As a Lymphoedema therapist, I often get asked what the difference is between Lymphoedema and Lipedema. In this blog, we will explore the differences, the similarities, and what can be done for prevention, management and treatment of those presentations. Furthermore, we will look into how Lipoedema can degenerate into a Lipo-Lymphoedema, and why this is not the case for everyone. What is Lipoedema? Lipoedema is a chronic adipose tissue disorder that primarily affects women. On a global scale, we know that about 11% of women are affected by this presentation, and it often runs in families as it has a strong genetic component. The major characteristics of Lipoedema are an abnormal and symmetrical accumulation of fat around the hips, buttocks, thighs, and legs, and upper arms. On the leg area, the fat appears in abundance in the medial side of the knee, too. Where feet are completely untouched by the fat accumulation, this fat is resistant to diet and exercise and is often painful to touch. The pain is due to the cutaneous nerve entrapped in the fatty tissue, and so delivers a pain response when stimulated. Other Lipoedema key features: Often triggered or worsened by hormonal changes Symmetrical fat distribution Soft, nodular, or lumpy tissue Pain and easy bruising – as per the pain, bruising is due to blood capillary compression from the fat, and so, is easily damaged by touch No skin thickening or pitting in the early stages Nowadays, there is increasing awareness about this presentation, and more and more women find benefit from a management protocol that is not only about cardio and exercise. Part of the Lipoedema management includes: Movement Compression stocking Antiinflammatory diet Skin care Where and if needed, cosmetic surgery intervantion What is Lymphoedema? Lymphoedema, on the other hand, is a condition where lymphatic fluid builds up in the tissues due to a malfunctioning lymphatic system, causing chronic swelling. Compared to Lipoedema, Lymphoedema is strictly related to the Lymphatic system. It can be primary (congenital or hereditary) or secondary (due to trauma, surgery, radiation, or infection affecting the lymphatic system). Lymphoedema characteristics: Unilateral or asymmetrical swelling (though it can be bilateral) Pitting edema – It consists of deep indentation (pitting) left behind on the skin when pressure is applied Skin changes over time (fibrosis, hyperkeratosis, papillomatosis) Affects feet and hands as well – primary lymphedema would start from the extremity Heaviness or tightness in the affected area – can potentially be pain-free, but the limb/s may feel very heavy It does affect men and women – only primary lymphedema has a genetic component Lymphoedema Management The management of Lymphoedema is more tricky than lipoedema, as everyone may react differently to the management, it can be related to other health issue which needs to be considered, and requires the patient to be active in the management side of things. At Melbourne Massage and Treatment, I treat different types of lymphedema, as per the upper and lower body, focusing on an initial reduction of the swelling via a combination of Manual Lymphatic Drainage (MLD) and compression with Combined Decongestive Therapy (CDT). The management of this presentation can take anywhere between 3 and 5 or more appointments, depending on the severity of the presentation. The treatments are better done in close proximity, 24 to 48 hours one after the other, so that we give no time to the body to accumulate fluid back under the skin. Once the combination of treatment allows us to achieve the desired result, which is bringing the limb/s to a thinner size, you will be scheduled for a custom garment wear compression, which will guarantee to maintain the results achieved. This is usually done at other clinics, like Sigvaris or Juzo clinics. Those clinics are specialised in the making of garment wear. Custom garments wear last about 6 months, so twice a year, you will need to change them, and if needed, because the limb/s may start swelling again (especially in summer, when there is a change of atmospheric pressure, due to the heat), a short series of MLD and CDT therapy may be needed. Key Differences between Lymphoedema and Lipoedema Feature Lipedema Lymphoedema Cause Abnormal fat metabolism Lymphatic dysfunction Gender prevalence Almost exclusively women Affects both sexes Onset Often at puberty, pregnancy, or menopause Can be congenital or triggered by injury/surgery Distribution Symmetrical, lower limbs and arms Can be asymmetrical; any body part Feet/Hands Spared Usually involved Pain Tender, painful fat Often painless, heavy feeling Skin texture Soft, nodular fat Skin thickens over time (fibrosis) Pitting Rare (early) Common (early) Response to elevation Minimal improvement Often improves with elevation (if early stage) Bruising Common Not typical Common Characteristics of Lymphoedema and Lipoedema As seen above, the characteristics of Lipoedema and Lymphoedema are different, but, both conditions share chronic swelling, potential functional limitations, and a need for long-term management: Both can cause leg discomfort, heaviness, and swelling Both may lead to reduced mobility Neither condition improves with calorie restriction or exercise alone – it is more about stop the intake of inflammatory food Compression therapy is often used for both Both can have a progressive nature if not managed properly – especially lymphoedema Misdiagnosis is common, often delaying effective treatment When Lipedema Becomes Lipo-Lymphoedema If we stick to a vision of Lipoedema progression, that is possible when no management is put in place, this presentation can degenerate into secondary lymphatic impairment, resulting in a combined condition known as Lipo-Lymphoedema. How this happens: As the fat keeps accumulating under the skin, and there is an increase in inflammation, the lymphatic vessels are put under major load and potential damage Over time, this leads to fluid retention and swelling due to the lymphatic system failing to do its job As the lymphatic system becomes overwhelmed, the person may start experiencing lymphedema symptoms (Example: swelling in the extremities, feet and or hands) Patients now experience both fat deposition and fluid buildup, making treatment more complex Signs that Lipedema has progressed: Swelling starts in the feet […]
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Femoral Anteversion: Why Your Hip Anatomy Changes the Way You Squat
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Simple thing you can do for your Lymphatic System Well-Being. Go For A Walk!
