Tag Archives: Pain

*Sale* 20% off Gift Certificates

Still looking for the perfect gift for that special someone, or perhaps the person who has is all…

Between now and Christmas Day I am offering 20% off all gift certificates*

To purchase please click on the Gift Certificate menu and choose from relaxation or remedial massage.

Each treatment is tailored to the clients specific needs, whether it is treating muscular pain and dysfunction or an hour of total relaxation. All treatments are suitable during pregnancy.

Also, please remember you can book online and to like my Facebook page to keep up to date with my services and offers.

 

*Gift certificates are valid for 12 months from date of purchase. They must be produced as payment at the time of the appointment and cannot be used in conjunction with any other offer.

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

Lymphedema: What is it, and How Can Manual Lymphatic Drainage Help?

imageWhat is lymphedema?

Lymphedema is the pooling of lymph fluid, due to an obstruction or blockage of the lymphatic system. The lymph vessels drain the fluid from tissues throughout the body and allow immune cells to travel where they are needed. A blockage may occur due to illness, damage or removal of the vessels or nodes of the system.*

What are the symptoms?

The main symptom is chronic swelling, usually of the extremities, limb or area where the obstruction has occurred. Other symptoms include a feeling of heaviness or tightness in the area, restricted range of motion, increased occurrence of infection and hardening or thickening of the skin. Some may also see a change in texture in the tissues of the affected area, such as an ‘orange-peel’ like effect where the fluid pools.

What treatment can help lymphedema?

Manual lymphatic drainage (MLD) is a physical therapy technique that is aids the natural drainage of the lymph fluid. The technique includes gentle massage in the area of the healthy lymph nodes, followed by a technique that is a gentle, circular, stretching of the skin motion that aims to push fluid out of the area of swelling, across to the healthy lymph nodes. It is quite different to normal muscular massage and is a slow and gentle technique. Other treatments include compression, range of motion exercises and in some extreme cases, surgery.

What can I do to help reduce lymphedema?

Lymphedema is a chronic disease that usually requires lifelong management. In some cases, lymphedema improves with time however, some swelling is often permanent. Drinking lots of water can aid flushing of the fluids, wearing compression socks or sleeves and elevating the affected area above heart height will all help reduce swelling. Gentle exercise such as walking, breathing exercises, self-drainage techniques and specific corrective exercises to the affected area may be prescribed by your physical therapist.

*If vessels or nodes have been removed due to surgery it is recommended you consult a MLD Vodder Technique specialist.

We service Massage clients from Malvern East and the surrounding areas, including: Chadstone, Malvern, Ashwood, Glen Iris, Caulfield North

Frequently Asked Questions

Everything you ever wanted to know about massage but were afraid to ask…

What happens on my first visit?

You will be required you to fill out a form detailing your health history and personal details. We will then ascertain what you want to achieve in your massage, be it relaxation, some deep tissue work or a focused remedial work on a specific area. I will ask some general questions to establish if there are any conditions needing to be addressed, and to determine if massage is appropriate for you. Occasionally I may perform physical assessments and testing to evaluate your condition and to see if you have any presenting complaints.

It is important to list all health concerns and medications so I can adapt the session to your specific needs without doing any harm. It is also important to list any allergies so I am aware if I need to use a different oil during the session.

6571789_origDo I have to get completely undressed?

You should undress to the level you are comfortable. For a full body massage, most get undressed to their briefs. However, if you will be more comfortable during the session you may leave your bra or shorts on. I will work around the clothes you left on as best as I can. If removing all your clothes makes you too nervous and unable to relax, then you are not getting the optimal benefit from the session.
I will give you privacy to undress and cover with a towel on the table.

If you prefer to stay fully clothed, then I recommend you explore the many other types of massage that are performed clothed.

Do I have to cover myself with a sheet or towel?

This is known as draping and is required by my industry associations code of ethics. All qualified, association therapists should insist on draping. Once you are undressed and on the table under the drape, I will only uncover the part of your body being worked on.
The genitals (women and men) and breasts (women) will not be massaged or uncovered. If I am going to work on a woman’s abdomen, a second towel or sheet will be used to cover the breasts so the main sheet or towel can be moved to expose the abdomen.

What do I do during a massage treatment?

Make yourself comfortable. If I need you to adjust your position, I will either move you or will ask you to move what is needed. Otherwise, let me know if you need to change your position anytime to make yourself more comfortable.
Many people close their eyes and relax completely during a session; others prefer to talk. It’s up to you. It is your massage, and whatever feels natural to you is the best way to relax. Do not hesitate to ask questions at any time.

