In my experience as a Clinical Myotherapist at Melbourne Massage and Treatment Myotherapy and Lymphoedema Clinic in Coburg, I often look beyond the area where a person feels pain. Sometimes, the problem is not simply a tight muscle or a local injury. The way a muscle contracts, controls movement or produces force can also tell us something about how the nervous system is working. To better understand this, let’s use an example: unilateral hamstring weakness, where one hamstring appears weaker than the other. This can become particularly important when someone continues training, lifting weights or performing exercises that require both sides of the body to work together, like a squat. There are several possible explanations for this presentation. One of them involves the lumbar spine, including irritation of the facet joints and, in some cases, changes that affect the nearby nerve roots. The important point is that you do not always need to experience numbness, tingling or the typical symptoms of neuropathy to have a problem with muscular control that deserves further assessment. What are the facet joint? The facet joints, also known as zygapophyseal joints, are small synovial joints located in the posterior portion of the spine on each side of the vertebrae, and they help guide and control spinal movement. Facet joints’ role is to contribute to each spinal segment’s stability, together with the intervertebral disc. Therefore, they help manage loads during movements such as bending backwards, rotating the trunk and returning to an upright position. As with any joints, even facet joints can become irritated if placed under excessive loading, repetitive movements, trauma or degenerative changes that develop over time. Indeed, anyone, in their lifetime, would experience some form of facet joint degeneration. When a facet joint becomes painful, symptoms may include localised lower back pain, stiffness and pain that refers into the buttock or thigh (Meralgia parestetica). That said, not everyone with facet joint irritation experiences the same symptoms, and degenerative changes on an X-ray or MRI do not automatically mean those changes cause the person’s pain. Indeed, as we already discussed in other blogs, pain is brain interpratiation of a stressor fact, not only a and not always a response to a “damaged” body tissue. That’s where, looking at research on facet joint disorders, we can see the importance of combining the clinical presentation with an appropriate physical examination rather than relying on imaging findings alone. Can facet joint irritation affect a nerve? The quick answer to the above question is: Yes, it can. But there is a catch too. Indeed, a facet joint irritation can manifest itself and refer pain to areas of the body that are far from the facet joint itself, but still not irritating a nerve or a nerve’s root. So in the first instance, the irritated facet joint produces pain. Therefore, surrounding muscles may become more sensitive, guarded or less effective at producing movement because of pain. On the other hand, structural changes around the facet joint may reduce the space available for a nearby spinal nerve root, leading to still pain, but also to a lack of motor control and ability to use a muscle. And again, to identify what is what, we need to go through a tailored assessment, and only via this approach can we get a better clinical understanding of what the root cause of your pain is. And what is most important to keep in mind is that not everyone experiences all these symptoms together. Can nerve involvement occur without numbness or tingling? As briefly explained before, when someone experiences facet joint irritation, as part of their symptoms, they may experience loss of control of a specific muscle or group of muscles. That said, the loss of motor control is not always related to numbness, tingling or burning pain. So a spinal nerve root contains fibres involved in both sensory and motor functions, and based on the location and severity of the problem, these functions may not be affected equally. Together with active, passive and resisted range of motion, we can then start narrowing down the clinical presentation and any potential facet joint irritation and/or involvement of a nerve compression. Why unilateral muscle weakness matters? If someone presents with unilateral muscle weakness, which can happen when there is inflammation at the facet joint along the spine, you may end up compensating during everyday movement or at the gym with the functional side to deliver an action. Let’s make an example by looking at a hamstring that is not firing, due to nerve impingement via an irritated facet joint. Let’s take the case of a client who presents at the clinic with a right hamstring group, the muscle in the back of the thigh, which is not firing. While this person does walk, squat, or does a double-leg hamstring curl, they may notice the impairment. And this is a common presentation when the weakness, given by a non-firing muscle, is not correlated to any form of pain, at least in the targeted muscle. What happens if you continue training with one weak hamstring? Now the concern is not that every strength difference will inevitably cause an injury. We know that one side is more efficient at delivering power than the other side; that’s because we are either right- or left-dominant. The concern arises when a meaningful weakness changes the way someone performs an exercise. Depending on the movement, this could involve shifting more weight onto the stronger leg, rotating the pelvis or trunk, changing the depth of the movement or modifying how the hips and knees contribute to the lift. The other side may consequently perform more work than intended. The weaker side may also be exposed to loads it cannot currently manage well. This is to say that having one side not firing or working as well as it should can lead to injury, but it also can lead to waste of training, as a muscle that can’t perform at its full potential, due to […]
Category Archives: Blog
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Facet Joint Irritation and Muscle Weakness: What You Need To Know
In my experience as a Clinical Myotherapist at Melbourne Massage and Treatment Myotherapy and Lymphoedema [...]
Continue readingOct
Blog
Chronic Pain: What it is, and what can you do about it?
Pain is something that we all experience, and it can start after an injury, during [...]
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Bunion and Morton’s Neuroma: Can a Bunion Affect Neuroma Recovery?
While a bunion and a Morton’s neuroma are two different foot conditions, if they are [...]
Continue readingSep
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Knee Pain in Coburg
Knee pain is a common form of injury and can affect people of all ages [...]
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Post-Surgery MLD Melbourne – Vodder MLD Therapist
Any form of surgery is an invasive procedure for the body to deal with, and [...]
