Manual Lymphatic Drainage if used along the correct type of condition, is a safe and well utile manual therapy. In the previous two blogs (Link 1, Link 2) I described how the Lymphatic System works and its relation to MLD. What body find benefit from Manual Lymphatic Drainage? As previously mentioned, the lymphatic system is so important to keep the homoeostasis of the body. Indeed, along with the following conditions, homoeostasis is compromised: Skin Burn Chronic Inflammation (plantar fascitis, tendinitis…) Lymphodema Oedema Scar reduction and prevention Pre and post-operation body rehabilitation Improving the bell function Head-each Skin puffiness and or Acne and more… How can Manual Lymphatic Drainage help with these conditions? Firstly, what all those conditions have in common, is that they are related to how the Lymphatic System deal with them. So again, the healthier and more vital is the lymphatic system, the better the body’s homoeostasis. If we look into oedema due to a hammered hand, we need a responsive and well-functioning lymphatic system to absorb that swelling. The stronger the lymphatic system, the quicker the healing process will be. Even a scar from a post-operation could heal faster if the lymphatic system gets adequately stimulated. More nutrients and less dangerous components will float around the wound if the lymphatic system works stronger. Secondly, some of these conditions are so painful that a massage is not applicable. As we applied MLD, we would not increase the pain, thanks to the light touch. If this post is talking to you, and you need a massage, book your next session by clicking here. Why should MLD not be painful? When we apply the different strokes by dragging the skin gently around, we will stimulate the lymph vessels to collect the obligatory lymph load. Still, we will not generate pain by stimulating pain receptors. Furthermore, the repetitive mechanical stimulation would activate what in science is called the gate theory. The gate theory looks into the interneurons’ inhibitory response, which reduces the pain signal reaching the brain, consequently decreasing the pain response. MLD and coontroindications. MLD can’t be applied to Acute infection, Untreated Cancers, Untreated Thrombus, Congestive heart failure, or intoxicated persons. Minor contraindications include Hypertension/Diabetes n1, Autoimmune disease, Asthma, Hypo/Hyperthyroidism, pregnancy, and a history of tuberculosis. In conclusion, I am honoured to have the knowledge and the skill to use and apply such a technique. Even though, for now, I can’t yet treat people with Lymphodema and or clients who had lymph nodes removed or are looking for a post-cancer treatment. What I got to offer to this patient, anyway, is a reference for other practitioners. So if this is you, please get in touch with me, and I can refer you to your nearest practitioner.
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Dec
A Watershed is an imaginary line that divides the body and the Lymphatic System into quadrants. Each quadrant has its lymphatic liquid collection canal, and the lower quadrant, as per the two legs, sends the liquid to the cisterna kili, a gland that sits deep behind the belly button that is connected to the upper left duct within the upper left quadrant. What the watershed division looks like? The main watersheds are four. A vertical one divides the body into two equal vertical halves. The other three lines are horizontal and parallel to each other. The top runs along the clavicle, the second runs through the belly button, and the third and last runs on top of the iliac crest. In doing so, we have six quadrants, two uppers, two medial and two lower. The importance of watersheds. As we dig more and more within the functionality of the Lymphatic System and MLD as a Lymphatic Drainage technique, we can see that in these specific quadrants, there are bundles of Lymph nodes that get loaded from the lymph vessels connected to it. So the watershed division allows having the liquid directed to a specific body area where lymph nodes are found. Indeed, the lymph nodes are the ones that do the cleanup of the lymph liquid, also called obligatory lymph load. When we do a treatment, we have to make sure where we direct the liquid because we want to ensure that the lymph liquid gets sent to the lymph nodes, to be processed and then transferred to the lymph/vein duct at the high of the cervical area. If this post is talking to you, and you need an MLD treatment, book your next session by clicking here. The upper watershed and the duct. After the obligatory lymph load reaches the upper watershed (the one running along the clavicle), it gets passed to the venous system. This happens after the obligatory lymph load travels with the trunk collector and passes through the duct. The duct is the last portion of the lymph trunk that connects to the venous system. In conclusion, we want to specify that the lower quadrants (R leg and L leg) and the upper L quadrant drain in the L thoracic duct within the L subclavian vein. Where the R upper quadrant does drain in the R duct connected to the R subclavian vein. Below here, is a list of blog posts that talk about conditions where MLD can be beneficial: Bone fracture Sunburn Preeclampsia TMJ Chronic Pain Fibromyalgia
