As a Clinical Myotherapist, I often work with patients who perform back squats as part of their exercise routine, and at the question: “What’s your goal with a back squat?” the answer is often vague and not specific to what this exercise is for. The reason why the answer is not specific, is simply because they don’t know what’s the difference between high and lower bar squat, and don’t know that the back squat, as long as it is an amazing functional movement, it doesn’t train at the same level all the lower body muscles. That’s where, to prevent injury, to perform better squats, and to strengthen more evenly all the lower body muscles, I would suggest them to do exercises like: Quods curl, Hamstirng Curl, Cable Machine Adduction and Diagonal Extension (Glut Medius). Back Squat: The Foundation of Strength The back squat is such a great form of exercise because it does train multiple joints and multiple muscles all at once, but also it does allow us to use our innate capacity of squatting, which is a functional movement, to move high loads, therefore achieving more strength gains. However, this leaves us with more responsibility to train smartly. So let’s start to break down the two main different types of back squat: High-Bar Back Squat (Upper Bar Position) The bar rests on the upper traps The torso remains more upright Greater emphasis on the quadriceps muscles Ideal if your goal is quad strength and knee-dominant movement patterns The fact that the bar is sitting on the upper traps, and that the torso sits straighter, would lead to a descending movement where your thigh would reach a parallel degree with the floor, and from there you will stand back up. This is how you put more force throughout the quads. Indeed, the combination of a higher bar, straighter torso, and reduced descending position allows the weight to sit in the middle of the centre of gravity, which is placed more posteriorly compared to a lower-bar back squat. Low-Bar Back Squat (Lower Bar Position) Bar rests lower on the rear deltoids Torso leans forward slightly more Greater load on the glutes and posterior chain Favoured by powerlifters Best for developing hip strength and glute activation On the other hand, the lower-bar back squat, as anticipated, is more for the posterior chain muscles, like the gluteus max. This is possible because the bending forward of the trunk stretches more muscle fibres in their origin point (the posterior aspect of the ilium (the pelvic bone), the sacrum, and the coccyx), allowing more fibre contraction in the ascending movement. Also, the lower position of the bar and the bending of the torso maintain the weight in the middle of the centre of mass, which is pushed forward at this time. How about if I cannot squat deep? The depth of a squat is the distance that you can cover from a standing position to the lowest point you can reach. How deep you can squat, it would definetely change what muscle group you can activate, but, not everyone can squat deep, and that’s absolutely ok. Each of us has biomechanics that are different, due to differences in how the skeleton is shaped. Without going into many details in this blog, we can definitely say that those who have a longer femur would have a harder time going for a deep squat, compared to those who have a shorter femur. The femur’s length is compared to that of the torso. But this is not all, indeed, there are also other femur and hip characteristics that can limit how deep you can squat, such as anteverted or retroverted femur head. Accessory Work for a Complete Lower Leg Program So, knowing when and why to use each back squat variation can help tailor your program toward specific goals or help rehab muscle imbalances through focused intent. No squat is right, no squat is wrong; it is all about your goal. However, we need to add work more specifically with other exercises for strength symmetry, muscle activation, and injury prevention. Quad Curl (Leg Extension) Isolates the quadriceps Improves knee tracking and squat depth Essential in rehab for knee pain or quad weakness Quads curl can be done in many ways, with a cable machine or on a bench with quads curl attachment, but even with kettlebell or resistance bend. It all depends on your setup. As per all the exercise, be consistent with your set up and progressions. What I prefer most for my training, and what I offer to my patient during the fitness class, is to do quad curls on a bench with the attachment for quad curls. The advantages of this set-up are: Confort Easy progressions Easy set-up Inclination of the back at about 45° to 65° and slight elevation of the quads. The last point is essential to ensure we engage both ends of the quadriceps femoris, which is one of the four quads, that crosses both the hip and knee joints. Hamstring Curl Focuses on the hamstrings, which during a squat are often undertrained Strengthens the back of the thigh and supports knee stability A must-have for runners and athletes prone to hamstring strains As per the quad curl, even the hamstring curl can be done with different variations; there is never one way to train those muscles, but again, it is all about the efficiency and the amount of load that we can put through the muscle, which makes a difference. And again, what I can offer at Melbourne Massage and Treatment, in Fitzroy North, is to do these exercises on a bench, using this time a lower inclination for the upper body (which is now in a prone position) so that the origin of the hamstring is put under greater load, allowing more movement and greater load. Cable Glute Medius Diagonal Extension Targets the glute medius, a key hip stabiliser Performed by extending the leg diagonally behind and outward Crucial […]