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Oct
Pain is something that we all experience, and it can start after an injury, during an illness, following surgery, or even without an obvious cause. Indeed, pain is not always related to body damage, like a muscle tear or a broken bone. In support of this, to better understand pain, modern science shows us that pain is a complex experience produced by the nervous system. It is influenced by information coming from the body, but also by previous experiences, expectations, emotions, stress, sleep and the context in which the pain occurs. The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. What we have to understand, to start with, is that pain can occur even when there is little or no ongoing tissue damage. That’s really important when we talk about chronic pain. What is chronic pain? By definition, chronic pain is described as pain that persists or recurs for more than three months. That said, this doesn’t mean that an injury has remained damaged for such a long time. In fact, in some people, pain initially begins because of an injury or another physical problem but continues after the original tissue has had enough time to heal. This is where chronic pain can develop, because the nervous system has become more sensitive to signals from the body. So yes, even after such a long time and with physical damage repaired, the nervous system is still in alert mode, creating a signal of pain, where actually nothing physical npothing is wrong. This is one reason why treating chronic pain is often more complicated than simply finding a damaged muscle, tendon or joint and treating that structure. Chronic pain can involve different mechanisms, including nociceptive, neuropathic and nociplastic pain, and more than one mechanism can be present at the same time. Pain does not always equal damage When I treat patients who suffer from chronic pain, including pain that recurs after years, I have to ensure I explain how pain actually works, and that pain and tissue damage are not always directly proportional. Indeed, we are all aware that we all have different pain tolerance, and that someone can have significant pain with relatively little tissue damage, while another person can have substantial structural changes with surprisingly little pain. This does not mean that the pain is imaginary, or that you have to feel crazy to be in constant pain. Unfortunately, the pain is real. But what this means is that we need to create a management program to change how your nervous system is dealing with pain management and response. Because at the base of it all is that when pain persists for a long time, the sensitivity of the pain system can change. This can contribute to increased sensitivity to pressure, movement or other normally tolerable stimuli. It is like an alarm that went on every day for weeks, and then months, and out of nowhere, any stimulus can trigger it. So yes, this is one of the reasons why chronic pain needs to be approached as more than a local problem in a muscle or joint. Why can pain continue after an injury has healed? After an initial injury, or a nociceptive stimulus, pain can hang around even when no stimulus of major level is left. A stimulus that could give you pain is getting spiked with a needle, for example, when doing a blood test. If that same experience is then associated with a major stressor, like a trauma- think of pain that started after a severe car accident- the pain can be more challenging, because your central nervous system is now associating the pain not only with a physical injury (a needle penetrating the skin) but to a severe car accident. That trauma, that intense experience, can now wire your nervous system to be in alert mode constantly and therefore constantly fire a pain response, even though the physical damage is repaired. Other factors can also influence pain processing, including: Higher level of stress Poor sleep Previous pain experiences Fear of movement Expectations about what a particular movement might do to the body. So yes, you now can also understand that avoiding movement completely is not always the best long-term solution, because that fear of movement can increase the pain expectation and experience. Can hands-on treatment help chronic pain? This is another topic I find myself sharing constantly with my clients. Hands-on treatment, yes, is extremely helpful with chronic pain, and here is why. Manual therapy, that is, Remedial Massage or MLD, can provide a strong sensory input to the nervous system. Any form of touch therapy, indeed, is simply a stimulation to the nervous system. The trust built with my clients and the nervous system touch stimulation create a positive cycle that can help modulate the pain response for the better. In more detail, touch, pressure and movement stimulate sensory receptors and provide the brain with new information about the area being treated. This can influence how pain is processed and may temporarily reduce pain sensitivity. A systematic review and meta-analysis of physical therapy interventions in people with chronic musculoskeletal pain found improvements in some measures associated with pain processing, including temporal summation and conditioned pain modulation. The authors concluded that physical therapy may have a modest effect on altered pain processing, although the results differed between treatment approaches. But even if science backed up the benefit of hands-on treatment for chronic pain, we have to remember that massage can only provide pain modulation, and no one, with their hands, can actually fix a problem or heal you. And I can stress this enough to my clients. In fact, I always explain to them that I see hands-on treatment as one part of a broader treatment plan, rather than the entire solution. The temporary reduction in pain can be useful because it may make it […]
Sep
While a bunion and a Morton’s neuroma are two different foot conditions, if they are co-existing, they can sometimes influence the way the forefoot is loaded, causing delays or difficulties in the recovery process. Starting with the bunion, which medically is known as hallux valgus, changes the position and function of the big toe and first metatarsophalangeal joint. On the other hand, Morton’s neuroma is a painful condition involving one of the common plantar digital nerves, most commonly between the third and fourth toes. If you present with both conditions, treating the neuroma without considering how the rest of the foot is functioning may not always address the mechanical factors contributing to your symptoms. This is what this blog is going to analyse: Can a bunion make it harder for a Morton’s neuroma to settle? The answer is not as simple as saying that a bunion causes a neuroma, as there is not enough evidence for it. But what we know is that hallux valgus can alter how load is distributed through the forefoot, and this may be relevant when managing a sensitive or irritated interdigital nerve. What is the relationship between a bunion and a Morton’s neuroma? As mentioned above, a bunion does not automatically cause a Morton’s neuroma. That said, both conditions can be influenced by the way forces are distributed through the forefoot. Indeed, Hallux valgus can change the position of the big toe and first metatarsal, which are sitting more laterally than they should be, and alter normal walking mechanics. We know, in fact, that while walking, the big toes should be the primary driver and taker of the body weight at the toe level, and if pushed to a lateral position, it can’t take such load; therefore, the body weight is then redistributed along the phalangea box and other toes. But to be more specific, and by following what the data show, we better understand this 2025 systematic review