Nov
MLD stands for Manual Lymphatic Drainage. As per a deep tissue massage, MLD treatment works on the lymphatic system and not the musculoskeletal system. This technique aims to boost the capacity and ability of the lymphatic system. Manual Lymphatic Drainage history. MLD is a technique implemented by Dr Vodder and his wife, Estrid Vodder, with the help of many other scientists and researchers. Dr Vodder can be described as a visionary of the lymphatic system role. He dedicates his life to the realisation of this technique. Dr Vodder and his wife formulated a series of hypotheses on how the lymphatic system works, and how it is essential to speed up recovery from diverse conditions. All their hypothesis, along the 20th century, were then confirmed and transformed in theory thanks to the works of many other scientists. As per result, after their first few years of hypothesis formulation, in the early 20th century, they could start promoting their work and run seminars and classes about MLD all around Europe. Nowadays, is in Austria in the village of Walchsee -Tyrol -Austria resides the Dr Vodder Academy –Lymphedema Clinic Wittlinger. The Austrian clinic was founded in 1971, and since that, the MLD spread all around the world, with courses that are taught in any continent. The Lymphatic System. To understand the importance of this technique, let’s analyse the body’s anatomy and the lymphatic system’s role. Indeed, for doing so, let’s compare the lymphatic system with the blood circulatory system. Firstly, the lymphatic system is an open system of “capillaries” (lymph vessels) and “veins” (pre-collector and collectors). Secondly, It differs from the blood circulatory system as it transports lymph, not blood, and is open and not closed. Thirdly, the lymphatic system doesn’t have a pump, as is the heart for the circulatory system. In fact, the lymphatic system, pushes the lymph around through a mechanism of osmosis pressure (at the lymph vessels system) and throughout an inner system of inner valves. Furthermore, the lymphatic system has filtering stations: lymph nodes. It is here where specific white cells live. Indeed, the role of the white cells is to help fight back infections carried by viruses and bacteria. Said so, the lymphatic system’s primary role is to collect waste. This happens at two different levels. At the superficial level (80%), where the lymph vessels are (lower dermis and the superficial zone of the subcutaneous tissue) and deep level of the body (20% below the deep fascia) return this waste to the blood system will then direct all the waste to the organs that clean the body, such as liver, kidney etc. How the lymphatic system works. So, our body is covered in skin, right? Below the skin, before the fascia and muscle layers, we got lymph vessels (the equivalent of capillary for the blood system). The lymph vessel spread on a vertical level all along the body in different concentrations. As per role, the lymph vessel collects the Lymph-obligatory load, the waste and excess material the body doesn’t need. Lymph-obligatory load is made from water, protein, lipids, exogenous substances, cells etc… The collection of the lymph-obligatory load comes through a suction and osmosis approach. The lymph obligatory load travels down to the pre-collectors from the lymph vessel. Indeed, pre-collectors are slightly more significant than the lymph vessel Furthermore, rather than spread along the undersurface of the skin, they travel deep down and pass the lymph fluid to the collectors. As per result, the collectors that interconnect the lymph nodes transport the lymph-obligatory load to the blood circulatory system. Another specification to look for is that the lymphatic system is divided into superficial and deep. But we will look at this specification in the next blog post, where we will also talk about the watershed and body quadrant. Manual Lymphatic Drainage compared to the massage technique. So, now that we have a better idea of what the lymphatic system is and how it works, we can say that massage techniques such as Myotherapy, Thai Massage, Remedial Massage, or even Relaxation Massage are not the most indicated for helping the lymphatic system. They still would improve its work, but as the lymphatic system sits right below the skin and works by light stimulation, the friction and pressure applied with these techniques would be too strong. Even though no damage occurs to the lymphatic system when significant pressure is applied to it.
