Tag Archives: compartment syndrome

Remedial massage now available at Real Fit Malvern East

It is with great excitement that I inform you, as of start of February 2018 remedial massage will be available from the new location of Real Fit Personal Training, 135 Waverley Road, Malvern East.

Just 3km from my current location, with tram access and street parking out the front, I will be available on Tuesdays and Fridays from 10:30am to 7pm. My contact details have not changed. You can still book online or call me to book on 0450 721 661.

Since I opened in Malvern East, your loyal support has helped my business grow, and now I need a more accessible space to serve you better. I have been looking for a new home for the past few months and I’m happy to say that I’ve found a friendly and welcoming local environment at Real Fit to work from.

If you have any questions about the new location or my services, please call and I’ll be happy to help. I look forward to seeing you at Real Fit!

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

Overuse Syndrome – What is it? How do I avoid it? How can I help it?

What is Overuse Syndrome?
Overuse syndrome is a disorder where a certain part of the body is damaged by repeatedly overusing it or subjecting it to too much stress.

For example, if you rely on your hands for your work, you are more prone to overuse injury of the arms.

Typists are prone to overuse injury of the wrists

What are the signs and symptoms?
Initially the area affected may feel fatigued, ache or tension; swelling, heat or redness in the area can also occur. If this fatigue is not resolved prior to your return to the activity, micro-trauma may occur, building up over time more serious syndromes can develop.

Weakness, numbness and or tingling in the extremities can occur as well as general aching or shooting pain.

Some common examples of overuse syndromes are:
Tendonitis
Bursitis
Carpal Tunnel Syndrome
Patellofemoral Pain
IT Band Syndrome
Plantar Fasciitis

ITB irritation is a type of overuse injury

Who gets over use syndrome?
Those who are prone to overuse syndrome are usually those involved in occupations that rely heavily on the use of hands or arms. Trades such as builders and electricians; check out or line production workers; typists. Some athletes may be prone to overuse syndrome in other areas of the body, and those with hobbies that require lots of ‘hand heavy’ work, such as knitting or crocheting,

How is it treated?
Most start with conservative treatments such as massage, physiotherapy and some stretching and strengthening exercises such as yoga or prescribed pilates.
At home treatments such as heat and cold therapies, rest, and the use of compression bandages can also help.
If conservative treatments are unsuccessful cortisone injections or surgery may be suggested.
Ideally, the best way to treat an overuse injury is to rest the affected area, and to discontinue the activity that is causing the injury. For some this may be impossible due to their work. The employment of an occupation therapist can be useful to help you change the way you operate and keep you working without pain or further injury.

Are there any complications?
It is always best to seek treatment as early as possible for an overuse injury. The longer an injury of this type goes on, the harder and longer it will take to heal. On-going injury can lead to tendon damage, calcification and spur build up, or cartilage damage, for example, all of which will require surgery to rectify.

How can I avoid getting over use syndrome?
Warming up and stretching before use. Before exercise and even before work, take some gentle exercise and stretching of the area.
Negotiating with your employer to change your routine work throughout the day. The less you repeat the same action, the less you are likely to cause injury.
Resting at the end of the day, to ensure any micro injuries heal before you next return to the activity.
Ensuring you are doing your activity with the best ergonomics possible. For example, ensuring your desk is set up for you.

Correct posture can help to avoid overuse injury

How can remedial massage help?
Remedial massage will use various soft tissue manipulation techniques to relieve any muscle tension build up that could cause further complications from overuse.
Deep tissue massage improves circulation around micro-trauma in the muscle to speed up recovery. It also breaks down calcification build up that leads to spur development.
Cupping stretches the connective tissue surrounding the muscles, allowing for release of compartment tension and greater movement of muscles.
Dry needling alleviates trigger points in the muscles and referred pain that may have built up with overuse.

Stretches for arm overuse syndrome from “Stretching” by Bob and Jean Anderson

Stretches Screen Shot 2015-05-11 at 3.33.54 pm

 

Shin splints or Compartment Syndrome

Shin Splints

Shin splints, a common term used amongst the athletic community, describes chronic shin pain resulting from overuse.

It occurs in two regions of the leg.

imageWhen it occurs in the front outside region of the leg, it’s called anterior shin splints. Shin splints is also regularly seen in the lower inner region of the leg, where it’s called posterior shin splints or medial tibial stress syndrome (MTSS).  Anterior shin splints is routinely confused with another overuse condition of the lower leg called chronic extertional compartment syndrome.image

Anterior shin splints usually result from overuse of the muscles the flex the foot down, for example, the muscles used when running downhill.  The condition usually occurs after continual repetitive use or sudden onset or increase of use. Most complain of the pain occurring at the beginning of exercise and then easing with use, only to return after stopping, even hours after.

What causes shin splints?

Anterior shin splints is usually an imbalance of the muscles of the calves and muscles of the front of the leg, usually afflicts beginners or runners who do not stretch enough. It is more likely to afflict the foot of the dominant side. For example, right handed people are more likely to suffer shin splints in their right leg.