Monthly Archives: May 2025
Pregnancy brings many wonderful changes, but it can also bring some discomforts, especially as the body adapts to the growing baby. Common complaints include swelling, water retention, and aching joints. An effective and non-invasive treatment for these issues is lymphatic drainage massage (MLD), which can offer relief, promote wellness, and help pregnant individuals feel their best. In this blog, we’ll explore the safety, benefits, and potential contraindications of lymphatic drainage massage during pregnancy, as well as how this therapy can be customised to suit each individual’s needs. The Benefits of Lymphatic Drainage Massage During Pregnancy Lymphatic drainage massage focus in boosting the work of the lymphatic system. By increasing the functionality of this body system, we promote the flow of lymph liquids and help the body to move unwanted substances, as well as reduce fluid retention. This type of massage has been shown to have specific benefits for pregnant individuals (Cataldo Oportus et al., 2013), particularly when it comes to managing swelling and improving overall circulation. The benefits of include: Reduction of Swelling (Oedema): One of the most common pregnancy-related discomforts is swelling in the feet, ankles, and legs. Lymphatic drainage helps to enhance the flow of lymph, which can reduce fluid buildup in the tissues and alleviate discomfort caused by oedema. Relief from Pregnancy-Related Back Pain: Lymphatic drainage massage can reduce tension in the back and promote better posture, helping to relieve pain caused by the increased weight and pressure on the spine during pregnancy. In this case, the treatment is delivered in a side position. Improved Circulation: Pregnancy can lead to changes in blood flow and circulation. Lymphatic drainage promotes circulation and can improve oxygen and nutrient delivery to both the mother and baby. Mental and Emotional Wellbeing: Lymphatic drainage massage is extremely relaxing, and this positive side effect of the treatment can help you in having a better sleep which obviously can overcome stress and body ache. Per standard and comfort, at Melbourne Massage and Treatment, I tend to deliver lymphatic drainage massage in a seated position for pregnant women. This is possible thanks to the reclined hydraulic table, which can be converted from a flat table into a comfortable and big chair. How Compression Stockings Can Help Reduce Swelling Another effective way to manage swelling during pregnancy is the use of compression stockings. I recommend and provide to my patient stockings from Sigvaris, which is one of the world’s leading stocking manufacturers. The idea of using stocking, is to maintain pressure and liquid moving along the day, while sitting or walking, or doing your daily activities. How the stocking works is by adding a constant compression, which still leave you with a comfortable feeling and does help in pushing the liquid towards the upper body, reducing the chances of fluid accumulation in the lower limbs. For pregnancy, the grade recommended is grade 2, which is a clinical grade stocking. Consider that grade 3 is what is recommended for presentation like Lymphoedema. In terms of measurements, I can easily take mesuraments on site for the best fitting compression, and have the leggings with in 2 to 3 business days. For any enquire about the product or the services please do not hesistate to contact me now. What to Consider When Delivering a Massage During Pregnancy Now we are going to talk about what to consider when we deliver a massage to a pregnant patient, and as you will read, often light pressure is a must in this type of treatment, which gives lymphatic drainage massage an advantage compared to traditional relaxation pregnancy massage. So, there are certain areas of the body that we tend to avoid working on during a massage treatment for pregnancy, or where we may work on, but with a really light pressure and a full verbal or sometimes written consent. Here is a brief summary: 1. Abdominal Area: Deep or direct pressure on the abdominal area is a big NO. Instead, we can do gentle, light strokes if the patient is comfortable with it and they request it. Explicit consent here is a must. 2. Lower Back (Spine and Sacral Area): This is another big NO for heavy pressure. The reason lies behind the fact that strong pressure can lead to strain of the ligaments that hold the joints together, which, as the pregnancy progresses to a later stage, become more and more relaxed, allowing the birth to happen. So again, gentle massage techniques such as effleurage (long, sweeping strokes) or light kneading can be beneficial, but light touch. 