Nov
Strokes that we use as Remedial Massage therapists. As previously mentioned, a remedial massage is different from a relaxation massage. Indeed, a remedial massage aims to speed up the recovery process from an injury or musculoskeletal dysfunction. Therefore, in a remedial massage, we use a bigger variety of strokes, and we can dive them into static, and dynamic. As per result, static strokes, don’t involve the client’s movement, like DIP. On the other hand, dynamic strokes require a resistance or a movement of the client’s body, like MET for example. Indeed, in the table below, we can find a list of strokes that remedial massage therapists use. MFTT – Myofascial Tension Technique Applied skin on skin with oil-based cream. The same principle is used in dynamic cuppings. It aims to break the fascia connecting the skin to the muscles, reducing cutaneous tensions and improving muscle and joint mobility. DIP – Digital Ischemic Pressure DIP is a stroke that consists in applying pressure on a Trigger Point. So, by applying this pressure, as therapists, we aim to reproduce pain within a comfortable zone (7 out of 10 at worst). As the pressure is applied the pain will decrease and the muscle will increase its mobility and length. MET – Muscular Energy Technique MET is a manual therapy that uses the gentle muscle contractions of the patient to relax and lengthen muscles and normalize joint motion. So, as therapists, we passively stretch the joint of the client to a safe level, and then we ask the client to meet our resistance to the movement. As per result, the muscle will increase their lengthening. PNF – Proprioceptive Neuromuscular Facilitation PNF techniques include passive stretching and isometric muscle contractions. Therefore, the PNF protocol involves a specific pattern of contracting, stretching, and relaxing. Cross Fiber Friction Cross fibre friction is a firm pressure applied perpendicular to the fibre direction. In conclusion, not all of these techniques can be used during one treatment. In fact, before applying a technique as therapists we have to evaluate the body tensions and the needing of the clients. If this post is talking to you, and you are in need of a massage, book your next session by clicking here.
Nov
In this post, I talk about Remedial Massage and how this technique is applied in my services. What is a Remedial Massage? How does it work? Where did I train for this type of massage? As per the name, remedial massage aims to improve the quality of life of the clients, by giving a remedy to her/his physical disconfort/s. So, to start with we describe the difference between a remedial massage and a general relaxation massage. Indeed, a relaxation massage is a combination of soft and deep strokes. Therefore, those strokes are applied using oils. A relaxation massage aims to stimulate physical and mental relaxation by pushing the blood and body fluids around the body. In regards to the remedial massage, the therapist, before the massage will go through a complete assessment of injuries and or musculoskeletal conditions. As per result, the therapist creates a comprehensive treatment plan to manage or rehabilitate the injuries or pain. Indeed, a remedial massage would speed up the process of healing and recovery. In conclusion, at the end of each session, the therapist would demonstrate and provide the client with corrective exercises that can support the client’s wellbeing and recovery. About my training for remedial massage, I did study at the RMIT University, here in Melbourne. In 2020, the world stopped because of Covid-19 I took the occasion to quit my previous job and get back to studying massage. I don’t regret my choice. Indeed I will keep studying in 2022, for the advanced diploma in Myotherapy. I want to keep learning and improving my massage skills and knowledge, to offer always a better service. Said so, I will keep offering Thai Massage as a massage service too. In fact, as I already mentioned in another blog post, the technique that I work with is not so demanding on my body. In fact, it allows me to enjoy more what I do and allows the client to receive a better level of healing. True fact is that the client after a Thai Massage session, here at Melbourne Thai Treatment, told me always how they feel lighter, better, less stressed and more aware of their body feels. In the next blog post, I am going to talk about the strokes that we use in Remedial Massage and how I implement those strokes in Thai Massage.
