 mg of magnesium each day. [6]

What happens if I don’t have enough magnesium?

The Symptoms

If you’re not getting enough magnesium in your diet then you may be experiencing symptoms such as;

  • Muscular cramp

    Muscular problems such as cramps, twitches, slow to recover from injury, aches and pains,

  • Fibromyalgia is sometimes linked to magnesium deficiency,
  • Migraines and headaches, including tension headaches,
  • Period pain and symptoms of premenstrual syndrome, including mood swings , fluid retention, premenstrual migraines,
  • Stress, irritability, insomnia and anxiety,
  • Fatigue, which may be a symptom of magnesium deficiency.

It may also play a role in helping to maintain cardiovascular health and healthy bone density.

What could be causing my magnesium deficiency?

The Seed

  • Stress (especially when prolonged or severe),
  • Inadequate sleep,
  • Profuse perspiration,
  • Excessive consumption of caffeine, salt, sugar and alcohol,
  • Heavy menstrual periods,
  • Eating large quantities of processed and refined foods,
  • The use of some multiple pharmaceutical medications,
  • Gastrointestinal disorders such as short-term diarrhoea or vomiting and conditions that affect your absorption of nutrients,
  • Getting older. [7]

Can I have too much magnesium?

Doses less than 350 mg daily are safe for most adults. When taken in very large amounts, magnesium is possibly unsafe.

Symptoms of magnesium overdose include;

  • diarrhea
  • nausea and vomiting
  • lethargy
  • muscle weakness
  • irregular heartbeat
  • low blood pressure
  • urine retention
  • respiratory distress
  • cardiac arrest. [8]

 

The best way to ensure you’re getting enough magnesium is to maintain a healthy diet of whole foods and steer clear of processed and refined foods. If you are getting regular cramps or muscular pain it might be a good idea to get some advice from your physical therapist.

Maintaining muscular health can be as easy as regular gentle exercise and stretching, fresh air and water each day, a 20 minute magnesium bath a week, some leafy greens and nuts in your diet and regular massage.

If you think you have a serious magnesium deficiency you should consult your doctor.

 

Have you ever used magnesium? How did it work for you?

Need a massage but in a lunch rush?

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Yoga or Pilates? What’s the difference? Which one is best for me?

Many of my clients, looking for a way to stretch and keep their muscles pain free ask me whether yoga or Pilates is a good option for them and which is best. The reality is that both are great ways to keep moving but are good for our bodies in different ways.

Pilates was developed in the early 20th Century by Joseph Pilates, a German physical trainer. He developed his concept of an integrated, comprehensive system of physical exercise, which he himself called “Contrology” through the study of yoga and the movements of animals combined with his knowledge as a gymnast, bodybuilder and boxer.

Reformer Pilates

Pilates is great for movement of joints and focused strengthening of the muscles. It can help strengthen areas that may be weakened by a sedentary lifestyle, injury or misuse of the area. It can help correct posture and motor skills through use of body weight exercises performed on the floor or with equipment such as the reformer or therabands, foam rollers and exercise balls.

Pilates equipment

Originating in India, yoga has been practised for centuries as a physical, mental and spiritual discipline. Various styles of yoga are popular today for developing greater strength, flexibility, relaxation and meditation. Popular styles throughout the world include hatha, iyengar and ashtunga yoga. Yoga can be used for improving the flexibility of the muscles and it will also increase the flexibility of the joints. Specific poses are said to massage organs, lengthen and strengthen muscles and tendons and promote inner wellbeing.

Yoga

While it’s impossible to tell how many people regularly practise both disciplines, it’s often said that yoga, with its countless offshoots and different styles is the most widely practised exercise system in the world. While Pilates estimate more than 25 million people worldwide as devotees, largely in western countries such as Australia, Canada and the UK.

Some experts say practising Pilates can help build strength to improve yoga performance. While stretching of yoga, will help relieve muscles sore from Pilates strengthening. As yoga and Pilates have different aims, it’s unlikely that combining the two would cause overuse. However, if muscles and joints are sore, give them time to rest and recover.