3. Legs: Inner thighs another area where we avoid strong pressure, due to the presence of pressure points that could potentially stimulate uterine contractions if over-stimulated (e.g., peroneal or acupressure points). 4. Ankles and Feet: Ankles and feet, as there are acupressure points (like those related to the reproductive system) that may lead to unwanted effects if stimulated too forcefully. That said, a gentle foot massage can help relieve swelling and discomfort. 5. Hand and wrist The area of your hand, between thumb and index, and the pulsing point on the wrist, are other areas where massage is not recommended as it can cause contractions. Always remember that this is a brief summary, and everyone can react differently to the work received in that area. Therefore, there is no need to be scared of making contact with other people, and you should feel comfortable with your body. Trimesters and Positioning The position to be in during a massage, including lymphatic drainage massage, also depends on the trimester in which you are. First Trimester (0–12 Weeks): Lying on the back or side is generally fine during the first trimester, as long as the client is comfortable. A reclining position with support (e.g., pillows or bolsters) is often preferred for comfort. Lying prone (on the stomach) can be done during the first trimester if the client feels comfortable. However, lying flat on the stomach will become uncomfortable and impractical as pregnancy progresses. Second and Third […]
The Star Excursions Balance Test (SEBT) is a fabulous functional test that can tell us a lot about the mobility and stability of the ankle, knee, and hip joints. On top of being a functional test, the star excursion can also be used as an exercise, and via a series of progressions, which we will discuss in more detail later, can help you train for better running performance and injury prevention. Why is the Star Excursion Balance Test Important? The importance of Star Excursions Balance Test’s lying behind the fact that this test allows for testing with one motion the capacity of your ankle to stay stable on the surface of support (the floor) and how this stability is transmitted to the knee first and consequently to the hip. This is possible because the transfer of vertical pressure that is appllied to each joint while you are aiming to get the movement done. The movement required is to keep the feet of the anchor down to the floor, from the toes to the heel, while with the other foot, you aim to reach the furthest point away within the eight cardinal directions (like a star *). Along those movements, then, we also get observational data about your: Proprioception: The ability to sense the position of the body and its parts in space. Balance: The ability to control the body’s centre of mass over a stable base of support. Functional Movement: How well the body can perform multi-directional movements, such as stepping, reaching, and stabilising. So, if you are someone who has sustained lower limb injuries, particularly around the ankle, knee, or hip, these capabilities are often compromised. By using the Star Excursion Balance Test, we can assess any deficits in these areas, which might increase the risk of re-injury or limit recovery progress. But not only that. Indeed, that information will shape the recovery program, allowing us to understand better which muscle group or joint we need to focus more on with the exercises. That said, runners also benefit significantly from the SEBT. Running is a dynamic activity that places high demand on the lower extremities. Even minor imbalances or weaknesses can lead to issues like IT band syndrome, shin splints, and knee pain. The Star Excursion Balance Test helps in identifying these early warning signs before they evolve into more serious conditions. What Does the Star Excursion Test Measure? The primary purpose of the SEBT is to evaluate a person’s capacity to control body movement while standing on one leg. In fact, the test consists of reaching with one leg in multiple directions (anterior, posterior, medial, and lateral and a mix of those directions) while maintaining balance on the other leg. This shows their neuromuscular control and postural stability. It mimics the demands placed on the body during dynamic activities like running, cutting, and jumping. In rehabilitation, the Star Excursion Balance Test trains and improves: Ankle Stability and Control: It challenges the ankle to support the body’s weight while shifting through various planes of motion. Knee and Hip Joint Function: By demanding strength and flexibility in the lower limb, it helps retrain the kinetic chain, especially after joint injury. Balance and Proprioception: The test improves your ability to sense where your body is in space, which is essential for both preventing and recovering from injuries. Postural Awareness: Training balance also trains your ability to maintain proper posture, which can reduce stress on your joints and muscles during exercise. The Progression of the Star Excursion Test The beauty of the Star Excursion Test is its