and meta-analysis involving more than 6,000 feet found that hallux valgus was associated with reduced hallux loading when measured inside footwear. But evidence that hallux valgus consistently increases loading beneath the central metatarsals was inconclusive. And this is important because it gives a distinction between bunion and Morton’s neuroma formation, as neither is the consequence of the other. Basically, the correlation and causation effect. Indeed, foot mechanics are individual. Your symptoms can be influenced by the shape of your foot, footwear, activity, walking pattern, joint mobility, strength, and how you distribute your body weight while moving. How can a bunion affect Morton’s neuroma recovery? Now that we clarify the distinction between the correlation and causation of Morton’s neuroma from hallux valgus, we can dig more into how the bunion can affect Morton’s neuroma recovery. Morton’s neuroma is a condition that can not be recovered by only exercises or some other external interventions, but, to start with, it needs rest. By rest, we mean reducing stress on the structure involved, not no movement at all. This is why footwear modification and pressure redistribution are commonly used in Morton’s neuroma management. Therefore, the bunion may become relevant because hallux valgus can alter the way the forefoot loads during walking. For example, some people with hallux valgus develop a tendency to move the centre of pressure away from the first metatarsophalangeal joint during late stance. Research has demonstrated this lateral shift in people with bilateral hallux valgus. As a result, if the big toe can not contribute effectively to propulsion, the body may find another way to complete the movement. So again, this can overload the neuroma site, limiting rest and slowing recovery. Think about the whole foot, not just the painful spot When dealing with a painful presentation, I always invite my client to stop focusing only on the painful spot, and start to understand that nothing work in isolation. Therefore, if someone has a neuroma, it can be tempting to focus entirely on the area between the toes. But a better approach would be asking: Why is this area becoming irritated? The answer is often made up of a combination of factors, which may include: Footwear used Training load or walking volume Forefoot structure or movement Possible pre-existing injury So that’s why treating the neuroma alone may not be enough if the mechanical contributors are still present. Can bunion exercises help reduce stress on a Morton’s neuroma? The short answer is yes, but it is not always as simple. Evidence suggests exercise can improve pain and some measures of hallux valgus, particularly in mild-to-moderate cases. However, this is different from saying that bunion exercises have been proven to treat Morton’s neuroma. So what we can therefore assume is that by improving the foot mechanics and load, we may reduce stress on the neuroma site, assisting the body’s natural recovery. Exercises may include: controlled big-toe movement exercises to improve intrinsic foot muscle control toe spreading exercises strengthening exercises for the foot controlled calf and ankle exercises balance exercises progressive weight-bearing exercises exercises that improve the way the foot controls load during walking And there is no one-size-fits-all. What we should focus on too is the ability and capacity of the individual, and then work on what they are missing out on. As an example, forcing the big toe into a position with a toe separator simply because someone has a bunion is not necessarily appropriate, and it may not create the desired change anyway. The aim is not to “push the bunion back into place”. The aim here is to improve the available movement and control of the foot and help the person tolerate load more effectively, yes, starting from the big toe, if a bunion is present, but the focus has to be also on the other toes, as well as the ankle. Can big toe mobility affect pressure on a Morton’s neuroma? For what we know, the big toe plays an important role during walking, particularly during the later part of stance. For simplicity, we expect […]
Sep
Knee pain is a common form of injury and can affect people of all ages and activity levels. Common mechanisms of action that lead to knee pain include an intense increase in load training, repetitive activities, osteoarthritis, a sudden change in direction during a sport activity, muscle or tendon tears, ligament injury or irritation around the kneecap. If you are experiencing knee pain in Coburg, the first step is understanding what may be contributing to your symptoms rather than simply treating the painful area. At Melbourne Massage and Treatment in Coburg, I use a combination of clinical assessment, hands-on treatment and exercise to help manage knee pain. Depending on your presentation, this may include Remedial Massage, Myotherapy and a progressive exercise program. What can cause knee pain? “Knee pain” is a symptom, not a diagnosis. As with any joint pain presentation, first things first, we want to rule out whether what we are looking at is a joint pain presentation or a muscle-related injury type of pain. To do so, we need an extensive understanding of the mechanism of injury, like how/when the pain started and how/when the pain increases or decreases. That information can start giving us some clues about what type of injury we may rule in or rule out Here is a list of common areas or presentations to which knee pain can refer to: Pain around or behind the kneecap Patellofemoral pain Knee osteoarthritis Patellar tendon pain Quadriceps or hamstring-related problems Pain following an increase in running, walking or gym training Knee pain following an injury Pain associated with changes in lower-limb strength or movement Stiffness and reduced knee function To give you a better understanding of how each area of the knee can correspond to a specific injury, let’s look at patellofemoral pain, which commonly becomes more noticeable during activities that load the knee, including squatting, stairs, running, jumping or prolonged sitting. But your pain, perhaps, could also be from an ACL injury, and it may present at the anterior portion of the knee, and this is why I don’t use a one-size-fits-all approach to knee pain. Unless we can pinpoint why you are in pain and what structure is responsible for it, going for a random treatment plan would not help. Knee pain assessment in Coburg During a Myotherapy appointment, I look at more than just the painful spot. The assessment can include your symptoms, medical history, previous injuries, training or work demands and the movements that reproduce your pain. Other things we may look at include: Knee range of motion Hip and ankle movement Quadriceps and hamstring function Hip strength Single-leg movements Squatting and stepping movements Running or other sport-specific activities How your symptoms respond to different loads Along with that information collection and movement pattern, I will ask you to go for, we can better understand what the structure that gives you pain is: a meniscus or a ligament, as per a quad tendon or a hamstring tendon. The purpose of this assessment is not simply to find something that looks “out of alignment”. It is to understand what may be contributing to your symptoms and determine what can be changed. How can Remedial Massage help with knee pain? Remedial Massage is an ideal hands-on treatment to reduce pain and stress on muscles that surround the knee joint, which may be contributing to your symptoms. Then, based on your individual presentation, treatment may include work around the quadriceps, hamstrings, calf muscles, gluteal muscles and other relevant areas of the lower limb. What is important to