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Cosmetic Procedure Recovery Melbourne: Liposuction Types and the Benefits of MLD in Fitzroy North
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Aug
When patients are seeking Lymphoedema treatment, they often ask if a GP referral is needed to start the treatment. The short answer is no, you don’t need a GP referral to come to Melbourne Massage and Treatment, but other practices may ask for it. I do understand that Lymphoedema can cause discomfort, swelling, and affect your quality of life, so I want to make it as simple as possible for you to access care. That’s why I offer a free 15-minute online consultation, where you can ask me questions about how we are going to work on your lymphedema, and where I can start to get a better picture of your clinical history. What I Require Before Your First Visit As already mentioned, no GP referral is needed, but before we commence any treatment, I will ask you to fill in an Initial Consultation Form. On this form, you will be asked to: Declare any present health conditions List any previous injuries, surgeries, or illnesses Note any medications you are taking Share any relevant lifestyle information that may impact your treatment A series of questions specific to your lymphedema presentation, such as mobility impairments or pain level, if any This ensures I have a thorough understanding of your current health and medical history so that I can tailor your treatment safely and effectively. This also allows me to understand the nature of your Lymphoedema, whether primary or secondary, and determine if there is a need to discuss other medical conditions with your GP or other health practitioners. Why No GP Referral? As a Clinical Myotherapist in Australia, I can offer lymphedema treatment without needing a GP referral to start with. On the other hand, since the Medicare plan does not yet cover Myotherapy (blame the politicians for it), I can’t offer a Medicare rebate for this type of service. But, if you are on NDIS as a non-registered provider, I can provide treatment for self-managed or plan-managed NDIS participants. Private Health Rebate for Lymphoedema Therapy As mentioned above, a Medicare rebate is not available at Melbourne Massage and Treatment, but private health rebates are. Indeed, Manual Lymphatic Drainage, that is the hands-on treatment I offer as a myotherapist to treat a lymphedema presentation, is covered under the scheme Myotherapy and Remedial Massage. The rebate percentage is based on the insurance contract you signed. And yes, you can do the claim on the spot here at the clinic, at the end of the session, once we go through the payment. Lymphoedema Therapy Cost at Melbourne Massage and Treatment Given the usage of bandaging during the lymphedema therapy, the cost of this treatment is higher than that of other services. The bandaging, indeed, is used after the Lymphatic Massage, to compress the limb/s to maintain pressure on them and move the liquid while you are in movement or at rest. As of August 2025, the cost of lymphedema therapy at Melbourne Massage and Treatment is as follows: Consultation Price 15-Minute Online Consultation FREE Initial Consultation – 90 minutes $ 190 Inc. GST Returning $ 145 Inc. GST To successfully reduce swelling and alleviate the symptoms of Lymphoedema, a series of sessions is typically required, ranging from 3 to 5 sessions, depending on your presentation. It is not always possible to estimate the exact number of sessions to start with, as the limb reduction also depends on your clinical history, medications, exercise habits, food intake, appointment frequency and more. Lymphoedema Appointment Frequency The appointment frequency when treating a Lymphoedema presentation is a crucial aspect of treatment success. This is because the lymphedema is there in the first place due to the lymphatic system being inefficient, and to ensure that we overcome this inefficiency, we have to stimulate the lymphatic system as often and frequently as possible. Ideally, treatment should be done every 24 to 48 hours. This requires time management and commitment from the patient, which I do understand is a challenge. But consider this appointment frequency to be the central pillar of lymphedema management. The more frequently we stimulate the lymphatic system and the more frequently we work on breaking down the fibrosis (which may have been building up below the skin), the quicker we can achieve the desired results, and the less likely you are to encounter complications. When we talk of complications, we refer to: Fibrosis builds up Skin craking Infections due to skin damage Reduced mobility and more… Get in touch now – No GP Referral Needed To start your recovery, book a 15-minute online consultation, fill in the forms, and let’s take it from there. Or if you have any questions that you prefer to address via email, just get in touch via the contact page. Furthermore, for those who have gone through cancer surgery or may suffer from a secondary lymphoedema on the Lymphoedema service page, you will find a questionnaire for Arm Lymphoedema and Leg Lymphoedema, which can help us understand the likelihood of lymphoedema development. In addition to the questionnaire, going