Nov
The history of Thai Massage. As per the name, Thai Massage is a technique of bodywork that finds its origin in Thailand. The history of Thai Massage starts about 2500 years ago with Jivaka Kumar Bhaccha (Shivago Kompara ) a friend of the Buddha, who had a really wise knowledge about medicine. Still nowadays, along the different mantras pronounced during the morning prayer time, for many Thai Massage courses, there is a prayer to Shivago, for his teacher’s role. As time did pass by, the technique did start differing from the rural Thai Massage and the Royal Thai Massage. The first one was passed orally from teacher to students between the pour people and monks. The second one, indeed, was based on the Royal family knowledge and had more influences coming from India, the Muslim world and China too. But what’s the difference between Thai Massage and other practices? Thai Massage is a dry massage therapy that is performed using different compressing and stretching actions that are similar to those used in Yoga. Indeed, as practitioners, when we offer a treatment we concentrate on our breath to ensure that we feel present, and also to improve the movement of our body. Personally to improve my technique I then on my own time practice Thai Yoga and meditation (Vipassana). But let’s get back to the History of Thai Massage and its benefits. Thai Massage is well known for: 1. Relieves pain and relaxes muscles. By combining stretching and firm pressures along with trigger points, this technique allows tight muscles to relax and length. Improving mobility, motility. 2. Improves joint motions By doing direct work on muscle tensions and occasionally on tendons too, there is an indirect benefit for the stimulation of lymph, synovial and cerebrospinal liquids, that run in the space between joints. 3. Improves blood circulation Along with the Thai Massage History, there are techniques of blood stops that help in improving blood circulation. 4. Improves immunity Many are the benefit of improving blood circulation. Along those, there is the strengthening of the immune system. 5. Improve mental relaxation By bringing the body to a deep level of relaxation, the mind would follow and adjust to a more relaxing state. 6. Improve sleep Combining all the benefits listed above, Thai Massage is a great technique of work that can help improve sleep. If this post is talking to you, and you are in need of a massage, book your next session by clicking here.
Oct
Fascia. What is Fascia? Why is it so important? How does it work?How can Thai Massage help improve fascia mobility? Fascia (from Latin: “band”) is a band or sheet of connective tissue, mainly made of collagen, that seats below the skin and attaches to, stabilizes, encloses, and separates muscles and other internal organs. Firstly, fascia can be classified by layers: Superficial; Deep; Visceral or parietal or by its function and anatomical location. Like as per other body parts, such as ligaments, aponeurosis, and tendons fascia is made from fibrous connective tissues. In addition, these connective tissues contain bundles of collagen fibres oriented in webby patterns, parallel to the direction of pull. About collagen fibres, they are produced from fibroblast, contained within the fascia. In conclusion, fascia differs from other body components such as ligaments and tendons. This is because ligaments hold bonds together and the tendon attaches the muscle to the bonds. Going ahead we can define F. based on its location and Superficial F. This is found just below the last skin layer, subcutis, in most regions of the body, blending with the reticular layer of the dermis. Muscular F. Defined as the fibrous layer seating around the muscle, or other body parts such as nerves, bonds. Visceral or parietal F. This type of structure suspends the organs with their cavities and wraps them in layers of connective tissue membranes. In regards to the functionality of the F., we look in too the ability of this tissue to allow the muscle to move freely. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. So let’s imagine this really thick web, seating between the skin and the muscle and around the muscle too. If the web is overconnected, that means is tight, the muscle would find difficulties in moving and sliding. The same would happen for tendons and organs that need to function by being able to move freely. For example, it does often happen to see customers that when asked to flex the shoulder, as they bring the arm over the head, past the 90° point, it is noticeable a dragging in the fascia along the anterior and or posterior and or lateral thoracic area. The person itself, unless get told to feel what happens in the thoracic area, would hardly be aware of any restrictions along the thoracic area. Said so, we can now open a pandora Jar and talk about the fascia lines. Fascia lines connect the body side to side in the long, for the horizontal and diagonal directions. As per the example, we have an F line that travels from the foot to the head. Indeed this F line starts from the Fibularis M, going up for the IT Band, in too the TFL, Obliquos Abdominal muscles, opposite Serratus Anterior, Rhomboids, and Finally to Splenius Capitis. As per result, someone that suffers from flat feet, and so has Fibularis M, under constant pulling force, may experience shoulder pain on the same side of the body because of Fascia restrictions. But the are more F. lines than the diagonal ones. In fact, we got a Superficial F. line, Functional F. line and Lateral Lines. So, lastly, how Thai Massage can help? Thai Massage can help with stretching the fascia by applying a force on the skin in the direction where the restriction is. Is enough to check in which direction the skin feels tight, and that’s the direction in too we want to apply a stroke with a pulling force, strong enough that the client does actually feel a stretch. At Melbourne Thai Treatment I use techniques of work like MFTT and or Cupping and static/dynamic stretching. In regards to cupping add MFTT are a technique of work that I did learn at RMIT along with my study for the Diploma in Remedial Massage. The static/dynamic stretch, indeed, is part of the techniques used along with the Thai Massage. In conclusion to this blog post, I then would like to invite you to see this video from Dr Gil Hedley, that dives in too the magnificence of Fascia.