So which is best to incorporate into your routine?

Stretching

There is little scientific evidence to say which is best for what. Although I would say that if you are currently injured or not exercising that some stretching and prescribed or clinical Pilates instruction from a qualified physiotherapist or remedial massage therapist might be best. Starting yoga with an existing injury or little fitness could lead to further injury.

That said, gentle styles of yoga such as hatha and iyengar with a good instructor can be beneficial to all, especially for those looking for relaxation and guided meditation techniques.

Devotees to both disciplines will say that theirs is the better option. However, the thing to remember is that all movement is good movement, and the best exercise is always the one that you prefer – as this helps motivation and consistency, with improved and long-term results.

The best strategy? Try them for yourself and see what you like best.

Why Am I Sore After a Deep Tissue Massage?

Deep tissue massage is a style of massage that is usually practised with oil on skin, with a firmer pressure than relaxation massage. It’s aim is to reach the deeper layers of muscle and connective tissue than those underlying the skin.

How does it work?

iStock_000010728710XSmallOur muscles are made of tiny fibres call myofibrils. When our muscles are overused or misused the fibres can adhere together or tear. It’s not really known why this happens but we know that heat and compression helps to break down the adhesions, attracting blow-flow to the area and help heal the tears. This is where deep tissue massage can help.

Deep tissue massage promotes blood flow to the injured area and creates micro-tears in the muscle tissue, to speed up the healing process. Because of this, the area becomes bruised, and this is what causes the pain after the massage. Usually this is only felt when you touch the area that was treated, and normally wont be visible on the skin.

The pain you experience after a massage should only be likened to how you feel after a heavy exercise session, and not a worsening of the pain of your injury that was treated. If your injury feels worse then the massage may have been too firm, or that your condition cannot be remedied with massage.

Who can benefit from deep tissue massage?

Hip painAnyone suffering from chronic or acute muscle tension. This can be caused by overuse or misuse, a pre-existing condition or recent injury.

Deep tissue massage can break down old scar tissue left from injury or surgery. It can help alleviate tension built up from conditions like arthritis or inflammation in the joints. It can help manage pain from poor posture or repetitive motion like sitting at a desk all day, using tools or long hours exercising.

What to expect in a massage?

Your massage therapist will start with a kneading style of massage, generating some heat in the tissue to start to warm up the muscle and help you relax. They then might perform firm stripping motions in the direction of the muscle they are treating. A good massage therapist will normally (but not always) be able to feel the change in tissue tension and know where you are tight, where you have trigger points and taught bands.

shutterstock_412363579Unfortunately this can often be uncomfortable. Your massage therapist should always work within your pain threshold and ask you if the pressure is okay. They may even ask you to grade the pain out of ten. Don’t be afraid to speak up if the pressure is too much for you. In this case, pain is not gain. Too much pressure may be doing further damage to the muscle and cause your injury to flare up further.

The massage therapist will just their palms, knuckles, fist, forearm and even their elbow. The speed of the strokes will most likely be slow and even stop and hold at points with more tension until it eases.

Don’t forget to breathe

Be sure to breathe throughout the treatment, this may sound obvious, but you’d be surprised how many people hold their breathe to cope with the pain. If you need to hold your breath, then the pressure is too much. Deep breathing can help you tolerate more pressure and the oxygen will help the muscles release. Your massage therapist may even ask you to take a deep breath ‘into the muscle’ that they are treating.

What to do after a massage?

shutterstock_252553801Your massage therapist should give you after care advise. It is recommended you rest after your massage, drink plenty of water to replenish fluids that have been flushed out during the massage and apply heat to the area you had treated. This will help your muscles recover from the massage and recover from your injury. Another great way to ease muscle soreness after a massage is to have an Epsom salt bath.

Bursitis: what is it and how can massage help?

What is bursitis?
Bursitis is the inflammation of the bursae. Bursae are small sacs of synovial fluid throughout the body. The bursae primarily rest where muscles and tendons slide across bones, to allow smooth movement of the joint.
When inflammation in the bursae occurs the tracking of joints, muscles and tendons becomes difficult and painful. This can result in stiffened muscle.