for a pre-appointment free consultation can also save us time to understand if there are any other conditions or contraindications about Lymphoedema that may need to be addressed first. Lymphoedema Treatment Contraindications – That’s where a GP referral could come through. Other medical conditions could be present while someone is suffering from Lymphoedema, and those presentations may be an absolute or partial contraindication to Lymphatic drainage. Lymphoedema absolute contraindications may be: History of heart failure Liver and or Kidney fatigue Untreated cancer Active infections History of DVT Lymphoedema relative contraindications may be: Asthma Open wound Pregnancy (present, not past) Lymphoedema Clinic in Fitzroy North My clinic is located in Fitzroy North, on 1/175 Holden St, and is inside the Fitzroy North Doctors’ GP clinic. This is a great opportunity also for the lymphedema patients, because if there is any need for wound management or extra care, the nurse on site can always help. The cost of the nurse services is not included in the […]
Aug
When we think of losing fat, the first action we picture in our head is to start running, walking, swimming or any form of cardio training. But is that actually the best fat loss solution? In this blog, we are going to look into why cardiovascular exercise has many benefits, but when it comes to losing fat mass effectively and sustainably, lifting weights deserves the spotlight. For fat loss, total body weight should not be your target: Focus on Body Composition Another go-to habit, when we focus on losing weight, is to check with a scale where we are at. But the reality of the fact is not as simple. When using a regular scale, you are looking at the total mass of your body, which includes not only your fat, but also your muscle mass, bone mass, etc… Indeed, losing weight isn’t the same as fat loss. Therefore, you should know that when you restrict calories, up to 50% of the weight you lose may come from muscle, not fat–unless you intentionally preserve it through strength training. Muscle is essential for more than movement – it’s a metabolically active tissue. That means it burns more calories at rest than fat. The more muscle you have, the higher your basal metabolic rate (BMR), making it easier to maintain fat loss long-term. Muscles Are Our Metabolic Engine When talking about muscles, we need to change the perspective on their functionality. The locomotive aspect of muscles, which means the ability of the muscles to move the skeletal system, is just one aspect of them, but not the only one. Therefore, when thinking about muscles, start considering that they are also glucose-hungry machines; indeed, they pull sugar out of the bloodstream and help convert it into usable energy. This process is critical for managing blood sugar and inflammation, which are two major drivers of fat storage and chronic disease. So to simplify it, less muscle mass means less body efficiency at using energy, therefore becoming more prone to storing excess calories as fat. Behind this mechanism lies the reason why losing weight without building muscle mass is not a long-term solution, as you will gain weight back. The Double Side of Cardio (When done on its own) When trying to lose weight, it becomes a combination of cardio and less energy intake (a certain type of diet), and to it you add the fact that muscles are not loaded, and by loaded I mean put under strength activities, it becomes easier to lose muscle mass. This happens because the body goes into a calorie deficit, and in order to keep functioning, it is going to take energy off the muscles themselves, reducing their size. This is an extra reason to ensure you are loading those muscles, to ensure the energy to burn is taken from fatty tissue. All of this does end up with yes, a weight loss, but also weakens the very system that helps keep fat off. It’s Never Too Late – Muscle Responds at Any Age This is a topic that we have seen in other blogs, and it is time to remember that age is only a perspective and not a mandatory fail. The body is designed to respond to stimulus, and get stronger and stronger under new and constant stimulus; it doesn’t matter the age. In fact, even older adults, including those in their 60s, 70s, and 80s, can gain strength and improve body composition with the right program. Muscle stem cells (satellite cells) remain responsive well into late adulthood. You don’t need to be a lifelong athlete – many people start lifting in midlife and see dramatic improvements in energy, mobility, and fat loss. How to Lift for Fat Loss As per all the forms of training, there are certain aspects that need to be respected to achieve the desired goal. For fat loss, then, you may want to look into: Focus on compound lifts such as Squats, deadlifts, bench press, and rows, so that you work multiple muscles and burn more calories. Train to near failure, which means from 4 heavy reps or 10 moderate ones, but with progressive overload. Lift 3–5 times per week as consistency beats intensity. And if a week you can do less, it’s ok, don’t be hard on yourself. Look into your eating habits, talk to your local GP about your eating habits and see if you need a referral to a specialist for