Tag Archives: tension

Three things your massage therapist will always tell you

If you’ve injured yourself there are a number of things that your massage therapist will tell you to do after your massage, but there are three things they will always tell you in order to help you get better;


  1. Stretch

If you’ve injured yourself or you have chronic muscular pain and tension, stretching is a really great way to ease that tension and manage the pain. It will almost certainly speed up your recovery.

And you know, we can tell when you’re not doing them!


2. Rest

If you’ve injured yourself during a specific activity, particularly during sport, it’s a good idea to rest that part of the body. If you’ve injured your shoulder at the gym, then make this week, leg week. If you’re doing a repetitive task at work, ask your manager to change your duties or switch to light duties. It’s important to rest your injury, to enable it to heal, otherwise you may just be exacerbating the issue.

3. Follow up

Even if you feel better, please have your follow up within 5 to 10 days of your initial appointment. There is often still tension there, even if those trigger points have been eased. If you are still tight, and return to the activity that caused the injury, the trigger points, and pain is likely to return too.

If you have that follow up the week after, you are likely to stay pain free for longer, and that is every massage therapists goal for you!


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

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

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

The Science


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

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

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

Magnesium is also an imperative part in;

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

Where can we source magnesium?

The Source

Nuts, Greens, Cocoa & Spices

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

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

Bath salts

Magnesium chloride

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

Magnesium sulfate

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

Topical creams and oils

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

Topical spray, supplements, bath salts


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

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

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

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

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

Recommended daily intake of magnesium is;

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

What happens if I don’t have enough magnesium?

The Symptoms

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

  • Muscular cramp

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

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

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

What could be causing my magnesium deficiency?

The Seed

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

Can I have too much magnesium?

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

Symptoms of magnesium overdose include;

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


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

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

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


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

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)

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

Stress Urinary Incontinence: a Muscular Problem

Urinary incontinence amongst women is an unreported epidemic. Reportedly 30 to 40% of women will suffer from incontinence of some form by the time of menopause and then rises steadily between the ages of 60 and 80. It does also occur in men, but for the sake of this article, I will be predominantly addressing the problem in women. There is little research to show the true causes of incidences but are likely be a result of bladder dysfunction, sphincter dysfunction or a combination of both.1

9e309625-de78-47bb-8b7c-1afe86633f93Determining whether the condition is stress or urge incontinence, or a mix can be difficult, based on symptoms alone.

The major symptom of stress incontinence is the loss of bladder control during physical activity. Such as experiencing anything from a few drops of urine to a larger involuntary flow while exercising, during sexual intercourse, coughing, sneezing, laughing or other kind of physical exertion.

The cause of stress incontinence is when there is tension and/or weakness in the muscles that control and support the bladder and the release of urine (urinary sphincter). These muscles include the pelvic floor muscles (otherwise known as the Kegel muscles, named after Dr. Arnold Kegel, American gynaecologist who invented the Kegel exercises), the deep gluteal muscle that attaches to the sacrum  and coccyx, Piriformis; and the large inner thigh muscle, Adductor Magnus that attaches to the pelvic bones.
The pelvic floor muscles act as a sling from the coccyx to the pubic bone supporting the bowel, bladder, the uterus and vagina in women. If they are tense or weak, the downward pressure of these organs can easily cause problems, and problems with these organs are likely the only symptoms you may have from these kinds of muscular tension or weakness.

What can cause these muscles to be tense or weak?

Injury or overuse, like any other muscle, can cause these muscles to be tense or weak. This could be from exercise, childbirth, constipation, heavy lifting, chronic coughing. Excess weight can cause undue pressure on these muscles and to cause weakness. Surgery, such as prostate surgery in men, can also cause weakness.

How can stress incontinence be treated?