notice, on the other hand, is that massage does not directly “fix” every cause of knee pain, and it should not be considered a replacement for rehabilitation when exercise is required. Research on massage therapy for knee osteoarthritis suggests that massage may provide short-term improvements in pain, stiffness and function, although the evidence is limited and the longer-term effects are less clear. [2] This is why I see Remedial Massage as one part of a broader treatment plan when appropriate. Myotherapy for knee pain Among the services that I do offer here at my Coburg clinic, Myotherapy takes a broader clinical approach to musculoskeletal pain. Rather than simply massaging the knee or surrounding muscles, treatment can combine: Assessment → hands-on treatment → movement → exercise → gradual loading` The exact approach depends on your symptoms and goals. Hands-on treatment may be used to help manage pain, muscle sensitivity or movement restrictions. Exercise can then be introduced or progressed according to what you need to return to. For someone who has knee pain when squatting, for example, the goal may not be to avoid squatting forever. Instead, we can look at how much load you currently tolerate and gradually build your capacity. For someone who has knee pain when running, the approach may involve modifying training temporarily while building strength and tolerance before progressively returning to running. Exercise is an important part of knee pain management Exercise is one of the most important components of managing many types of knee pain, and probably any form of pain. From research to clinical experience, I support exercise therapy for knee osteoarthritis and any form of knee pain with different types of load and forms of exercise, including resistance training, cycling and other exercise approaches showing benefits for pain and function. [4] Why exercise is the way to go is because we want you to be functional and capable of loading your knee with as little trouble as possible. So, by increasing the load gradually and exposing your knee joint to positive stress as a controlled load, it works in favour of our long-term goal: you being pain-free. And of course, based on your presentation, we may need to change the type of exercises, especially in the early stage, when the inflammation is still acute, the level of sensitivity is still high, and the structure it may not be ready for any random load. Therefore, the important point is that […]
Sep
Any form of surgery is an invasive procedure for the body to deal with, and finding yourself with oedema post-surgery, pain, sensitivity, stiff scars and/or fibrosis is a natural process and consequence. Those presentations indeed are also the result of a temporary effect on the body’s tissues and the lymphatic system. This is one reason Manual Lymph Drainage (MLD) may form part of a post-operative recovery plan. But there is an important distinction that is often missed: MLD is not simply a “lymphatic massage”. Indeed, when I work with clients who specifically have undergone procedures such as liposuction, abdominoplasty, breast surgery, body contouring and other cosmetic procedures, I have to explain that MLD is performed using the Dr Vodder method, which gently stimulates the swollen areas to direct the fluid towards the nearest lymph node. And not just pressing hard or applying some oil on the skin and starting to massage it in the hope of some relaxation. Because if you are someone who is recovering from cosmetic surgery, that difference matters. What happens to the lymphatic system after cosmetic surgery? Surgery is a controlled injury to the body. As a consequence of this procedure, tissues may experience inflammation, disruption of small blood and lymphatic vessels, changes in tissue pressure and temporary impairment of normal fluid clearance. Post-operative oedema is therefore not necessarily a sign that something has gone wrong. In fact, swelling is a normal part of the body’s healing response, although the amount and duration can vary considerably between individuals and procedures. Recent research has highlighted postoperative oedema as a common consequence of aesthetic surgery and has also drawn attention to the need to better understand lymphatic complications following these procedures. That’s where, as a clinician, I don’t only think of: “How do I get rid of the swelling?” But I also look into: “What is happening to this person’s tissues and lymphatic drainage at this stage of recovery?” And that’s where clinical assessment becomes important. MLD is not about squeezing swelling away As cosmetic surgery is becoming more and more popular, and many Melburnians are heading overseas to get their surgery done, I was quite shocked the first few times I had someone call for MLD post-cosmetic surgery and asked how I would push the liquid out of their body. My response was as clear as it could be: MLD is not about squeezing liquid out of your body. This is not only a dangerous and illegal procedure here in Australia, but it is definitely not how Dr Vodder MLD is designed to work. The original Dr Vodder method uses gentle, specific skin-stretching techniques applied with appropriate pressure, direction and speed. The technique is intended to assist lymph flow and drainage of tissues. This is particularly relevant after surgery because recently operated tissues are not the same as healthy, uninjured tissue. In fact, more pressure is not necessarily better. That’s where post-operative treatment needs to respect the stage of healing and the condition of the tissues being treated. Why the treatment cannot be exactly the same for everyone No single “post-cosmetic surgery MLD protocol” fits everyone. Consider the difference between someone recovering from: liposuction of the abdomen abdominoplasty breast surgery a combination of procedures body contouring liposuction of the thighs or arms The surgical areas, incisions, tissue trauma and areas of swelling can all be different. And after a few years of experience, I can tell you, I got to work with people who did a few of those surgeries all at once, and coming up with a clinical reasoning on how to move the fluid was a good challenge. On the other hand, there is to consider that there can be variation between patients, based on their general wellbeing and health status. Two people may have the same procedure but very different presentations. One person may have relatively mild swelling and good tissue mobility. Another may have significant oedema, restricted movement, areas of tenderness or developing tissue firmness. This is why post-operative MLD should be individualised rather than treated as a routine massage sequence. What Do We Look At As a Vodder Therapist? Before commencing an MLD treatment, even with a returning client, we start with more than simply locating the swollen area. First thing first, we consider the person’s overall presentation and the stage of recovery. Depending on the situation, this may include considering: The procedure What surgery was performed? Which tissues were affected? Where are the incisions and treated areas? The stage of healing Post-operative tissues change considerably over time. A technique that is appropriate at one stage may not be appropriate at another. The distribution of swelling Swelling is not always confined to the area that was operated on. The lymphatic pathways MLD is based on understanding lymphatic anatomy and drainage pathways rather than simply rubbing towards the closest lymph node. The condition of the skin and tissues Changes in tissue texture, sensitivity, mobility and firmness can provide useful information about how recovery is progressing. The person’s symptoms and function Pain, tightness, restricted movement and discomfort may influence how treatment is approached. Compression and movement MLD is not necessarily an isolated treatment. Depending on the individual’s situation, compression, appropriate movement and other elements of recovery may also be relevant. And again, this is one reason why seeing a therapist with specific lymphatic training can be different from booking a generic “lymphatic massage”. Why the direction of MLD matters The lymphatic system is a complex network, not a simple pipe running directly from the swollen area to the nearest lymph node. Indeed, when performing MLD, we use specific manual techniques and treatment sequences to influence lymphatic drainage. Our aim as MLD therapists is to direct the fluid from the congested area, away from and across the watershed (an imaginary line that divides the body into quadrants, from which the lymphatic system vessels start), aiming for the fluid to reach the lymphatic duct (the connection between the lymphatic system and the bloodstream in the […]