improving your food habits. Add sprint intervals twice weekly: Brief, high-intensity cardio can enhance fat burning and insulin sensitivity without causing muscle loss. Fitness Class at Melbourne Massage and Treatment At Melbourne Massage and Treatment, in Fitzroy North, I got the skills and the equipment needed to help you achieve your goal, but also, help you learning how to deliver safe exercises for your wellbeing and your athletic preparation. Indeed, when talking about lifting weights, we always want to look at first where your training level is, what your abilities are, and with no judgment, take the first step from there and help you to achieve your short-term and long-term goals. If you are keen to learn more and want to have a chat about your goals, book a 15-minute free online consultation now, so that we can discuss how I can help you and where we can get you with your exercise routine. In Conclusion: Lift First, Then Move More In this blog, we emphasised how strength training is ideal for fat loss, and what we want to tell you with this is that cardio has a place for heart health and endurance, but it’s not the most effective path to long-term fat loss. Prioritising strength training, especially as you age, helps preserve muscle, boost your metabolism, and shift your body into a fat-burning machine. And most importantly, let’s stop chasing a number on the scale. Instead, start chasing strength, power, and metabolic resilience.
Jul
The term “inflammation” originates from the Latin word “inflammare”, meaning “to set on fire” or “to ignite”. And this is why it may sound scary, and sounds like a bad thing to go through, but in the initial phase of an injury, the inflammation is actually a necessary part of healing. Indeed, this initial step is how your body signals that something is wrong and starts the repair process. On the other hand, if the injury is not looked after, especially when we talk about major injury, the inflammatory process can become problematic. In this blog, we are going to look into what the steps are to take when going through an injury, which can be a sprained ankle, recovering from surgery, or managing chronic pain, in order to have the best recovery. The 0–72 Hour Rule: Respect the Acute Phase When going through the initial phase of an inflammation, which is the first 72 hours post-injury, the body enters the acute inflammatory phase, and this is absolutely normal and necessary for the body to start taking action towards safe healing. In this process, the immune system rushes white blood cells and inflammatory mediators to the area to begin cleanup and repair. Things to avoid: Avoid anti-inflammatories (NSAIDs or corticosteroids): As this process is needed from the body to understand what has happened and to clear up the area from eventual pathogens, taking something that suppresses the process is not ideal. Avoid ice: Ice is a vessel restrictor, which means it would slow the amount of blood that is sent to the area. Yes, it may reduce the swelling, but that swelling is innoquos compare to the consequence of not having blood rushing to the area with the nutrience and substance needed to start the healing process. Things you can do: Protect and rest the area. Avoid using the injured area and place weight on it. Rest it and where possible do really some minimal movement that may not cause pain or disconfort. Compression and elevation help reduce fluid buildup. If your goal is to reduce swelling, you can apply compression and keep the area elevated. After 72 Hours: Shift to Recovery Support Past the first 72 hours, the inflammatory response was meant to be settled. If that’s not the case, that’s when it ok to take anti-inflammatories. That would help manage the pain in the long term and allow you to start moving freely. That said, before you take any medication, always consult your GP or pharmacist. Moving forward, this second phase of the injury recovery is called remodelling and repair. In this phase, it is the time to: Introduce gentle movement and rehabilitation exercises – most often isometric hold, which we spoke about in another blog. Use anti-inflammatory agents (if needed) under professional guidance. Massage therapy and heat packs become helpful — they promote circulation, lymphatic drainage, and tissue flexibility. While the remodelling and repair phase starts past the 72h post injury, the recovery itself may last weeks or months, depends on the type of injury. For more details about the healing process of different tissues, read this blog. What Are The Symptoms of Inflammation Post-Injury You may notice that soon after an injury the body has a really specific way to respond to what just happened. This response include: Swelling – more blood is sent to the area; Skin redness Pain to touch or movement Those are some of the visible or more noticeable aspects of an inflammatory response post injury, but on the macroscopic level, there is more happening, such as the rush of white cells to the injured area, and the increase of blood clotting cells, if the skin is cracked. Food, Fats, and Chronic Inflammation: The Lymphatic Link An inflammation is not a process that comes only from an injury. The food and drinks that we intake are a significant source