Will the massage hurt?

This depends on the type of massage and the depth of the strokes. A light, relaxing massage that doesn’t go very deep into the muscles, shouldn’t hurt. With that being said, there is a ‘feels good’ hurt and an ‘ouch, stop it’ hurt. A good massage, even a really deep tissue massage, should always stay in the ‘feels good’ hurt range.

Pain can be an indication that the muscle is possibly injured or inflamed and pressure should be adjusted. Also, pain can cause you to tighten up and negate the relaxing effects of the massage. The most effective and deepest massage always works with your body’s natural response, not against it.

I will always work within your own pain threshold, regardless of the type of massage you are having.

How often should I have massage?

“Some is better than none.”

What does that mean? Well, it varies from person to person. If you are just looking for some occasional relaxation, then a session every 3-6 weeks may be fine for you.
However, if you are looking to address a specific condition, then it is recommended to go more frequently at first and then slowly taper down to a maintenance schedule. I always discuss a treatment plan with you when you first come. If you have something specific to treat, I always recommend having a second to see the rate of your recovery and then recommend further treatment as may be required.

Can I talk during the massage?

Sure, if you’d like to talk go right ahead. The important thing to remember is that this treatment is all about you relaxing and enjoying the experience. I prefer to discourage talking hoping that you will relax, to aid the healing process, and help you feel better.

In many instances, people may feel more relaxed starting off talking, and as the massage progresses, enter quiet states of relaxation.

The important issue here is that there are times when you need to speak up. If you are ever uncomfortable; with the pressure of massage, position you are lying in, area i am massaging or temperature of the room, you should let me know immediately.  If something is not working for you – speak up! It’s your massage!

Do I have to listen to your music?

No. While many therapists play slower, quieter, ‘new age’ type music, you can choose to have different music or no music at all. Studies have shown that music at under 60 beats-per-minute has a calming, relaxing effect on the body and therefore can enhance your experience.
However, while this may be true, any music you like to listen to while you relax can be listened to while you get a massage. If it relaxes you and you enjoy it at home, why wouldn’t it do the same during your treatment? I use Spotify most of the time, so please just let me know.

How will I feel after my visit?

Most people feel very relaxed. Some experience a significant decrease or freedom from long-term aches and pains. Many feel a little slowed down for a short period and then notice an increase of energy, heightened awareness and increased productivity which can last for days.
If you received a deep massage, you may be slightly sore the next day – much like a good workout at the gym. Sometimes a hot shower, or a soak in the tub can ease this soreness. Sometimes deep work around the head and neck muscles can make you feel light-headed and may induce a headache. This usually eases after an hour or so.
After your session you should increase your water intake a bit. Just a glass or two more than normal is usually fine. This helps keep your body’s tissues hydrated and healthy.

How many sessions will I need?

Honestly, its hard to say. Every person is unique and every condition is unique to each person. It may take one session or it may take several. We will be able to talk more specifically about this after your first session when I have had a chance to evaluate your body’s tissues.

When should I not get a massage?

In my opinion there are few conditions which would prevent you from enjoying massage. You should not book a massage if you have a fever, cold/flu, or contagious skin infection. That’s it.

There are many other conditions in which I will need to adapt my techniques (i.e. arthritis, osteoporosis, herniated disc) or avoid an area completely (i.e. cuts or burns). With some conditions it is a good idea to get an approval from your physician before you receive massage (cancer, certain heart conditions, pregnancy). This doesn’t mean you can’t get massage. But its always better to err on the side of caution. Please advise me when booking if you have any condition you’re not sure about.

What if I get an erection during my massage?

Sometimes it happens. Yet, most men avoid massage for fear this will happen to them. Or, they get a massage but are unable to relax because of this fear. But there is no reason to be embarrassed.

Sometimes men get an erection during a non-sexual, therapeutic, full body massage. Touch administered to any part of the body can activate the parasympathetic nervous system, which can result in a partial or complete erection.

An educated, professional massage therapist understands this and it will not be an issue for them. If you are still concerned, I recommend wearing more fitted underwear (briefs or boxer briefs) which provide more support than traditional boxers.

Note: If the therapist feels that the session has turned sexual for the client, male or female, they may stop the session to clarify the client’s intent, and may decide to end the session immediately.

I’m not sure I’m comfortable with a stranger touching me

It is not uncommon for first-time clients to be apprehensive with the personal nature of massage therapy. Most clients lose this apprehension within the first few minutes of treatment. Massage therapists are trained professionals who respect your feelings and go out of their way to allow you to feel comfortable.