Sep
In the many presentations I get to see here at Melbourne Massage and Treatment in Coburg, hip pain is quite a common one. When we talk about hip pain, though, we refer to a variety of presentations which can be defined primarily by the site of pain in the hip area. So it can be the frontal side, including the groin, or the side of the hip, near the femoral head, or even the gluteal area, upper or lower. Hip pain, like any form of pain, can be debilitating, and as with other conditions, like back pain, it can make everyday activity more difficult and challenging, as the hip is a joint we use for basically any movement, and even while sitting or lying down can still be uncomfortable. That said, “hip pain” does not always mean that the problem is coming directly from the hip joint. Pain around the hip can involve muscles, tendons, ligaments, nerves, the sacroiliac joint (SIJ), or structures around the outside of the hip. Conditions such as femoroacetabular impingement (FAI), gluteal tendinopathy and greater trochanteric pain syndrome can also produce different patterns of hip pain. At Melbourne Massage and Treatment in Coburg, assessing where your pain is located, what movements aggravate it and how your hip and surrounding areas move can help determine what may be contributing to your symptoms. What Can Cause Hip Pain? As briefly mentioned above, there are many possible causes of hip pain and injuries. Below, we are going to go through some of the most common hip pain presentations I get to see at my Myotherapy clinic in Coburg. Ligament Tear Ligaments are soft tissues that connect bones to bones and help provide stability around joints. Even though the hip joint is most often well supported via those 3 ligaments Iliofemoral, Pubofemoral, and ischiofemoral a significant force, sudden movement, or sporting injury can damage a ligament around the hip or pelvis. When we said that most often, the hip is well supported by those 3 types of ligaments, we refer to the fact that genetically we all have different presentations, and someone who was born with hip dysplasia may present naturally with less stability at the hip joint. Moving forward, a ligament injury may cause pain, tenderness and a feeling of reduced stability. The gold standard diagnostic method for a ligament tear, lastly, would not be a basic hands-on assessment, but a magnetic resonance arthrogram (MRA). Muscle Tear The muscles surrounding the hip are among the bigger and stronger muscle groups in the body; let’s think of the quadriceps muscle group or the hamstrings. Those muscle groups, on top of being really important for overall hip functionality, are also really important for hip stability. But, as with any muscle group, a sudden increase in load, sprinting, jumping, changing direction, or an unexpected movement can result in a muscle strain or tear. Depending on the muscle involved, you may feel pain around the front, side, or back of the hip. Muscle tears can range from relatively minor strains to more significant tears, which result in severe pain, swelling, and bruising and may require a longer rehabilitation period. Hypermobility Hypermobility is a condition that involves many of my clients and is about having more laxity in the ligament tissue. However, being hypermobile does not automatically mean having an injury, but it means that more strength in the hip muscle group is needed to avoid injuries. This is because the hip ligaments, in a hypermobile presentation, are less capable of holding the femur head into the hip socket. Therefore, the goal is not necessarily to restrict movement at your hip joint, but to improve strength, control and tolerance to load. Femoroacetabular Impingement (FAI) Femoroacetabular impingement, commonly called FAI, is a condition that can affect even fairly active people, including athletes. It is characterised by extra tissue that can grow on the femoral head or on the hip socket, which may get irritated when the hip goes into flexion. Symptoms may include pain around the groin or front of the hip, particularly with certain positions involving hip flexion and rotation. In contrast to a hip ligament tear, imaging findings do not always explain someone’s symptoms on their own. A clinical assessment is needed to understand how the hip structure, movement and symptoms relate to each other. But, commonly, in ligament tears, the strengthening of muscle groups that cross the hip joint is quite important, including quads and adductors. Femoral Nerve Pain Even though femoral nerve pain is less common than sciatic nerve pain, it is still quite relevant to the topic of hip pain. A common cause of femoral nerve pain is Meralgia Paresthetica, a nerve entrapment at the inguinal ligament that can cause numbness and pain at the anterior portion of the thigh. Furthermore, femoral nerve pain can also result from back injury or nerve entrapment at the spine level, specifically L2, L3, and L4. To differentiate which pain comes from where, a tailored assessment is needed, including a clear understanding of the mechanism of injury and changes in body mass (especially if it happens in a short period of time) and, where needed, a scan can also be helpful to rule out either one or the other condition. Sacroiliac Joint (SIJ) Discomfort The sacroiliac joints are a complex structure that connect the pelvis with the sacrum and are located near the back of the pelvis. SIJ pain can present with different levels of discomfort and in different locations, including the sacral area, upper gluteal area, or, if nerve entrapment is present, pain can refer all the way down the shin via the sciatic nerve. Because symptoms from the lower back, pelvis and hip can overlap, identifying the exact source of pain can be difficult without an appropriate assessment. Gluteus Medius Bursitis / Greater Trochanteric Pain Syndrome When pain is present on the outside of the hip, it can be described as “hip bursitis” or “Greater Trochanteric Pain Syndrome”. A bursa is […]
Aug