Hips, shoulders, elbows and knees are the most commonly affected.

What causes bursitis?
A number of things can cause bursitis. Most commonly repetitive movement and excessive pressure on the joint. Other causes include trauma to the joint like a knock or fall, autoimmune disorders, infection and medication.

Who gets bursitis?
Anyone that has had a joint trauma is at risk of developing bursitis. Also those in professions that require repetitive motions or pressure on the joint, such as cleaners, students, trade 2102_LayCarpet_25workers, and athletes particularly in impact sports such as football, rugby and roller derby are all at risk.
Those with other inflammatory conditions such as arthritis, diabetes and systemic lupus can also be at risk.

How is bursitis treated?
Your GP may refer you for an ultrasound scan to diagnose the inflammation. They are also likely to prescribe a course of NSAIDs. Once the inflammation has subsided physiotherapy and soft tissue therapy is recommended.

Your GP may recommend a cortisone injection into the sight of the bursae for persistent inflammation.

Qualified therapist doing pressure point massage on a womans hip

Qualified therapist doing pressure point massage on a womans hip

How can massage help?
Although massage cannot cure bursitis, it can help alleviate the muscle pain and tension that is either a result of the inflammation or the cause. A massage therapist will work to release taught bands and trigger points in the agonist and antagonist muscles; above, below and opposite the site of the bursitis.

What can I do to help alleviate bursitis?
In the 72 hours following the trauma or onset of pain use the RICE (rest, ice, compression, elevation) first aid for the injury. The less you can use the joint, the better. This will help stop inflammation from getting worse. Ice will also help reduce the inflammation and pain.

Once inflammation has eased, massage, gentle stretching and heat to the surrounding muscles will help ease soft tissue pain.

The once soft tissue pain has eased strengthening exercises can be used to help rehabilitate the joint and the muscles around it.

Stretching; the when, what and how.

When should I stretch ?

In the first 24-72 hours of injury the best treatment is R.I.C.E.R. (rest, ice, compression, elevation, and referral). At this stage, stretching is not advised. It’s best to rest the injured area and apply ice for 10 minutes of every hour until the swelling goes down.

Head to the emergency department if you think you may have a bone fracture or to your health physician for further investigation.

After the initial 72 hours, with clearance from your health physician, you can start some rehabilitation techniques over the next 10-24 days.

Over the period of 2 to 5 weeks you should aim to regain your flexibility, strength, power, muscular endurance, balance and co-ordination.

Long term, once you have recovered from your injury, it’s time to regain fitness, strengthen the injured area and improve flexibility.

When we talk about injury, this doesn’t always mean a serious injury. It could be anything from also waking up with a stiff neck or straining a muscle while picking something up to tearing a muscle during sport or exercise.

What types of stretches are there?

Static Stretching

Static stretching is used to stretch muscles while the body is at rest. It is composed of various techniques that gradually lengthen a muscle to an elongated position (before the point of discomfort) and hold that position for 30 seconds.

Passive Stretching

Passive stretching is a form of static stretching in which an external force exerts upon the limb to move it into the new position. This is in contrast to active stretching. Passive stretching resistance is normally achieved through the force of gravity on the limb or on the body weighing down on it.

Active Stretching

Active stretching eliminates force and its adverse effects from stretching procedures. Active stretching stimulates and prepares muscles for use during exercise. … Agonist refers to actively contracting muscle or muscles while their opposing muscles are termed antagonists.

PNF Stretching

Proprioceptive Neuromuscular Facilitation (PNF) is a more advanced form of flexibility training that involves both the stretching and contraction of the muscle group being targeted. PNF stretching is a very effective for rehabilitation.

Dynamic Stretching
Dynamic stretching is a form of stretching beneficial in sports utilizing momentum from form, and the momentum from static-active stretching strength, in an effort to propel the muscle into an extended range of motion not exceeding one’s static-passive stretching ability.

When should i use these stretches?

Static and passive stretching should be used in the early days after injuring.