Massage of the gluteal and thigh muscles and pelvic floor muscle exercises are the best way to treat and maintain muscular health and avoid incontinence, and maintain bladder control.
Massage has been shown to reduce incontinence by more than 20% after the first treatment and up to 100% within a month of regular treatments.2

How to locate your pelvic floor muscles


Pelvic floor in women

Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
Squeeze the ring of muscle around your anus, as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Youre not just squeezing your buttocks, but deeper, down to the tailbone.
When sitting on the toilet to empty your bladder, try to stop the stream of urine, then start it again. Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.
If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine, ask for help from your doctor, physiotherapist, or continence nurse. They will help you to get your pelvic floor muscles working right. All women can benefit from pelvic floor muscle training.

How to exercise your pelvic floor muscles

Sit or lie in a relaxed position. Squeeze and draw in the muscles we just identified. Lift them up and squeeze them away from the tailbone. Hold them strong and tight for 8 seconds and then relax, letting all the muscles go.
If you can’t hold for 8 seconds, hold for as long as you can. Gradually build up the length of time you can hold them for.
Do 8 to 12 squeezes, three times, daily. If you do not see a marked improvement within three months seek help from your doctor, physiotherapist or continence nurse.
Once you get used to doing them, you can do them sitting, lying or standing. Be sure not to hold your breath while holding the muscles, oxygen will help the muscles stretch and release tension.

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


Clam Shell exercise


Hip Abductions


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.


Stretches for ITB


Standing ITB stretch


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:
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


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


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.


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.

Headaches v. Migraines

If a client is experiencing neck & shoulder tension, I usually ask them if they are having headaches and often they tell me they’ve been having migraines. But what you may not realise is that there are a number of different types of headaches, and migraines are not a bad headache, per-say but have a different pathophysiology to headaches altogether.

Often mistaken for a tension or sinus headache, a migraine is a neurological condition caused by an overreactive “switch” in the brain stem.

Symptoms include throbbing pain; sensitivity to light, sounds, and smells; nausea and vomiting; and other symptoms. Twenty percent of sufferers have aura—symptoms such as visual disturbances that precede the onset of pain. The pain is moderate to severe, with triggers such as stress, hormonal changes, weather changes, some foods. Treatments include stress relief, lifestyle changes, OTC and Rx medications

Tension headache
This is by far the most common type of headache, affecting as many 90 percent of people at some point in their life. It’s caused by tightness in the muscles of the scalp and the back of the neck. Symptoms include dull pressure or tightness in a band around the head, especially the forehead. Usually no other symptoms. The pain is usually mild to moderate caused by stress, fatigue or activity. There are specific trigger points in the head, neck and shoulders that cause referral pain into the scalp.


Over the counter pain relievers like ibuprofen and paracetamol can help. Massage, hydrating properly and taking some time to de-stress—deep breathing, gentle yoga, napping, or meditation—might also help.

Sinus headache
It’s fairly uncommon; most people who think they have one actually have a migraine. “Almost half of people with migraines have runny or stuffy nose or teary eyes with their headaches,” Dr. Tepper explains. Symptoms include pain around the nose and eyes; runny nose, often accompanied by fever. The pain can be mild to severe and is triggered by an acute sinus infection. Treatment includes over the counter pain relievers and sinus meds.

Cluster headache
Rare, it affects 0.1 percent of the people, more commonly men. Because it tends to occur at the same time every day, doctors suspect the hypothalamus—the part of the brain that controls the body clock—is involved. Symptoms are intense, penetrating pain behind one eye that usually starts shortly after you fall asleep. They last an hour or two but come in clusters of one or two headaches a day over several weeks. Excruciating pain, that can be triggered by alcohol, diet. Also more common in smokers.
Because not much is known about the cause there is little treatment. Prevention can include prescription drugs, nerve blocks injected into the back of your head, and melatonin. Triptans and other medications are used to treat an attack once it’s started.

Here’s some points to consider telling your doctor for a diagnosis and effective treatment;
Are my headaches are severe and pounding?
Do I often feel nauseous or sensitive to light and noise during a headache attack?
The headaches come before or during my menstrual cycle.
My parent/sibling has the same kind of headaches.
I have missed work or important events because of my headaches.
Moving around too much or bending over can make the pain worse.
The pain is often on one side of my head.
Pain killers don’t help much (or not at all).
My headache can last from about five hours to several days.