flexibility. It can be adapted based on the individual’s injury level, fitness, and goals. The test itself involves several variations, which I implement depending on the stage of recovery or the individual’s needs: Softer Ground: For those in the early stages of rehabilitation, we may perform the test on a softer surface, such as a foam pad or balance disc. This reduces the stability of the base and forces the individual to engage more stabilizing muscles, which aids in proprioceptive training and can be beneficial for rebuilding ankle and knee control. Weight on the Ankle: For those who have had ankle injuries, I often modify the test to place more weight on the injured ankle. This helps rebuild strength and functional control, as it forces the injured area to bear load and engage in movement patterns that may have been avoided during the healing phase. Eyes Closed: To increase the challenge, I sometimes ask my clients to perform the test with their eyes closed. This removes visual input, forcing the body to rely more on internal feedback (proprioception). This is especially important in the latter stages of rehabilitation, as it helps to refine neuromuscular control and reduce reliance on external cues. Using the Star Excursion Test with Lower Limb Injury Recovery and Runners The SEBT is a functional test that I like to use, with all its variations, to assess the progress of patient recovery. Either that you present with an injury, or either that you want to improve your form and body functionality through out exercises, the SEBT allows us to look in depth in what we need to work on too. For example, after a sprained ankle, I’ll often use the SEBT to check whether an individual is able to move without compensation, ensuring that their body has regained sufficient control and strength before returning to activities like running or sports. And this, don’t be surprised, is something that I do and has to be done whenever someone presents with complaints about knee or hip pain too. Again, an unstable ankle would transmit that instability up the chain. On the other hands for runners, the test helps evaluate areas of weakness that might predispose them to injuries such as Achilles tendinopathy, patellofemoral pain, or iliotibial band syndrome. Since running places repetitive stress on the lower limbs, identifying and addressing weaknesses early can prevent long-term problems and improve overall performance. Myotherapy and SEBT […]
Knee replacement surgery, or knee arthroplasty, is a transformative procedure designed to alleviate pain and restore function in patients suffering from severe knee damage. While the surgery is a crucial step toward improved mobility, the journey doesn’t end in the operating room. The rehabilitation process is vital for ensuring a successful recovery and regaining your pre-surgery quality of life. A key component of this recovery is Manual Lymphatic Drainage (MLD) and a tailored exercise program. Understanding Knee Replacement Surgery Knee replacement surgery as the name says, is basically the replacement of a damaged knee joint with an artificial one. There are two type of knee replacement surgery: a total knee replacement (TKR), which replaces the entire knee joint, or a partial knee replacement, which targets only the damaged part of the joint. Nowadays, the decision to undergo knee replacement surgery is often made when conservative treatments, such as medications and physical therapy, have failed to provide relief. This is because, we are more aware now than ever, of how surgery are complex intervention that can yes, give pain relief and benefit, and save life, but occasionally can come with complications and leave the person with other permanent damage. The Rehabilitation Process As in any surgery, the rehabilitation process is extremely important to ensure that the patient returns to the best of their functions. What the rehabilitation involves are physical therapy, exercises, and, where needed, even mental support. Immediate Post-Surgery Care: Pain Management: Right after your surgery, you will be given pain relief medications and antibiotics, which will help in managing the pain response and keep you free from infection risks. Initial Movement: As a few days are pass, is super important to start moving. Initially would be a matter of few mm or cm, passive and active movement, but as days goes by these movement has to be increased, in order to avoid further muscle atrophization and to increase the blood flow to the area. Exercise: Isometric Exercises: As per discussed in many other blogs, those exercises are the first step in the recovery process. An isometric exercise consists of muscle contraction and barely any limb movement. This allows for maintaining a connection between the muscle and the Central Nervous System (CNS), which is essential to ensure muscle engagement for more complex tasks. Initially, those exercises can be achieved with only 25% of your strength, and within 10 days post-surgery, you may start pushing at 50% of your strength or more. Strengthening Exercises: This second step in the exercise journey can start in week three or four after surgery. The process