PNF stretching can be used in the later weeks as the muscles are beginning to regain their strength. This type of stretch is often performed with a physical therapist.

Dynamic and active stretches should only be used when the muscles are healed and are strengthening. They should never be forced and always a controlled action.

What techniques do i use to stretch?

  • Focus on the muscles that are sore;
  • Ease into the stretch, do not over stretch or force the muscle into position or into pain;
  • Hold the stretch for 20-30 seconds;
  • Breathe! Oxygen helps the muscle release;
  • Stretch both sides. The other side is likely to be carrying the work of the sore muscle.

Stay tuned!

In the coming weeks I will be adding some fact sheets on stretching routines for each of the major muscles groups, such as the calves, quadriceps and hamstrings, lower back, neck and shoulders, rotator cuff, and forearms.

 

Muscle in Review: Sternocleidomstoid

Sternocleidomastoid muscle highlighted in red

Sternocleidomastoid, regularly abbreviated to SCM is located superficially, either side of the neck.

It originates at the sternum (sterno) and inserts at the clavicle (cleido) and mastoid process of the skull. It’s main function is head rotation and flexion of the neck.

How does SCM become injured?
SCM can be easily injured with sudden movement or jerks of the head, mostly commonly with whiplash.

 

Muscles in Upper Cross Syndrome

 

It is also often innervated in ‘upper cross syndrome’ where the upper neck and lower shoulder muscles are weak, while the upper shoulder and chest muscles are tight. This is largely due to poor posture as we hunch to use the mouse/keyboards or crane our necks over to look at our laptops or mobiles, or while driving.

What are the symptoms of an injured SCM?
A strained SCM can produce swelling and redness along the muscle, at the site of the injury. In severe cases, you also may see bruising along the path of the injury. If the strain results in a muscle spasm, you may notice a twitching or fluttering beneath the surface of the skin along the side of your neck. Stiffness, muscle fatigue and difficulty holding your head upright may occur, along with dull pain along the path of the injury, accompanied by sharp pain when turning or tilting your head.

Trigger points in SCM can cause headache pain in the back of the head, behind the ear, in the forehead but it can also cause a list of other symptoms that some may not normally attribute to muscles.

SCM trigger points

Primary Symptoms include;
Back of Head Pain
Cheek Pain (like Sinusitis)
Dizziness When Turning Head or Changing Field of View
Double/Blurry/Jumpy Print Vision
Dry Cough
Ear Pain
Earaches/Tinnitus (Ringing)/Itch
Feeling Continued Movement in Car After Stopping
Feeling Tilted When Cornering in Car
Front of Chest Pain
Frontal Headache
Headaches or Migraines
Post Nasal Drip
Runny Nose
Sore throat
Tearing/Reddening of Eye, Drooping of Eyelid
Temple and Eyebrow Pain
Temporal Headache (Temples)
Temporomandibular Joint (jaw) Pain
Throat & Front of Neck Pain
Travelling Nocturnal Sinus Stuffiness
Vertex Pain
Visual Perception Problems

How is SCM treated?
Applying ice for 10 minutes several times daily may relieve swelling and redness. Wearing a neck brace supports the weight of your head, temporarily relieving the stress on SCM although may only recommended temporarily and only in severe cases. Over-the-counter nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Advil, Neurofen) and naproxen (Naprosyn, Aleve) and analgesic rubs can relieve some of the pain associated with the strain.

SCM is very responsive to massage and other soft tissue techniques such as gentle cupping, dry needling, and stretching.

  • Rotate your head to look over your shoulder, as far as is comfortable, not to strain.
  • Then gently tilt the head to the same side, as if trying to reach the ear to the shoulder.
  • Hold for 20-30 seconds, rest and stretch the other side.

 

 

If you are a yogi, some basic yoga poses that can help lateral and anterior neck tension include;

Bitilasana (Cow Pose) and Marjariasana (Cat Pose)

Cow-Cat pose is a gentle up-and-down flowing posture that brings flexibility to the entire spine. It stretches and lengthens the back torso and neck. It’s a wonderful and easy movement to open and create space through the entire neck.
To begin with cow pose, kneel on your hands and knees in a neutral, tabletop position. Be sure to align the hands below the shoulders and knees directly beneath the hips. Looking straight ahead, inhale, and slowly extend through your spine as you look up and forward, softly arching through the back and neck. Take care to expand through your chest and lower your shoulders down and back.