Oct
Rotator Cuff Muscles and Bursitis. What muscles are the rotator cuff muscles? And why are so important? What happens when the rotator cuff muscles are out of balance? What is Shoulder Bursitis? Firstly, we look in too which 4 muscles are the rotator cuff muscles. Subscapularis Origin Subscapular fossa of scapula. Insertion Lesser tubercle of humerus. Action Arm internal rotation; Stabilizes humeral head in the glenoid cavity. Infraspinatus Origin Infraspinous fossa of the scapula. Insertion Greater tubercle of the humerus. Action Arm external rotation; Stabilize the humeral head in the glenoid cavity. Teres Minor Origin The inferior lateral border of the scapula. Insertion Greater Tubercle of Humerus. Action Arm external rotation, arm adduction; Stabilizes humeral head in the glenoid cavity. Supraspinatus Origin Supraspinous fossa of scapula. Insertion Greater tubercle of the humerus. Action Arm abduction; Stabilization of the humeral head in the glenoid cavity. Now, that we are more aware of the rotator cuff muscles’ anatomy, we can look into their functionalities. So, the rotator cuff muscles’ functionality is to hold the humerus bond in place in the glenoid cavity. Furthermore, if it was not for those groups of muscles when our arm goes into abduction, the humorous head would pop out of the shoulder joint. Indeed, for abduction, we refer to the arm movement, where the arm goes away from the body laterally. As listed above, all those muscles originate from different areas of the scapula. As per result, muscle as Infraspinatus and Subscapolaris are responsible for balancing the scapula along the sagittal plane. For instance, if the Infraspinatus is overtaking in force the Subscapularis, the scapula would result in a winged position. Consequently, this would affect other muscles that insert onto the scapula, for example, Rhomboids, Lat Dorsi etc… Regarding the injuries, as I already mentioned in the blog post “functional test”, the rotator cuff muscles can easily be injured. This is due to the acromion clavicular joint anatomy. Indeed the space between the humeral head and the acromion is quite narrow and hosts what we call Bursa. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. So, a Bursa is a soft bag, that seats between the bonds, allowing tendons to run through the joint without being exposed to pinch between bonds, and keep the bonds separated, avoiding frictions. As per result, by putting the Bursa under repetitive stress, it tends to swallow and get inflamed. Consequently, the tendons that run below the bursa can get squeezed, creating shoulder bursitis, or shoulder impingement.
Oct
Functional test and the empty can test. What is a functional test? What is an empty can test and how does it work? Firstly, functional tests are used to test the strength or load capacity of a single muscle. Secondly, the importance of a functional test is due to avoid misinterpretation of the muscle status and joint health conditions. Furthermore, functional tests can be positive or negative. So, for positive, we refer to a test that gave us the result we were suspicious of. For example, if I do an empty can test, and the client during the test complains of pain in the shoulder acromion, the test is positive. But if for instance, the client complains of pain in another area of the shoulder or arm, the test is negative. Even so, as a therapist, we are aware that other area of the arm or shoulder needs to be looked after. What is an “empty can test”? An “empty can test” is a functional test used to validate the state of health of the supraspinatus tendon, at the high of the acromioclavicular joint. In addition, to better understand how this specific test works, let’s look in too the anatomy of the Supraspinatus m. Origin: Supraspinatus fossa of scapula Insertion: Greater tubercle of the humerus Action: Abduct the shoulder and stabilise the humeral head in the glenoid cavity. As per result, the action of the supraspinatus is to laterally elevate the arm and hold in place the humeral head (the Humerus is the bond of the upper arm). Furthermore, the supraspinatus is one of the rotator cuff muscles. The rotator cuff muscles are: Supraspinatus, Teres minor, Infraspinatus and subscapularis. But let’s get back to the empty can test. The empty can test can be done from seated or standing. In addition, the test is conducted in 2 different stages. Initially, we will ask the client to bring the arm in flexion at about 45° and in abduction at 45°. The arm now is sitting aside from the client’s body, on a diagonal line. Now will ask the client to rotate the arm on itself, as if they are emptying a can. As per the result, if at this stage of the functional tests, the client feels pain in the shoulder at the acromioclavicular joint, the test is positive. If that’s not the case, then we can proceed with the resistant part. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. The resistant part consists of placing our hand on the client’s forearm and asking the client to meet the resistance, at 3 different stages. For each stage, the resistance increases and lasts from 3 to 5 seconds. If during any of the 3 stages the client feels pain, at the high of the acromioclavicular joint, the test is positive. But why the client can feel pain during this type of functional test? To answer this question, we have to look in too the acromioclavicular joint anatomy, but I will talk about this topic in the next blog post.
