Tag Archives: muscular pain

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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.

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

Allied Health Care Professions: Shiatsu

Shiatsu or Japanese finger pressure therapy practitioners use touch and pressure to rebalance the energy of the body. The practitioners aim is to align the mind, body and spirit of their patients using their energetic system and their meridians.

The practitioner will take a diagnosis of their client using yin and yang, the five elements and their qi (energy). As a result of diagnosis the practitioner will then be able to determine what meridians will be best used in the treatment.

Shiatsu is performed on the ground or lying down on a table. The client is not required to remove their clothing as they are not using any massage oils or lotions. The practitioner will use elbows, knees, feet as well as finger and palms to apply pressure along the meridians they are working on.

The meridians are the energetic pathways through the body that were codified in Chinese Medicine. There are twelve major channels that we deal with, each one being given the name of an Organ (in the Eastern, not the Western medical sense). The twelve Organs are: Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Heart Protector, Triple Heater, Gall Bladder and Liver.1

According to Tokujiro Namikoshi, the founder of Shiatsu therapy, the underlying principal of shiatsu is that the body can fix itself if the qi is balanced.

The meridians

Modalities Used
The modalities used in shiatsu are; qi (energy), yin and yang; the 5 elements (metal, water, wood, fire, earth), meridians, acupuncture and acupressure points, exercise, stretching, pressing, touch, massage and diagnostics.

When would you seek this practitioner?
Shiatsu is good for treating headaches, back pain, aid relaxation, arthritis, muscle stiffness, sports injuries, digestive problems, menstrual problems, asthma, insomnia, anxiety, depression, sleeping disorders, and pregnancy problems.

 

 


1. http://shiatsudo.co.uk/about-shiatsu/meridians

 

Allied Health Care Professions: Hydrotherapy

What is the definition of the practice?

Hydrotherapy is the use of water to treat a disease or to maintain health. The theory behind it is that water has many properties that give it the ability to heal: Water can store and carry heat and energy. Water can dissolve other substances, such as minerals and salts.

Cooling or heating the body encourages blood flow either towards the organs or out to the skin aiding in elimination of toxins. By alternating the temperatures, elimination through sweating and circulation is increased. Hydrotherapy also aids, in rehabilitation, the musculoskeletal system by using the buoyancy of water to provide support for joints following surgery or injury.

Colonic irrigation is also considered a form of hydrotherapy.

What modalities does this practice involve?

Irrigation – colonic and also eye and ear irrigation.

Thermal therapy – heated pools, saunas and steam baths, hot compresses, cold compresses, cold baths

Herbs – used in rinses, compresses, steam baths, localised baths as in for an eye or for an infection or wound, orally infusions. Some common herbs used are scouring rush tea, alum and hay flowers.

Full and half baths – involves the patient to submerge part or all of their body in cold water for a short period of time, wrapping themselves in a sheet whilst still wet and tucking themselves into a warm  bed, allowing their body to warm itself up. This is more of a home remedy.

Joint mobilisation – exercises designed to be performed in the pool

In what instances might you see this practitioner?

In the case of a musculoskeletal injury or following re-constructive surgery of a joint that would benefit from the combined resistance and support to the water provides as well as the added benefit of heat. This would also benefit those suffering from rheumatoid or osteo-arthritis, general joint and muscular pain.

Who in Mildura does Hydrotherapy?

Callahan Physiotherapy

Myosports

 

References

  1. Harris, P., Nagy S., Vardaxis N., 2006, Mosby’s Dictionary of Medicine, Nursing and Health Professions, Elsevier Australia, NSW, Australia
  2. Keller J, 1968, Healing with water, universal Publishing and Distributing co, New York
  3. Physiotherapy and Rehabilitation Centre Melbourne: Beleura n.d viewed 2 August, 2011<http://www.beleura.com.au/index.php>