Move into cat pose by reversing the movement as you exhale and bring your chin towards your chest while gently hunching and rounding your back. Repeat this sequence for 7 to 10 cycles, softly flowing with your breath.

Ardha Matsyendrasana (Seated Twist Pose)

The seated twist is a wonderful pose to bring flexibility to the entire spinal column. It provides an inner massage to the abdominal organs and encourages side-to-side flexibility of the neck.

Begin seated on the floor with both legs extended in front of you and hands at your sides. Bend the right knee and draw the right foot to the outside of the outstretched left leg. Sit up tall, inhale, and extend your left arm out to your left. As you exhale, draw your left arm across your body so the elbow joint gently wraps around your right knee. Take your right hand and place it palm down on the floor near your tailbone, fingers pointing away from you. Draw your chin toward your right shoulder, making sure to keep your spine tall, and the crown of your head reaching toward the sky. Bend the right elbow slightly to allow the right shoulder to sink down.

Breathe deeply in this pose for 5 to 7 breaths, making sure to twist (not crank) your spine comfortably. Repeat on the left side to maintain the balance in your body and spinal column.

Ear to Shoulder Pose

This is an easy pose that can be done just about anywhere. The pose facilitates the lateral movement of the neck as well as stretches down into the shoulder and trapezius muscles. This pose can be performed standing or sitting, provided the spine is straight.

Begin by looking straight ahead with your arms down at your sides. Take a deep breath and as you exhale, bring your right ear down toward your right shoulder. Try to avoid leaning your head forward or back so that your head remains in the same plane as your shoulders. Inhale as you draw your head back to center and exhale as you repeat the movement to the left.

To deepen the stretch, place your right hand on the left side of your head as it drops over towards the right shoulder. Don’t pull your head over; just allow the weight of your hand to softly guide it down. Perform this cycle 7 to 10 times per side before returning to centre. (1)

Cupping: what is it and should I get it?

Ancient Chinese cupping

You may have seen the dark, bruise coloured circles on the backs of the Olympic athletes at the current games in Rio. Many of you may be wondering what they are or have heard from the commentators and media articles about this ‘new’ treatment the athletes are receiving called cupping.

What is cupping and where does it come from?
Cupping is not something new. Early records of cupping have existed since ancient Egypt around 1500 BC. Hippocrates, the father of modern medicine, prescribed cupping. The Chinese have been using cupping dating back to 281 AD. The British were using cupping by the 1800’s with observation of Hippocrates writings. However, with the rise of scientific medicine, the practice of cupping has declined in the West in the last century, until a recent resurgence from traditional Chinese medicine (TCM) practitioners practicing here in the West and other physical therapists using it to aid in soft tissue therapies.

The method of cupping uses a cup with vacuum created by a flame, pump or suction applied to the skin. Animal horns, bamboo, hollowed out wood or clay, even shells have been used for cupping practices throughout history. The cups used nowadays are most commonly made from glass, plastic or silicone.

How does it work?
TCM practitioners use cupping to move energy and correct internal imbalances, as well as to clear the effects of external injury and climatic influences such as the cold.1 In myotherapy, remedial massage and other physical therapies the cups are used to stretch the underlying tissues such as muscle and fascia.

What is fascia?
Myers (2014) says that while everyone learns something about bones and muscles, the origin and disposition of the fascinating fascial net that unites them is less widely understood, although that is gradually changing.2

Pith acts like fascia

Connective tissue is an apt description of fascia as its web-like structure binds every cell in the body to it’s neighbour.3 Imagine the pith in a mandarin, how it sticks to each segment and holds the segments to each other, and the skin to the flesh of the fruit. In very basic terms, this is what fascia is like.

It is primarily made up of collagen and keeps our muscles and organs where they should be. It also helps transport proteins and nutrients around the body as well as supporting the circulatory and nervous systems.