focuses on strengthening the muscles surrounding the knee joint. These exercises are essential for supporting the new joint and improving overall stability. Strengthening exercises may look different from person to person, in terms of load, but they all aim to increase the load to which the knee joint is placed, to stimulate muscle growth, blood flow, and restore all tissue damaged along the surgery. Plyometric Exercises: Lastly, along the rehabilitation process, there are the plyometric exercises, which consist of loading the tendon like a spring (that’s what their function is) and releasing that loading in a fast motion. For a knee joint, think of explosive squat-type exercises. These type of exercises would start around week 8 to 10 post surgery. This is a step-by-step guide of what a rehabilitation process may look like. Each individual then may have a different journey to follow, given their clinical history, and other factors, including genetics and return to daily activities. In addition to the exercises, physical therapy Consistency: Adhering to a home exercise program is crucial for maintaining progress during therapy sessions. Monitoring Progress: Regularly perform your home exercises and track your progress. If you encounter any issues or experience increased pain,get in touch with your physical therapist to discuss what you are presenting with and what can be done about it. Monitoring and Follow-Up: Your surgeon and physical therapist will evaluate you on an ongoing basis to ensure that your recovery is progressing as expected. Any complications or concerns will be addressed promptly. The Importance of Manual Lymphatic Drainage (MLD) Manual Lymphatic Drainage (MLD) is a gentle, hands-on therapy designed to stimulate the lymphatic system and reduce swelling, which can be particularly beneficial following knee replacement surgery. Here’s how MLD supports recovery: Benefits of MLD in Knee Replacement Recovery: Reducing Swelling: Fluid Management: Swelling or edema is a common issue after knee replacement surgery. MLD helps move excess fluid away from the surgical site and reduces overall swelling, which can enhance comfort and mobility. Enhancing Circulation: Improved Blood Flow: By promoting lymphatic flow, MLD also improves blood circulation, delivering essential nutrients and oxygen to the healing tissues, which supports a faster recovery. Reducing Pain and Discomfort: Pain Relief: The gentle massage techniques used in MLD can help alleviate pain and discomfort associated with swelling and inflammation, contributing to a more comfortable recovery experience. Facilitating Faster Recovery Helping the Healing: By reducing swelling and improving circulation, MLD can lead to a more efficient recovery process, enabling more effective physical therapy and exercise. Incorporating MLD into Your Rehab Routine Timing: MLD can be introduced a few days to a week after surgery, depending on your surgeon’s recommendations and your individual healing progress. How can I help? At Melbourne Massage and Treatment, as a Clinical Myotherapist I am trained in helping people recovering from knee surgery or other major surgeries, either with Fitness Class, which can be part of a Myotherapy treatment plan, but even via treatment like Manual Lymphatic Drainage. So if you are about to get a surgery, that is a knee replacement or any other surgery, and you are looking for someone that can assist you with your recovery, get in touch now to discussed your needs and I can give you a rund down on how I will be able to help you. Knee replacement surgery and lymphoedema. As mentioned earlier, we can all have different outcomes from the […]
Muscle tension headache and migraine are two different types of presentation that have in common a pain, which can also be debilitating, in the head area. Back in 2019, in Australia, 3 million people were estimated to suffer from migraine (Wijeratne et al., 2023), where, define how many people are suffering from muscular tension head-ache is a bit more tricky, as is not a presentation that can be easily tracked, due to self managed protocols, and other miss data counting. That said, they have different origins, symptoms, and treatment options. In this blog post, we will explore the key differences between muscle tension headaches and migraines, helping you understand how to identify and manage them. What Are Muscle Tension Headaches? Muscle tension headaches, or tension-type headaches, are the most common. This type of headache originates from cervical or facial muscle tensions, which recreates a pattern of pain on the head of facial area. As with all muscles, but even joints, the pain that we can experience can be local or in an area around the tense spot. These headaches are often linked to stress, lack of good posture, anxiety, and even sleep disturbances. They can be chronic or occasional, but compared to migraine, they lack neurological symptoms. Symptoms of Muscle Tension Headaches: Dull, aching pain or pressure around the head, especially in the forehead, temples, and back of the head. A sensation of tightness or “band-like” pressure around the head. Mild to moderate intensity (usually