Lymphatic Walking is another trend that you really don’t need to overthink. But let me introduce myself first. My name is Giovanni, and I am a clinical myotherapist specialised in Manual Lymphatic Drainage (MLD). I work with client who has an intact Lymphatic system but even with client who have Lymphatic System pathology, like Lymphoedema. In this blog, I am going to share the basic knowledge and explanation of why Lymphatic walking is a nonsense term, but you should still walk. Walking is good for you. It gets your muscles moving, supports cardiovascular health, improves fitness and can be an easy way to stay active. But recently, you may have heard of lymphatic walking. Your lymphatic system is already working, no matter what. So no, you don’t normally need a special walking technique to “switch it on.” The lymphatic system is a complex transport network that continuously moves fluid, proteins, fats and immune cells through the body. Lymphatic vessels have their own pumping mechanisms, while movement of surrounding tissues, breathing, and other mechanical forces can also influence lymph transport. Does walking increase lymph flow? Yes. And with this, we already gave enough credit to this trend. Any form of movement can help the lymphatic system work more and can help your body feel less bloated and tight. This is because any form of muscle contraction is going to directly stimulate your lymphatic system capillaries to collect more liquid and therefore move more fluid. Now, walking is a perfectly reasonable activity for supporting normal circulation and lymph transport, because the primary movers in the body for walking are your legs. Legs contain the biggest muscle group of the body, and are a body area where the fluid has to travel the most, in a proximal direction, to reach the clavicle, where the lymphatic fluid is then dumped into the bloodstream (at the subclavian veins). But again, there is nothing particularly magical about “lymphatic walking.” Again, your lymphatic system responds to many forms of movement. Walking, cycling, swimming, resistance training, climbing stairs and ordinary daily activities all involve muscular contractions and changes in pressure that can contribute to lymph movement. In other words: You don’t need to learn a special walking pattern to make your lymphatic system work. But what I really want to make sure we all understand is that there is nothing inherently wrong with doing them. Just don’t confuse a different walking technique with a medically necessary way of “activating” your lymphatic system. Do you need to boost your lymphatic system? Ok, this is another big topic that I often find myself talking to my clients about here at Melbourne Massage and Treatment in Coburg. If, overall, you are a healthy person, no, you don’t need to boost your lymphatic system. And the reason is quite simple. Your lymphatic system, like many body systems, works fine just by you doing the right thing. If you keep yourself in motion- yes, in this case, even just walking- your lymphatic system works even stronger than usual. This is why phrases such as: “Your lymph is stagnant” “You need to activate your lymph” “Your lymphatic system is blocked from sitting” “Do this walk to detox your lymph” “You need to flush your lymph” should be treated with some scepticism, as are a bunch of nonsense words. That said, there are, of course, genuine lymphatic disorders. People with conditions such as lymphoedema can experience impaired lymphatic transport and may require appropriate assessment and management. Exercise and movement can form part of lymphoedema management, but that is very different from saying that everybody needs to perform a special walking routine to prevent their lymphatic system from becoming “stagnant.” What if you have lymphoedema? This is where we need to sit and talk. Medically talk, no social media trend chat. If someone has lymphatic dysfunction, simply telling them to “walk more to boost their lymph” is not an adequate treatment plan. In fact, exercise can be beneficial for people with lymphoedema. But when someone presents with Lymphoedema, we need to take into consideration the bigger picture, which is their medical and clinical history. Therefore, management of lymphoedema may involve several components, depending on the individual, including exercise, compression, skin care, education, self-management and appropriate manual techniques. That is very different from following a social-media video promising to “flush out toxins.” Lymphatic massage is not the same as Manual Lymphatic Drainage Something that I already touched on is the topic of lymphatic massage and what’s the difference between Lymphatic Massage and MLD. A massage advertised as “lymphatic” is not automatically Manual Lymphatic Drainage (MLD). MLD is a specific manual technique with particular principles and techniques. It should not simply be used as a marketing label for any gentle massage that claims to “drain toxins.” Understanding this distinction is particularly important if you are looking for treatment for an actual lymphatic condition. But also, if you are looking to find a therapist who can tell you more about your lymphatic system needs, if any, and not just grab your money promising a healthy trend. So, what is MLD? Manual Lymphatic Drainage is a specialised, gentle manual technique that increases lymphatic fluid transport. Vodder Academy is the world academy that has a patent for MLD as a technique and treatment modality. That’s the academy I studied with for my Applied MLD, Lymphoedema Management and Cosmetic Surgery recovery specialisation. That said, there are other schools that offer training for other lymphatic treatment, but personally, with extended research, I found that the Vodder Academy was the best school to study with. Not only because they hold the gold standard for Lymphoedema treatment, but also because the training doesn’t stop at the course; there is a real network of teachers and students who spend time sharing resources and experiences from all over the world. Can healthy people have MLD? Yes, of course they can. If you are overall healthy and not suffering from any lymphatic condition, you can still receive […]
Aug
Shoulder pain is a common presentation I get to see and treat here at my Myotherapy Clinic in Coburg. It ranges from clients who have difficulty reaching overhead to those who have no mobility issues but a constant pain or ache along the shoulder blade area. Myotherapy treatment can help with this presentation, settling the pain once and for all, by guiding you on what structures need tension relief and which ones need strength. So if you are looking for shoulder pain treatment in Coburg, it is important to understand that shoulder pain does not always come from one specific muscle or structure. The shoulder works as part of a larger movement system involving the neck, upper back, shoulder blade, rotator cuff and the rest of the arm. What Can Cause Shoulder Pain? Let’s start by pointing out what structures can create shoulder pain. Some people notice pain after lifting weights, playing sport or performing repetitive movements. Others develop shoulder pain gradually without a clear injury. Common factors associated with shoulder pain can include: Repetitive overhead movements Sudden increases in training load Poor tolerance to certain movements Reduced shoulder mobility Reduced strength or endurance Rotator cuff-related pain Irritation following an injury Neck and upper-back problems contributing to symptoms Changes in activity or training Prolonged periods of inactivity Cervical facet joint irritation Bursitis The tricky bit with any pain, including shoulder pain, is that the painful spot does not always tell you exactly which structure is responsible. That’s why, along with our Remedial Massage or Myotherapy treatment, an initial consultation always comes with an assessment first. We want to pin down, at best, what structure is responsible for your pain. A classic example is: muscle or joint pain? Shoulder Pain Is Not Always Just a Shoulder Problem As briefly explained before, your shoulder does not work alone, as it takes part in a more complex mobility and stability joint complex system. That said, the shoulder is also one of the weakest and most exposed joints in the body, given that it has to have really major mobility capacity, but it is also required to play a strong, stable role (scapular/thoracic joint). So what actually can influence your shoulder capacity and load; therefore, what can also influence your shoulder pain is your neck, your thoracic spine, and even your elbow area. For