Oct
Firstly the Cervical Occipital muscles are a group of muscles, that seat inferior to the skull and are bilateral to the first and second cervical vertebrae. Cervical Occipital muscles are responsible for 45° of rotation out of 90°. Along with these muscles we find: – Obliquus Capitis Inferior; Origin: Spinous process of Axis (C2) Insertion: Transverse process of Atlas (C1) Innervation: Suboccipital nerve – Obliquus Capitis Superior Origin: Transverse process of Atlas (C1) Insertion: Superior line of Occipital bone Innervation: Suboccipital nerve – Rectus Capitis Posterior Major Origin: Spinous process of Axis (C2) Insertion: Inferior line of Occipital bone Innervation: Suboccipital nerve (posterior ramus of spinal nerve C1) – Rectus Capitis Posterior Minor Origin: Spinous process of Atlas Insertion: Inferior Line of Occipital bone Innervation: Suboccipital nerve The actions supported by Occipital Muscles are to extend and rotate the head. How tight Occipital Muscle affect ROM. When rotating the head, so looking at your right or left, you may notice that you don’t have a full range of 80° to 90°, and you start rotating with the thoracic too. One possible reason for this is tension at the occipital area, due to muscle tension and or facet joint irritation. Moreover, to the rotation and extension actions the Cervical Occipital Muscles, are responsible for holding the head up straight. This characteristic is to be taken into consideration with the anti-gravity functionality. In addition to the Cervical Occipital Muscles, other anti-gravitational muscles are the Soleus, Quadriceps Femoris Group, Gluteus Max, and Erectors Spines group. The anti-gravity functionality is essential for the body to fight back gravity (9.81 m/sec2) and allows the body to stand straight up. This group of muscles received information in regard to the gravity pressure from the feet. This information travels along the nervous system starting from the Center of Gravity (COG) of the feet. If the COG is not balanced all body gets affected with a loss of balance as per result. Furthermore, in modern days, the Cervical Occipital Muscles are under constant stress as per all the other anti-gravitas muscles. This is due to spending long hours standing or seating. For example, standing for long hours would overload the feet, leg and back muscles, whereas seating would inhibit the leg muscle but overload the back and cervical muscles. On top of that, spending long hours looking at the phone and or PC would additionally put stress the Cervical Occipital Muscles muscles, as they get over-stretched. How massage can help? As per massaging this area, as therapists, we look into avoiding the Suboccipital triangle, which is defined by the border of the OCI, OCS, and the RCMaj. The Suboccipital triangle is an endangerment site. This means contains superficial, delicate structures that are relatively unprotected and therefore prone to injuries, such as the Vertebral artery, Suboccipital nerve (C1) and Suboccipital venous plexus. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. And what about exercises? As per all the muscles of the body, there are exercises that can be done for the Cervical Occipital Muscles. Along with Thai Yoga, I teach a really simple exercise that recalls the Scap Off Load Test ( a Functional test used to determine what muscle of the cervical region may affect the head rotation). Firstly, in this exercise, available in the Melbourne Massage and Treatment YouTube playlist, you are seating on the floor with a cross leg (a yoga block or pillow can be used as per support), hands projected backwards, with wrists seated below shoulders on a straight line. As per result, the neck would seat in between the shoulders. Secondly, by flexing the head forward, reach the manubrium (the bond that connects the clavicles) with the chin, and with a gentle rotation movement, start rotating the head in a circular movement. Indeed per many Thai Yoga exercises, it is important to be aware of the movement, the body sensation and the speed of movement, which is to be slow and weighted out.