Are you eligible for private health insurance rebates?

Yes. Most health care extras cover include remedial massage therapy and some even have online billing. I do not have HICAPS for on the spot rebates however.

Do you offer massage gift certificates?

Yes I do! A therapeutic massage is a great way to show someone how much you care. For details please ask.

When is a bruise not a bruise? When it’s a cupping mark.

Cupping, in Chinese medicine, is a therapy in which glass cups are applied to the skin
along the meridians of the body, creating suction as a way of stimulating the flow of energy.

It is also a modality of deep tissue, myofascial release that I perform as part of my remedial massage treatment. Using suction to create vacuum pressure, cupping is used to soften tight muscles and tone attachments of muscle to bone, loosen adhesions within the muscle and lift connective tissue, bring hydration and blood flow to body tissues, move deep inflammation to the skin surface for release, and drain excess fluids and toxins by opening lymphatic pathways.

It works by suctioning a glass cup to the skin. A vacuum is created when a flame briefly inserted into the cup heating the air, the cup is then placed onto the oiled skin to seal the vacuum. The air in the cup cools and the skin, fascia and muscle tissues underneath, stretch up into the cup.

As a result blood and fluids are drawn out of the muscle beneath and towards the skin. This leaves the appearance of a bruise where the cup was placed.

Typically a bruise is caused by tears to the muscle fibres after an impact to the area. Blood pools and clots in the area to aid healing to the muscle tissues. The cups do not cause tearing, but rather suction and stretching.

Also, a bruise is generally painful to the touch due to inflammation of the injury. A cupping mark is not.

There has been little scientific research into the marks left by cupping but their continued use throughout history indicates a popularity in traditional and alternative medicine practice. The only research known into the marks was performed at the Australian Institute of Sport where cupping tissue samples were observed under microscope. The finding was “old blood”.1

In Chinese medicine the cupping marks are used a diagnostic tool. An indicator to the level of ‘stagnation’ of energy in the area. I would say, in my practice, I have observed that the greater the area of tension is, the deeper the colour of the mark. Some people however, do not mark at all.

Most people are alarmed by the sight of cupping marks, as there is nothing in our frame of reference in modern medicine that indicates a mark as a safe or healthy response to treatment. However, in my experience as both a therapist and an avid receiver of cupping I can comfortably say that the marks are usually forgotten once the muscle tension has been relieved.

 


  1. http://www.healthtraditions.com.au/uploads/212-cupping-proof.pdf

 

Winter Special Add-on – Dry Body Brush

With the end winter near (thank-goodness!) our skin is likely to be dry, scaled and flakey. The cold air and wind, juxtaposed with indoor heating is drying for skin.

Until the end of November I’m offering a special add-on of a half hour, full body, dry body brushing with your choice of massage.

The technique uses a soft, natural-fibre body brush, starting with the extremities of the body such as the hands and feet, with long flowing movements up towards the body. This aids the lymph system to drain. Small back and forth motions are used between the fingers and toes and small circular strokes in a clockwise direction on the stomach, to aid the movement of the digestive system.

Body brushing helps speed up the process of detoxification via the lymph stimulation. The lymphatic system is important for eliminating waste and dead cells from our body, by transferring them to the bloodstream ready for elimination.

Exfoliating like this also rids the skin surface of dry and dead skin cells, allowing more moisture to penetrate the dermal layers. Following the dry brushing in your choice of massage we use a moisturising almond oil, a refreshing peppermint foot cream and nourishing almond oil hand cream.

Other ways to avoid dry skin in winter is to use a humidifier at home. Increasing humidity means more moisture in the air and your skin is less likely to dry out. Also drink plenty of water, limit harsh facial peels or scrubs and super hot showers during winter, as they are all drying to the skin.

Winter Special Add-on Dry Brushing $30 p/half hour

Click here to book now, then chose Dry Body Brush and your choice of massage.

Runners Knee, it’s not just for runners


itb-syndrome-mWhat is ‘runners knee’?