of chronic, low-grade inflammation, especially when they include excessive amounts of long-chain fatty acids found in ultra-processed foods, deep-fried items, and fast food. Given the chemical structure of those fats, which are made from a chain of 16 carbon atoms (therefore long-chain), they can be absorbed directly by the capillary of the bloodstream, due to the narrow passage at the capillary end. Indeed, those fats would get absorbed by the lymphatic system, which capillaries have a wider aperture. That said, once the fat is travelling along the lymphatic system, it would be recognised as an external element and attacked by immune cells such as macrophages, and this is an inflammatory response. Now, when the lymphatic system becomes overburdened with inflammatory fats, it can lead to chronic inflammation. This is also why some people feel bloated, puffy, or in pain even without any injury. This also explains why, when seeing people with Lymphoedema, we refer them to a GP to discuss an anti-inflammatory diet. Given the excess load of the lymphatic system along this presentation, it is better not aggravating it. And to loop back on the topic of this blog, even when you hurt yourself badly with a major injury, or you may be suffering from chronic pain, a balanced diet rich in veggies and fruit, grain and fresh food, is recommended over junk food and inflammatory meals. Top Pro-Inflammatory Foods to Watch Out For: Highly refined vegetable oils Fried foods High-sugar snacks and drinks Ultra-Processed meats How Massage Therapy Helps (and Why Sometimes Hurts) Many forms of massage, especially those where you may experience discomfort and pain, like Remedial Massage or Thai Massage, or even technique like Dry Needling, aim to reproduce microinflammatory response, and that’s why they are effective in helping you with recovery. Indeed, that pain response, is an alarm for your nervous system, which is pushed to send nutrience to the area affected by the pain. Now, what is important is to understand the time frame of healing, the subjective history of the patient we are working with and the level of injury they are presenting with. Massage helps by: […]
Jul
When we have to choose what to do with our free time, in order to help our body stay fit and strong, we better choose wisely on the type of activity that we do. That’s why knowing what does what to your body can help you make smarter choices for your well-being and your future. In this blog, we are going to break down the benefits of Pilates and strength training are and why, for improving your muscle mass (not becoming bulky, but mainly maintaining a minimal strength) and improving your bone mass (which we all are going to lose while we age, especially women) you better start lift heavy. Muscle Mass: Strength Training Wins As discussed in many other blogs, while we age, our muscle mass decreases, and not only that, but the muscles become less efficient in doing what they are supposed to do. So, if your goal is to build muscle mass, which has nothing to do with becoming bulged and a gym junk, there’s no debate that strength training is the superior option compared to pilates. This is possible because, to stimulate the muscle to grow and stay active, they need to be placed under load, specifically, and an increase in load. In fact, strength training involves lifting weights or using resistance to progressively overload your muscles. This is what would trigger muscle hypertrophy, which is the process by which muscle fibres grow in size and strength. For doing so, you may use dumbbells, resistance bands, barbells, or bodyweight exercises; what matters is the intensity and the gradual increase in load, which can not be done only via body weight. On the other hand, Pilates focuses on control, alignment, and core stability. Some small muscle initially would be place under an increase form of load, and yes, they would get stronger, but, once you reach the max setting of you reformal machine, or the max weight in your mat pilates training, there would no be any extra stimulus for your muscle mass to increase, because all off that doesn’t provide enough resistance to stimulate hypertrophy. Bone Density: Strength Training is More Effective Bone density is one of those hot topics in the realm of longevity. Bone density, especially in women who have reached menopause it is a real concern. In fact, women who are past 2 years of menopause, on average, lose about 25% of their bone mass, which does leads to higher chance of osteoporosis, osteopinia and bone fracture. So, one of the most powerful tools we have for maintaining or improving bone density is strength training, especially weight-bearing, high-impact, or resistance-based movements. The reason why this is a fact lies behind the bond’s response to mechanical load. When we lift weights, our bones, like the muscles, experience stress, a positive stress, which stimulates osteoblast activity. Osteoblasts are simply the cells responsible for laying down new bone tissue. While we age, this process slows down, due to metabolism changes, and an external stimulus, such as impact load (jumping literally with weights on), leads to stronger, denser bones. It is simply a cause-and-effect relationship. Regarding