‘In short muscle is elastic, fascia is plastic’

Fascia is different to muscle in that, when stretched it won’t easily ‘recoil’ to it’s original form. Stretched quickly, it will tear. Stretched slowly it will warp and deform. In short muscle is elastic, fascia is plastic.4 Over time fascia will however, lay new fibres to rebind. This is what western, or modern, cupping aims to facilitate This is called myofascial release. Myofascial release can be achieved manually, with a slow, deliberate massage technique, heat and compression but the suction of the cups lifts and separates the muscle fibres and surrounding connective tissue in a way that cannot be achieved manually. It also increases the blood flow around the restricted muscle to help restore its function.

Australian TCM practitioner and modern cupping pioneer, Bruce Bentley says “Judging from what we can see and feel, we can suppose that the various layers of the skin and the fat beneath are drawn inside the cup, together with a positive tension exerted on the underlying fascia”. He goes on to say “we can presume therefore that the suction effect and the drawing out and elevation of these tissues facilitates an increase of local blood supply to the immediate area, which in turn implies an enhanced metabolic uptake of oxygen and feed of nutrients to those parts. It therefore relaxes and reduces pain [caused by] congestion and contracture”.5

Cupping works fast, with minimal pain to re-knit the connective tissues with a ‘trickle down’ effect to underlying muscle tissues, circulatory and nervous systems and perhaps even organs.

But what are those ‘bruises’?
Bruce Bentley maintains that a cupping mark is not bruising but the physical outcome of pathogens, toxins, blockages and impurities (waste products) that are an undesirable presence in the body.6

MediNet defines a bruise as an injury of the soft tissues that results in breakage of the local capillaries and leakage of red blood cells. In the skin it can be seen as a reddish-purple discoloration that does not blanch when pressed. When a bruise fades, it becomes green and brown, as the body metabolizes the blood cells in the skin. It is best treated with local application of a cold pack immediately after injury.7

However, when tested, the composition of the dark pigmentation left from cupping was found to be ‘old blood’, stagnant blood in the tight muscle fibres.8 Blood that is not moving, the more it thickens, congeals and darkens. TCM also recognises the different colours, shape, temperature and texture of the marks as a diagnostic tool to signify varying pathogens or deficiencies within the body.

Rest assured the marks left by cups are painless, they do not feel like bruising and fade within a few days to a few weeks, depending on how dark they are. I also have observed that clients who have regular cupping tend to mark less and less.

What is the difference between the different types of cups?

L to R: plastic pump cups, silicone cups, glass cups with aspirator suction pump, plastic suction pump with magnets, glass

There are many and varied types of cups. Glass, plastic suction pump, rubber, silicone, glass with a vacuum pump, plastic with a vacuum pump and magnets. The most common used by physical therapists are the glass, plastic suction pump or the silicone cups.

The glass cups are considered the traditional cups, largely used by TCM practitioners. They are used by some physical therapists too. The vacuum is created by placing a fueled flame, usually a cotton wool ball doused in methylated spirits, into the cup for a second or two. The flame is removed and the cup is quickly placed on the oiled skin. The heated air in the cup then cools to create the suction, the oil on the skin acts as the seal to the vacuum.

Flame to create vacuum in cup

It does not feel hot on the skin. Often clients expect it to feel warm and are surprised that the glass is cool. The wide lips on the glass cups feel smooth on the skin. Depending on how much suction is created, the cup can be left where it’s placed, or moved around to massage with. The suction with the glass cups is often strong and tends to leave strong marks, like the ones you might have seen on Michael Phelps at the Olympics.

There is no exact way of measuring the suction on these cups and it takes some experience before a practitioner can judge the amount of suction the flame will create.

Plastic pump cups are often used by myotherapists and some massage therapists. They are fast and easy to use as there is no need for a flame and the amount of suction is easily controlled via the pump. They can be used static or moved to massage with also. They tend not to mark as much as the glass cups but can leave a slight pinkish circle where the cup is placed or a strip where the cup is moved.