Runners knee, or iliotibial band friction syndrome (ITBS) is when iliotibial band irritates the lateral (outside) of the knee to cause knee pain.
The band is thought to be a type of tissue with little or no elasticity, similar to a tendon, that runs from the hip joints along the femur (thigh bone) and works with the quadriceps (thigh muscles) to provide stability to the outside of the knee joint during movement.
What are the signs and symptoms?
Pain on the outside of the knee, particularly during activity such as running. Pain is likely to get worse until the activity is stopped, only to start again once activity resumes. Running downhill or on banked surface is likely to cause more irritation.
Who gets iliotibial band friction syndrome?
Most common in runners particularly women but can occur in anyone.
Poor posture and/or poor biomechanics such as over-pronation of the foot may increase risk of irritation. Also weak hip flexors and gluteals can increase risk of developing the injury. Overuse, increase of training too fast, returning from injury too soon can all lead to ITBS.
How is iliotibial band friction syndrome treated?
• Rest
Take a break from running. Try an alternative such as swimming that does not put pressure on the same structures.
• Ice & heat therapy
In the initial stages of inflammation use ice or cold packs for 10-15 minutes every hour until the pain has eased. Then repeat 2-3 times per day or after exercise until the pain does not return. Once the initial inflammation has eased, the muscles around the ITB may require heat to ease tension. Apply a heat pack for 10 minutes a day to keep the joint from stiffening at times of rest.
• Stretching and foam rolling
Stretches to the quadriceps, hip flexors, hamstrings, TFL and gluteals will all help take the pressure off the ITB (see below). Using a foam roller to self massage is always a great way to treat any injury at home.

TIP: rolling directly over the ITB can be quite painful. Try rolling the quadriceps and hamstrings, and then then the hip flexors, just below the front hip bone instead.

ilotibial-band-foamroller • Physical therapy including massage, acupuncture and electrotherapy can be very effective for ITBS
• Strengthening exercises
Strengthening the gluteal muscles and the hip abductors, on the outside of the hips will help take the pressure of the ITB
For example
Heel drops, clam exercise and hip abductions

ClamShell

Clam Shell exercise

HipAbd

Hip Abductions

Heeldrp

Heel Drops

 

• Modification to training, footwear and biomechanics

How can massage help?
Massage will help release the tight muscles around the ITB to, in turn, help release the ITB. This may include the muscles that feel weak like the gluteals.
Are there any complications?
Typically there are no long-term complications of iliotibial band syndrome but without taking proper steps to reduce the pain and correct any biomechanical problems, the pain may persist.
How can I avoid getting iliotibial band syndrome?
Running on a flat or soft surface. Wearing arch support and having adequate footwear for training. Adequate warm up and stretching each time you exercise and modifying your training routine will help.
References
http://sportsmedicine.about.com/od/flexibilityandstretching/qt/IT-Stretch-B.htm

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/iliotibial-band-syndrome

Stretches for ITB

itb_stretch

Standing ITB stretch

PigeonPose

Pigeon Pose

 

 

 

 

 

Stretches for runners from “Stretching” by Bob and Jean Anderson

Stretches 3, 4, 5, 7 are recommended for ITBS

Screen Shot 2015-06-15 at 5.39.11 pm

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.

How Myofascial Dry Needling and Cupping Works

In the past couple months I have added myofascial dry needling and cupping to my services.  I offer it in my remedial treatments, if I think that a client is suitable to the therapeutic benefits these two modalities can offer.

What is myofascial release?

Fascia under chicken skin, for example

Fascia under chicken skin, for example

Fascia is a connective tissue that covers all our organs and muscles and groups of muscles. When we stretch we are stretching the facia as well as the muscle. The fascia is connected to everything and so releasing tension in one area can also help ease pain in other areas of the body. There are many myofascial release techniques including massage, stretching, compression, skin rolling, foam rolling, and strain-counterstrain techniques. Cupping works in a similar way to deep tissue massage or skin rolling to release myofascial tension.

Gwyneth Paltrow (Photo by Jim Spellman/WireImage)

Gwyneth Paltrow with cupping marks

What is Cupping?

Cupping is a therapy in which a jar is attached to the skin via suction. It is an ancient practice found in Chinese, Hindu and Egyptian scriptures. Cupping fell out of favour in western regions the early 20th Century with the favour of chemical drugs but recently there has been a resurgence of interest with physical therapists using it for myofascial release. It is very effective for musculoskeletal pain, headaches and migraines, sporting injuries, asthma, chronic cough and gastrointestinal disorders.

Cupping Therapy

Cupping

It is generally safe and the only side effect are the purple ‘bruising’ marks that are left on the skin. Cupping cannot be applied to open wounds, dermatological problems such as acne, or sunburn.

A flame is inserted into the jar to remove the oxygen and allow the cup to suction. The flame and treatment of cupping can look daunting but it is relatively pain free, most clients describe it as a ‘pinching’ feeling. It works fast to reduce muscle and fascia tension.