Pilates, particularly on the mat or even when using a reformer machine, it is low-load and low-impact. This characteristic, as just explained above, doesn’t apply to the kind of mechanical force needed to drive fundamental improvements in bone mineral density. Neuromuscular Control: This is Where Pilates Shines While I am sharing this fact about strength training, I want to make sure that this blog post doesn’t pass as a message against Pilates. In fact, if there’s one area where Pilates truly excels, it’s neuromuscular control. Neuromuscular control is the ability of your nervous system to efficiently coordinate muscle movements. Basically, the ability to switch on a muscle when needed. If we break down pilates in its practice, we can see that in a session, we do controlled movement with a strong focus on alignment, breath, and core engagement. This type of mindful movement is what can help in retraining the brain-muscle connection, which would lead you to improve coordination, proprioception, balance, and posture. And here is a short list of who would benefit from it: Recovering from injury. Dealing with chronic pain. Develop better movement awareness. That said, even strength training improves neuromuscular efficiency, especially when doing functional movement under load, like squats, but it’s typically more gross motor-focused. The fine control and subtle activation required in Pilates make it unique for developing stabilising muscles and corrective movement patterns. So, Which One Should You Choose? As expressed at the start of the blog, if you have to choose between the two, as you may have limited time to dedicate to fitness and or limited budget to pay for a class or a trainer, you should choose based on your fitness goal. Do you want to improve your neuromuscular control at the expense of low bone mass and the increased risk of losing bone mass (especially if you are past your 40s), then go for Pilates. On the other hand, if you want to guarantee that your body can keep up with the slowing of metabolism and can maintain its functionality in the long term, strength training is the way to go. In summary: Use strength training to build muscle, strengthen bones, and increase metabolic function. Use Pilates to refine your movement, stabilise your joints, and enhance your core control. And if you can do both, go for it. Together, they complement each other beautifully. And if it helps, think of strength training as your foundation, and Pilates as your refinement. How often should you train then? This is a common question that people ask all the time. The answer depends on what you are aiming for and what your needs are. If we simplify the case scenario, and we look at someone who has great mobility (not flexibility, but mobility) and does aim to build muscle strength and bone mass, they should train between 3 to 5 days a week with strength training. If […]
I did stop counting the number of times I hear patients say that their hamstrings are tight, and that’s why they can’t bend forward. And I did stop counting, because this happens so often that it is really hard to find someone who actually knows what tissue is limiting their movement. In fact, most of the time, what is happening is not hamstring tightness, but rather a lack of hip hinging and associated hip mobility, or neural tension (in this case, the sciatic nerve neural tension). What Is Neural Tension? When we discuss neural tension, we refer to the lack of mobility of the nervous system’s connective tissues, so the actual nerve as a fibre or tissue, when it’s put under mechanical stress (like tension, compression, or stretch). Here is an example: When we bend forward, the sciatic nerve (the largest nerve in the body) runs from the lower back (Ventral rami spinal nerve L3-S1), through the buttocks (below the piriformis muscle most of the time), and down the back of the leg (right between the hamstrings muscles). When doing such an action, the nerve needs to glide freely, and if any where along its journey, there is a compression, due to other tissue tightness or inflammation, or even a physical outer pressure (a belt from the pants) it becomes irritated, compressed, or “stuck” ending not moving well. That’s where you may experience a pull on the back of the leg. That is neural tension. More specifically, your symptoms can be: A deep pulling or burning stretch in the back of the thigh or calf. Tingling or numbness (especially if holding the stretch for a longer time) A sensation of “snapping” or “tugging” deep in the leg when stretching Limited range of motion that doesn’t improve with traditional hamstring stretches How Is Neural Tension Different from Muscle Tightness? While neural tension and muscle tightness may feel similar, they are fundamentally different in their causes and treatments. Muscle Tightness Neural Tension Origin Muscle fibres are shortened or tense Nerve or nerve sheath is restricted or irritated Sensation Broad stretch, fatigue, cramping Sharp, burning, electric, or pulling sensation Area Felt Localised to the muscle belly Along a nerve pathway (e.g., back of the leg) Improved by Stretching and massage Nerve gliding/mobilisation, reducing irritation Common in Athletes, post-exercise, poor posture