Frequent cause of MTSS is over pronation, inadequate stretching, worn shoes or excessive stress placed on one leg from running in one direction, such as on a track.

It is suggested that during overuse the muscle separates itself from the shin bone, which results in inflammation and pain.

How to treat shin splints?

Rest

Firstly you need to rest. Stop what is causing the pain, ice your shin to reduce the pain and inflammation. Start some rehabilitation such as stretching and strethening exercises after you have rested. Over-training or not addressing the issue as it arrises, may lead to serious injury.

exercise-to-treat-shin-splints

Exercises

Ankle flexes, with bent knee and straight knee
Seated on the floor, use a thermoband wrapped around the foot to flex the ankle forward. Do this first with a bent knee, and then with a straight knee

Toe flexes
Seated on the floor with a straight leg, wrap the thermoband around the toes and flex forward

Ankle rotations
Seated on the floor with a straight leg, wrap the thermoband around the sole of the foot and rotate the foot. Do this in both directions.

Heel & toe walk
First walk on your heels on a soft surface (carpet) for 25metres. Then walk back on your toes.

Standing calf raises
Standing on a step, raise up onto your toes and hold for 10 seconds. When you come down, go past the level of the step so your heel dips down. Do ten of these.

Standing toe raises
Leaning against a wall, raise your toes up, so you’re on your heels. Hold for a few seconds.
Or you can perform a simple toe tap, this can be done anywhere, anytime.

Glute, core and pelvic strengthening
Any glute, core or pelvic strengthening will help take added pressure of the legs.

Stretches and massage

Stretching can increase range of movement and help reduce any tension that may be causing your pain. It’s not always the cause but is an important part of recovery process.

Front of shin stretch
Kneel on the ground and sit back on your heels. Stretch the front of your shins. Hold for 15 seconds. If this is too strong, stand, with the top surface of your toes on the floor, stretching the front of your shin

Calf stretch
Keep your knee straight and place your toes to the edge of a platform. Feel the stretch in the calf and the bottom of the foot. Hold for 15 seconds.

Achilles stretch
Follow the same steps and bend your knee to target the stretch to achilles and lower calf. Hold for 15 seconds.

Hip flexor stretch
Start by standing straight, bend your knee forward and step straight back to the ball of your foot. Keep your hips even and hold the stretch for 20 seconds.

Knee to chest
Laying flat on your back, bring the right knee toward the chest as far in as possible. Hold for 15 seconds. Repeat with the other leg.

calf-foam-rollFoam roller techniques for calf and shins (go easy on the foam roller, as this can be quite painful)

When treating shin splints I will use a combination of myofascial release, with both cupping and dry needling, and some deep tissue massage. Releasing through the longitudinal fascial lines from the lower back, the hamstrings, calves and bottom of the foot. Warming the tissue of the calf with some massage and then muscle stripping of the individual muscles of the calf and shin. Then treating any remaining trigger points through the major calf muscles with deep ischemic pressure. I would then have the client turn face up and treat any remaining trigger points in the front of the shin, either with deep ischemic pressure or dry needling.

Wear the correct footwear

Being fitted for the correct footwear for you can make all the difference.

Avoid hard running surfaces

Hard surfaces have greater impact on your body and can cause trauma to the shins. Dirt, grass or unpaved surfaces are better than the footpath or road.

Also add variety to your training, as repetitive motion, such as running on a track in the same direction can add stress to your body.

Strengthen core and glute muscles

This will take further pressure off the muscles of the lower leg by being able to balance and control your legs more effectively .

There are various other supportive methods for shin splints such as, tapping, compression sleeves, ice and heat treatments. It’s best to see your physical therapist to help you with these treatments, to learn the best techniques on how to use them.

Compartment Syndrome

Fascia surrounds all our muscles and groups of muscles in compartments. Compartment Syndrome is increased pressure of fluid within the body’s compartments that contain muscles and nerves. Most commonly occurs in the lower leg and can often be misdiagnosed as shin splints. Chronic Exertional Compartment Syndrome is what most runners experience. It is induced by overuse and exercise where the pressure in the muscles increase to extreme levels. This creates a decrease in blood-flow and deprivation of oxygen to the muscle.

Symptoms include sensation of extreme tension in the muscle and burning increasing through exercise.  The pressure usually decreases after exercise has stopped and the pain will be relieved.

Chronic or chronic exertional compartment syndrome are not emergency situations but can cause permanent damage to the muscle and nerve function of the limb.

Treatment

Calf-massage-300x200Conservative treatment to reduce the pressure include rest, anti-inflammatory medications and manual decompression such as myofascial release. Do not elevate the limb or apply pressure to the area. Instead lie with the limb at the level of the heart. Massage can help once the inflammation has gone down.

Invasive treatment such as surgery can be an effective for sufferers of compartment syndrome.