not as severe as a migraine). Pain can last from 30 minutes to several hours, sometimes even days. Tenderness or tightness in the neck, shoulders, and scalp. Causes of Muscle Tension Headaches: Stress: Emotional and mental stress is one of the primary causes of muscle tension in the neck and scalp muscles. Lack of good posture: Sitting or standing with poor posture and lack of strength in the musculoskeletal system, especially for long work, can strain muscles and trigger headaches. Sleep issues: Sleep deprivation or poor-quality sleep can exacerbate muscle tension and lead to headaches. The body recovers from the fatigue of the day before during sleep, especially in the early morning hours. Sleep deprivation would increase the chance of a headache. Dehydration: Not drinking enough water can lead to tension and headache symptoms. The body withdraws water from the brain to keep the organ functioning, causing physical brain shrinkage, which leads to headaches. Recent studies have indicated that chronic tension-type headaches (CTTH) are often exacerbated by environmental stressors, and poor posture in daily activities can cause muscle imbalance and contribute to the frequency of these headaches (Bendtsen et al., 2018; Grazzi et al., 2016). Treatment Options: Pain relief: Over-the-counter pain relievers, like ibuprofen or acetaminophen, can help ease the discomfort. Heat pack: Applying a warm compress to the neck and shoulders can help relax tense muscles. Keep always in mind that heat application should be limited to 10-15 minutes, once or twice a day. Massage: Gentle massage of the neck and shoulder muscles can reduce tightness and alleviate headache symptoms. Stress management: Practising relaxation techniques such as deep breathing, thai yoga, and meditation can reduce stress and prevent muscle tension headaches. Strengthen muscles: Strengthening the muscles around your cervical and shoulder area can help reduce the chance of suffering a headache by reducing the inflammatory response that the muscle would activate due to a lack of strength. What Are Migraines? As I mentioned above, the significant difference between headaches and migraines is due to neurological symptoms, a unique characteristic of migraines. Migraines are neurological events that involve complex brain activity. They are characterised by intense, throbbing pain, usually on one side of the head. They are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are more debilitating than muscle tension headaches and can last a few hours to several days. The intensity of the headache doesn’t have to be severe. Symptoms of Migraines: Although many people experience nausea, vomiting, and light sensitivity, migraine symptoms can vary, with some individuals experiencing dizziness or visual disturbances without significant head pain. Throbbing or pulsing pain, usually on one side of the head. Nausea and vomiting. Sensitivity to light, sound, and sometimes smells (aura). Visual disturbances such as flashing lights or blind spots (this is known as an aura, which can occur before or during the headache). Dizziness or feeling lightheaded. Migraines are understood to be primarily driven by neurovascular changes and neuronal hyperexcitability (Feng et al., 2021). A review by Wagner et al. (2021) found that the pathophysiology of migraines involves alterations in neurotransmitter systems, notably serotonin and CGRP (calcitonin gene-related peptide), which contribute to the vasodilation and pain signaling pathways. Causes of Migraines: Genetics: Migraines tend to run in families, suggesting a genetic component. Hormonal changes: For many women, changes in estrogen levels, such as during menstruation, pregnancy, or menopause, can trigger migraines. Environmental triggers: Bright lights, strong smells, certain foods (like chocolate, cheese, or caffeine), weather changes, lack of sleep, and allergies that cause sinus issues are common migraine triggers. Neurological factors: Migraines may involve changes in the brain’s nerve pathways, chemicals, and blood vessels, which cause inflammation and pain. Treatment Options for Migraines: Prescription medications: Triptans and anti-nausea medications are commonly prescribed to treat the acute pain of migraines. Preventive medications: For frequent migraine sufferers, medications such as beta-blockers, antidepressants, or anti-seizure drugs may be prescribed to reduce the frequency and severity of attacks. Lifestyle changes: Regular sleep, a healthy diet, and consistent exercise can help reduce the frequency of migraines. Cognitive-behavioural therapy (CBT): Managing stress through therapy can help alleviate migraine triggers. Alternative therapies: Acupuncture, biofeedback, and massage therapy are sometimes used as complementary treatments for migraine management. Recent studies support preventive treatments for chronic migraines, such as CGRP antagonists (Kundera et al., 2020) and neuromodulation techniques like transcranial magnetic stimulation (Lefaucheur et al., 2017). Key Differences Between Muscle Tension Headaches and Migraines Although muscle tension headaches and migraines involve head pain, they differ […]