example, reaching overhead requires coordinated movement between the shoulder joint and shoulder blade. Your upper back and neck also influence how this movement occurs. This is why two people with similar shoulder pain may require completely different treatment approaches. One person may need to improve shoulder strength. Another may need to work on mobility. Someone else may need to gradually rebuild their tolerance to lifting or overhead activity. Common Types of Shoulder Pain From what I get to experience as a practitioner here at Melbourne Massage and Treatment in Coburg, shoulder pain can present in many different ways. I did see clients who present with shoulder pain while: Lifting the arm at any degree Pain reaching overhead Pain when reaching behind the back Pain when sleeping on the affected side Pain during gym exercises Shoulder stiffness Reduced range of movement Pain around the front or side of the shoulder Pain extending towards the upper arm Shoulder pain associated with neck tension That said, we have to be aware that some shoulder problems can also develop gradually, while others occur following a specific injury. What I would suggest about your shoulder pain is that if you experience severe pain, following a significant trauma, and having major weakness or loss of movement, appropriate medical assessment may be required. So do not hesitate to book in a Myotherapy session, and let’s start understanding how serious your presentation is. What About Rotator Cuff Pain? The rotator cuff, which is a group of muscles that surround your humerus head and give stability to the humeral head, is important for shoulder health, but occasionally it can be overlooked and blamed for your shoulder pain. While this group of muscles needs to be strong in order to minimise the chance of shoulder pain, we have to consider that, taken alone, they are not going to be the only muscles you want to focus on for your shoulder health. Therefore, let’s not automatically label it as a “rotator cuff injury” simply because it hurts during a particular movement. A proper assessment considers your symptoms, movement, strength, training history and how your shoulder responds to different loads. Can my Shoulder Pain be Part of Menopause Symptoms? Yes, it can. Menopause, as discussed in many other blogs, is a life-changing experience that women experience at an average age of 52 years. Along this transformational journey, as estrogen starts fading away, conditions like Frozen Shoulder (Adhesive capsulitis) are quite common. In a more recent study by MD Jocelyn Wittstein, women who were suffering from this condition and took HRT saw their symptoms drastically improve. More information about menopause and Frozen Shoulder is available from this article. How Can Myotherapy Help Shoulder Pain? At Melbourne Massage and Treatment here in Coburg, when someone presents with shoulder pain and wants to get on top of what the problem is, I do offer Myotherapy treatment as a form of pain relief but also as a form of strengthening program for the shoulder complex. So I would treat shoulder pain in Coburg with a combination of: Movement assessment Hands-on treatment Soft tissue techniques Myofascial techniques Joint mobilisation where appropriate Dry needling where appropriate Mobility exercises Strengthening exercises Education about activity and load management My aim, again, as a clinical myotherapist, is not to make you feel better only after the treatment, but to give you tools to empower yourself and to make you stronger and live better, possibly pain-free. To do so, in the longer term, we need to understand what may be contributing to your symptoms and gradually improve your ability to move and load the shoulder. Shoulder Mobility Is Important — But […]
Aug
Lower back pain is a leading cause of disability in Australia. That said, not everyone who experiences lower back pain has to end up with debilitating pain for months or years, and so how can we prevent that? Therefore, to prevent severe musculoskeletal pain, including back pain, movement is our best option. That said, we have to be aware that even pros who do regular movement can occasionally suffer from lower back pain. As we will see in more detail soon, pain is a brain response to a stimulus, which can be physical but also psychosomatic or from a rise in stress or lack of sleep and/or more. So, for many people, lower back pain improves with time and appropriate movement. However, persistent or recurring pain can interfere with work, exercise, sleep and everyday activities. Then, if you live or work in Coburg and are experiencing lower back pain, understanding what may be contributing to your symptoms is an important first step to ensure your presentation doesn’t become a chronic one. What is lower back pain? Let’s start with a better definition and understanding of what lower back pain is. Lower back pain refers to pain experienced in the area between the bottom of the ribs and the buttocks. It can feel different from person to person, and it may be really local to this area, or it can refer to your leg, within the anterior portion (femoral) or the posterior portion (sciatica). Other than what you may experience: A dull ache or soreness Sharp or sudden pain Stiffness Muscle spasm Pain when bending or twisting Discomfort when standing up after sitting Pain during lifting or exercise Occasionally, someone may experience symptoms associated with nerve irritation, such as pain, tingling or numbness travelling down the leg. All of this said, when talking about what lower back pain is, we have to touch base on the meaning of “non-specific back pain”, which means there is no single identifiable structure that can be confirmed as the cause of the pain. In fact, this is very common and, and that’s what we briefly talked about earlier. Pain can, yes, be associated with physical damage or a physical impairment, but it is not always the case. So, education and understanding of what pain is and how it comes to be is a really important step to take when suffering from chronic pain conditions. What can cause lower back pain? As a clinical myotherapist here in Coburg, I often have to explain to my client who suffer from lower back pain that it is not as simple to find the reason for their lower back pain. Indeed, your lower back works as part of a larger movement system (mobility and stability joint chain) involving the hips, pelvis, abdominal muscles, legs and upper body. How these areas move and how much load they are exposed to can influence how your back feels. Therefore, we may want to look at some common factors associated with lower back pain, which include: Sudden increases in physical activity As someone who loves to do and promote physical activity, I also warn my clients to be aware when starting their moving journey, step by step. Indeed, a common situation that can cause lower back pain is doing more than your body is currently prepared for. Here are some common case scenarios on how this can happen: Start a new gym program Increase your running distance Return to exercise after a long break Lift something unusually heavy Spend a weekend doing physical work Increase your training volume too quickly A sudden increase in load can temporarily make the lower back more sensitive. Prolonged sitting The reason why so many people nowadays may suffer from aches and pain, including lower back pain, can definitely be attributed to a sedentary lifestyle. Indeed, long periods of sitting, particularly when combined with little physical activity throughout the day, can contribute to stiffness and discomfort. This is because not using the body for what it was designed for in the first place leads to a loss of function. The typical “use it or lose it” situation. But let’s be clear, we are not