Sciatica, herniated discs, hipo-mobility, and a sedentary lifestyle Now, Let’s Talk About Forward Bending When bending forward with the upper body, aiming to reach the toes or the floor with the hands, we may experience a stretch in the back of the leg. That stretch it may not be only your hamstrings but also the sciatic nerve. When this nerve lacks mobility, as expressed earlier, due to things like disc issues, facet joint irritation, piriformis syndrome, or general irritation, it can feel like your hamstrings or calf or back are tight, even when they’re not. A good way to understand if the feeling of tightness is from your nerve or not is to perform a Slump Test. How to perform a Slump Test? Below is a step-by-step guide on how to perform the slump test: Sit on a chair or table, where both feet are off the ground; Slump your body forward, while looking straight ahead, and your arms are crossing behind your back (which means your spine rounds backward, your shoulder drops forward); Now, start lifting up one leg, while the other one is bent at the knee at 90°; While you lift up the leg, start noticing if you feel any pulling sensation from the lower back going down to the back of the leg or calf (it could be anywhere along the lower back to the feet); If you manage to reach full leg extension, now, start looking down (you may notice tension arising or increasing); If nothing happens yet, then bring your toes (of the leg raised) backwards (ankle dorsiflexion); If, along any step of this process, your pulling sensation increases (more intense) or becomes longer (like from only the back of the leg, it now feels even in the back or in the calf), this is neural tension. Indeed, the tension would feel like a long rope pulled across multiple joints (lumbar, hip, knee) with a burning sensation and maybe some pins and needles. Next, to experiment further with the neural tension, start looking up with the head, go if you can in full cervical extension, and you should feel relief in the back of the leg tension. This last step is proving to you how, by releasing the central nerve (that travels in the central canal of your spine), the neural tension slows down. You are stopping the nerve’s pull from its origin, the brain. Should You Stretch a Nerve? No, not really. Nerves aren’t designed to be stretched like muscles. In fact, if you keep stretching a nerve aggressively, you may end up irritating the nerve and worsening the symptoms. Instead, use nerve gliding or joint mobilisation exercises, which are gentle, rhythmic movements that help the nerve move through its surrounding tissues without overstressing it. And to stay in the loop, let’s look at the sciatic nerve glide: Lying on your back, lift one leg while keeping the knee slightly bent. Slowly extend the knee and flex the foot back toward you, then release. Repeat in small, pain-free ranges. This can help restore nerve mobility without aggravating the nerve. If this is not the case, and you still experience pain and discomfort, then it is probably time to book an appointment (myotherapy) to ensure there is not significant entrapment along the nerve pathway, and see what can be done to relieve that compression. How Myotherapy Can Help with Neural Tension? As a Clinical Myotherapist, I specialised in assisting people with any sort of musculoskeletal issue. Neural Tension is one of those. During a Myotherapy session, we would address, via a detailed clinical history and a series of assessments, what may be the cause of the neural […]
Jul
When the space between the collarbone and first rib gets tight, during movement or even at complete rest, it can lead to Thoracic Outlet Syndrome (TOS). Between the two structures mentioned above, we have the passage of the thoracic plexus (nerves) and blood vessels. The compression of those structure, can result in pain, weakness and numbness radiating down the shoulder, arm, and hand. Because TOS has multiple causes and presentations, effective treatment depends heavily on accurate assessment and an individualised approach, and that’s where myotherapy can play a crucial role. What Causes Thoracic Outlet Syndrome? As there are different tissues passing by this space, the nature of TOS can be broadly categorised into three types: Neurogenic TOS: Compression of the brachial plexus (nerves). Venous TOS: Compression of the subclavian vein. Arterial TOS: Compression of the subclavian artery. But not only can different tissues be compressed, but different structures can be responsible for the compression. Indeed, the compression can be due to the scalene muscle, pectoralis minor or bone. And here are some common causes: Muscle imbalances that lead to poor posture (forward head/rounded shoulders); Repetitive overhead activities (which lead to constant compression of the tissues); Trauma (e.g. whiplash or clavicle fracture); Anatomical variations (such as a cervical rib). The Role of Myotherapy in TOS Assessment As a myotherapist, when treating someone with suspicious TOS, we go for a series of assessments that we compare to the clinical history and symptoms. The test itself would aim to reproduce the patient’s symptoms and guide us on what potential structure is compressed. If we are suspicious of TOS, we can aim