What is dry needling?

Dry needling is similar to acupuncture, in that they both use fine, solid needles, inserted into certain points in the muscle. From there, the two practices diverge. Acupuncture works on a Chinese philosophy that pressure points along energy channels running throughout the body can be pin-pointed to treat all of the bodies systems.

Doctor uses needles for treatment of the patient

Dry needling

Dry needling is a Western based philosophy, pioneered by Janet Travell, MD, where the needles are inserted into the trigger point or ‘knot’ in the muscle to treat musculoskeletal pain. Although, there is a high degree of similarity between the locations of trigger points and acupuncture pressure points for pain relief. Dry needling is performed throughout much of the western world by myotherapists, and is becoming increasingly popular in Australia by various physical therapists, who are seeing the physical benefits of myofascial release.

Dry needling of a trigger point will elicit an involuntary reflex in the muscle fibers, blood, oxygen and inflammation will be forced into the muscle and the nerve endings in the muscle will be stimulated, all resulting in a reduction in pain and release of tension in the muscle. The same response as with non-invasive trigger point therapy and deep tissue massage. There are a number of different techniques used by various practitioners to date from injecting the muscles to just piercing the skin with the needle like acupuncture.

Many studies have concluded various reasons as to why dry needling and acupuncture reduce pain including; stimulation of the spinal reflex arc; eliciting a local twitch response during the application of any needling technique; change in neuropathic condition and a histamine release that causes local irritation and relaxation of the muscle; mechanically breaking up the nodularity of the tissue; decrease in stiffness of the muscle through an electrical event; bleeding causing release of so called platelet derived growth factors, which aids in the healing of the muscle; normalization of the pH and of several biochemicals and neurotransmitters that are involved in regulation of pain.

Unfortunately however, no scientific study to date has reported the reliability of trigger point diagnosis.

Dry-Needling-PicWhat side effects are there?

Mild muscle soreness or ache is a common side effect after the procedure, bruising is also common. Typically, the soreness lasts between a few hours to a few days. Recovery from dry needling can be aided by the same techniques as deep tissue massage like drinking water, resting, mineral salt baths, gentle stretching, and ice or heat over the effected area.

Complications

Like any medical procedure, there are possible complications. While these complications are uncommon, they do sometimes occur and must be considered prior to giving consent to the procedure.

  • Any time a needle is used there is a risk of infection. However, using new, disposable and sterile needles, along with sterilising the skin, infections are extremely rare.
  • A needle may be placed inadvertently in an artery or vein. If an artery or vein is punctured with the needle, a hematoma (or bruise) will develop. Usually the needles used are too fine to puncture the wall of an artery and bend around to avoid it. If any bleeding from a vein occurs, it is no larger than a pin-prick bleed.
  • If a nerve is touched, it may cause paresthesia (a pins and needles sensation) which is usually brief, but it may continue for a couple of days. It is theorised that this can help the function of the muscle and in some practices encouraged.
  • When a needle is placed close to the chest wall, there is a rare possibility of a pneumothorax (air in the chest cavity). If you experience pain in the chest, pain on exertion, shortness of breath, dry cough or decreased breath sounds during auscultation up to half an hour after treatment, you should seek medical attention.

Contraindications and precautions for dry needling

You should not receive needling if you are suffering from blood disorders such as Hemophilia or VonWillebrands disease. Those with blood borne diseases need to disclose their condition to their therapist. Patients on Warfarin, Plavix may not be able to have needling, all medications should be disclosed to the therapist before treatment. Infants cannot have needling and children need parental consent. Those with cancer should seek advice from their practising physician before needling treatment. Patients with sensitivity or allergy to nickel or chrome may react to materials in the needles. Epileptic patients also need special attention and strong stimulation is forbidden in treatment. Those with heart disease or recent cardiac surgery also cannot have needling.

Should I have cupping or dry needling?

Ultimately your physical therapist will advise you if they think you can benefit from either modality. Either are rarely a treatment in itself and is usually done in conjunction with other manual and physical therapy treatments, such as massage and stretching.

myofascial_releaseThere is no specific, predetermined number of treatments for patients with myofascial pain. Chronic conditions will require more treatments than acute conditions. In addition, the amount of treatments will also depend on concurrent other medical conditions, your compliance with any at home treatment, your age and physical condition. If your therapist does recommend it, then don’t be afraid to try the treatment and make a decision yourself about how you like the results.