Silicone cups are becoming more and more popular among massage therapists and other physical therapists due to their ease of use, durability and gentleness on the client. Suction is created by squeezing the cup and placed on the skin. Suction can be created without oil but seals better with a little bit of lubricant and the cups can be massaged with. This technique is especially good for myofascial release. These cups are not as strong as the glass or plastic pump cups, and therefore leave very little marking on the skin.

What are the contraindications of cupping?
The cupping contraindications are similar to that of massage. Cupping cannot be performed on skin that is broken, has acne, rash or other contagious skin disease. Cupping on pregnant women should be considered with caution, not to the soft tissue areas of the abdomen or lower back. Although I have seen good results on the sore hips of pregnant clients. Cupping shouldn’t be performed on existing bruising as it can be uncomfortable, although I have experimented on myself with the silicone cups to see if it move the bruising out quicker, which it did quite successfully I might say.

Are there other types of cupping?
Facial cupping for skin rejuvenation, headache, sinus and TMJ disorder relief; cupping to reduce stretch marks, scarring and cellulite all exist.

Wet cupping or Hijama, is an Arabic tradition. It is where an incision is made on the skin and the cup is placed over the incision to draw the blood out for therapeutic purposes. This practice is not used by physical therapists and has a risk of infection.

If you are considering myotherapy or massage for a chronic injury or muscular tension, consider trying some cupping with your physical therapy. It is a fast and effective way to mend soft tissue and alleviate muscular pain.

 


  1. Bently, B., Cupping, viewed 11th of August, 2016 <http://www.healthtraditions.com.au/course-details/cupping.htm>
  2. Myers, T 2014, Anatomy Trains – Myofascial Meridians for Manual & Movement Therapists, Elsevier Health Sciences, London
  3. Myers, T 2014, Anatomy Trains – Myofascial Meridians for Manual & Movement Therapists, Elsevier Health Sciences, London
  4. Myers, T 2014, Anatomy Trains – Myofascial Meridians for Manual & Movement Therapists, Elsevier Health Sciences, London
  5. Bentley, B., ‘Modern Cupping’, The Lantern Vol 10-3, pp.15
  6. Bentley, B., ‘A Cupping Mark is Not a Bruise’, The Lantern Vol 12-2, pp.16
  7.  Definition of a Bruise, viewed 11th of August, 2016 <http://www.medicinenet.com/script/main/art.asp?articlekey=2541>
  8. Bentley, B., ‘A Cupping Mark is Not a Bruise’, The Lantern Vol 12-2, pp.16

Condition in Review: Whiplash

Whiplash is a non-medical term describing a range of injuries to the neck caused by sudden distortion and extension. Injury may be to the cervical vertebrae or their associated ligaments and muscles.

Whiplash is often associated with vehicle accidents especially when hit from the rear. However, whiplash can also be caused by falls, sports accidents or being hit, kicked or shaken. It is the result of a violent back and forth movement of the head and neck, most commonly occurs in a rear end vehicle collision, damaging the cervical vertebrae and/or associated tissues. Whiplash is usually confined to the spine from the neck to the mid-back.

Symptoms can appear directly after injury but often are not felt until the days following. Pain and aching in the neck and back, referred pain to the shoulders, pins and needles in the arms, dizziness, headaches and occasionally nausea.

Victims of suspected whiplash should be referred to a GP for a medical imaging and examination to rule out any possible bone fractures and any other serious injury.

Whiplash should be treated as a sprain/strain injury therefore no heat should be applied to the area for the first 12 to 72 hours. During this timepiece can be applied to slow the spread of injury and inflammation. A cervical collar may be needed during the first 3 days while sleeping or for no more than 3 hours at a time during the day.

Massage can be applied after the first 72 hours and when more serious injury or fractures have been

Sternocleidomastoid trigger points & pain referral

ruled out. Massage will help increase blood and oxygen flow to the injured site, speeding up the healing process. Massage also reduces tension, eliminates trigger points and increases range of motion. Cupping therapy also helps release muscle and fascia tension and draws oxygen rich blood to the area.