saying that sitting does damage to your back. But what we are saying is that if you do a job that involves long hours sitting or standing at a desk, you should take regular breaks from that position and do a bit of movement that can maintain your body functionality throughout the day. Taking regular movement breaks and changing position throughout the day can also be helpful to keep your brain active and more productive, due to more blood flowing through the full system, including the central nervous system (Brain). Reduced physical activity Again, as with the whole body, even your back is designed to move. When you become less active because of pain, fear of movement or a busy lifestyle, you may gradually lose confidence and capacity with certain movements. This can create a cycle where movement becomes uncomfortable, so you move less, which makes returning to normal activity more difficult. What we need, indeed, is an equilibrium between movement, load and rest. Lifting and repetitive movements As already mentioned in the blogs that talk about tendinopathy, repetitive movement, which in the case of lower back pain can be bending, twisting, lifting and/or carrying, can place significant demands on the tendons and tissues around the lower back. And again, let’s stay firm on the fact that any of those movement are absolutely safe to do, as long as the load applied to it is gradually introduced and increased, and not suddenly placed there. Because that’s the typical case of the seasonal Coburg gardener: when the spring season kicks in, they start working hard and harder in the garden without proper training or warm-up, ending up with lower back pain. Strength and conditioning Strength is one part of the bigger picture. Your ability to tolerate lifting, running, bending, carrying and other activities depends […]
Aug
If you have been living in Coburg and the surrounding area, like the Merri Bek or Darebin councils, you probably notice how Coburg is a suburb full of movement. From people cycling along Merri Creek, walking around Coburg Lake, training at local gyms, playing community sports, or simply trying to stay active despite busy work and family commitments, movement is a big part of everyday life in Melbourne’s northern suburbs. As a Myotherapist based in Coburg, I see many different people who share one common goal: They want to move better, feel better, and get back to doing the activities they enjoy. And this can be due to recovering from an injury, managing ongoing pain, or improving physical performance. That’s where Myotherapy can play an important role in supporting your body and wellbeing. Why Active People Often Experience Injuries One of my mottos here at Melbourne Massage and Treatment Myotherapy and Lymphoedema Clinic in Coburg is: “Move More, Live Well”. But being an active person doesn’t mean you are never going to be in pain or experience some discomfort. Indeed, pain is a complex neurological response, and movement, in some way, is what is needed to alleviate the pain or change this neurological response. On the other hand, if your level of activity is not constant but sporadic- so after a long period of no load, you increase the load suddenly- that’s where the injuries happen. And here are some common presentations I see in my Coburg clinic that are related to overloaded movement: Calf strains and tightness Achilles tendon pain Hamstring injuries Shoulder and neck pain Lower back discomfort Hip and knee issues Overuse injuries from repetitive activities These problems can affect anyone. It could be someone preparing for a running event, a cyclist spending hours on the bike, someone returning to exercise after a break, or simply someone who spends most of their day sitting at a desk. Myotherapy Is More Than Just Massage One common misconception is that Myotherapy is simply a stronger form of massage. Well, let me tell you, it is not. Indeed, hands-on treatment is part of a Myotherapy treatment, and it is an essential component of creating trust between me, the therapist, and you, the patient, but what really is going to fix your pain, or reduce it the most, is movement under the right load. And that’s what really Myotherapy is. Massage, load, and Education about your wellbeing. My approach combines: Clinical assessment Hands-on treatment Movement analysis Exercise advice Education about your condition In fact, our goal is not just to temporarily reduce symptoms, but to understand why a problem may have developed and what we can do to improve your long-term movement. And of course, every person is different, which is why I don’t believe in using the same treatment approach for everyone. Helping Coburg Residents Stay Active If there is something that really attracted me to come back to Coburg to run my clinic, it is the variety of people I get to meet. Some clients come to me because they are dealing with an injury that is stopping them from doing what they love. Others come because they want to improve their mobility, strength, or recovery. For example: A runner may need help managing recurring calf tightness. A cyclist may need support with hip mobility and lower back discomfort. A gym enthusiast may need assistance returning safely after an injury. Someone working at a desk may need help with neck, shoulder, and posture-related discomfort. The treatment approach may be different for each person, but the goal remains the same: helping you move with confidence again. Recovery Requires More Than Rest Along with the educational protocol I put in place in my clinic here in Coburg, I explain to my clients when rest is needed and for how long it is needed. I dedicate a full blog to the inflammatory response. And understanding this concept allows you to regain confidence in your movement as early as possible. Because resting for too long may cause you to lose muscle mass and confidence in movement. Therefore, depending on your presentation, this may include: Improving mobility Building strength Gradually increasing load Learning better movement strategies Again, the body adapts to the demands we place on it. The challenge is finding the right progression, not just resting for too long or rushing to load more quickly. This is where Myotherapy, exercise prescription, and education can work together. Supporting the Coburg Community and Surrounding Suburbs Moving forward from what Myotherapy is and how it really works, being located in Coburg allows me to support clients not only from Coburg itself, but also from surrounding Melbourne northern suburbs including: Brunswick Pascoe Vale Preston Reservoir Fawkner Thornbury Essendon The clinic at 325A Moreland Road is easy to reach by car and public transport. Indeed, you have plenty of car parking along Haig Avenue next to the clinic or Moreland Road (with some parking limitations in terms of time) or a bus stop (BUS 510) which stops right in front of the clinic, or a walking-distance tram (6, 19, 58) and train stop (Moreland Station, Upfield Line). These options make it convenient for people looking for Myotherapy, Remedial Massage, Manual Lymphatic Drainage, and lymphoedema care in Melbourne’s north. My Approach: Move More, Live Well Why I started looking into Myotherapy as a form of treatment is because teh movement is a key component of this type of therapy. Indeed, Move More, Live Well, do really match the essence of this form of therapy. I don’t believe that someone has special powers or magical hands that can fix your pain. I do believe that the right therapist can have the right clinical reasoning to help you overcome your pain and show you the right movement underload that can help you overcome your pain, but also help you understand your body, improve your movement, and give you the tools to stay active. Again, whether you are recovering from an […]