to reduce tension in soft tissue and give exercises that can reinforce those structures to alleviate any compression in the area. Orthopedic Testing & Myotome Assessment Some common assessments include: Adson’s Test (for scalene involvement) – It consists of reproducing a drop of heart bit in the wrist (affected side) by asking the patient to abduct and extend the arm while rotating (same side) and extending the neck. This would add extra compression on the suspected structures. Roos/Elevated Arm Stress Test (to reproduce vascular or neural symptoms) – It is about asking the patient to lift the arm at 90°/90° and start closing and opening their hands repetitively for 30 seconds to 1 minute. A drop of strength or symptom reproduction would lead to a positive test. Costoclavicular Maneuver (to assess space between clavicle and first rib) – It is delivered by having the patient with depressed and retracted shoulders. The positivity of this test is given by the reproduction of symptoms or a reduction in the distal wrist. Wright’s Hyperabduction Test (for pectoralis minor tightness) – The patients get asked to lift their arm (affected side) above their head while the therapist stands behind and keeps count of the wrist heartbeat. Any symptoms, reproduction, or drop in bit is considered positive. In addition to those tests, we would use: Myotome testing: which assesses the motor function of specific spinal nerve roots; Clinical history: Any history of previous injury, surgeries, work and sport loads; Type and timing of symptoms: When and how those symptoms are reproduced on daily life. All this said, we always have to consider that as therapists, myo or physio as per osteo exc… we can assume that the positivity of many of those test leads to a positive or negative conclusion regarding TOS. Hands-on treatment and exercises in combination can be the easy steps to take to treat the presentation, but can not always guarantee the best outcome, due to each individual’s unique presentation. Hands-On Treatment and Exercise Prescription Once we have more understanding of what is potentially happening in terms of compression, a myotherapy treatment focuses on addressing the underlying causes: Manual Therapy Myofascial release of the scalene, pectoralis minor, and upper trapezius muscles. Trigger point therapy to reduce local and referred pain patterns. Joint mobilisation to improve scapular movement and rib mechanics. Neural gliding techniques to encourage nerve mobility and reduce irritation. Exercise Rehabilitation Postural re-education, particularly strengthening the deep neck flexors and lower trapezius. Scapular stabilisation exercises to improve shoulder mechanics. Breathing retraining is necessary if dysfunctional patterns (like apical breathing) are contributing to compression. Neurodynamic stretches are appropriate for nerve mobility. Together, these interventions help reduce symptoms, improve function, and support long-term recovery. The time frame for improvement, if not complete reduction of the symptoms, can be different per individual, but we can estimate a period of time that goes between 12 and 16 weeks. If no changes are reproduced within this time frame, that’s where we would refer the patient elsewhere for further investigations, like a scan. When Is Surgery Needed for Thoracic Outlet Syndrome? Surgical intervention is typically reserved for cases where conservative care fails or in cases of vascular TOS, where there’s a risk of thrombosis or embolism, but also where anatomical variations, like a cervical rib is present. Surgical procedures may include: Scalenectomy (removal of the scalene muscles) First rib resection Clavicle decompression or repair if there’s previous trauma These operations aim to create more space in the thoracic outlet, thus relieving the compression. Post-Surgical Recovery and the Role of Myotherapy In case of surgery, as a myotherapist, we can still help and ensure a correct recovery post-intervention. Treatment like MLD can help in flushing excess liquid out of the surgery area, but again, we would look into exercises as a form of recovery and rehabilitation of the area affected by the surgery and or affected by the lack of strength that is a consequence of a prolonged period of muscle weakness. More broadly, myotherapy treatment can help with: Pain management Scar tissue Muscle guarding or weakness Neurological symptoms that may persist or reappear Do You Need a Scan if we’re suspicious of TOS? Imaging, as discussed in other blogs, may be recommended when we are suspicious of other presentations, or if standard method are not creating any difference. For example: To rule out cervical disc herniation, tumours, or other causes of neurovascular symptoms. When […]
Jul
Nerves are the body tissue that control motion, sensory feeling, and can create a pain response. When nerves get damaged or compressed, due to tight structures, like muscle or ligaments of the spine, because of lack of strength, injury, external forces, the pain reproduced or the weakness caused to certain muscles can be quite annoying and make daily activities challenging. In this blog, I will break down the basics of nerve structure, the types of nerve injuries, how nerves recover, when surgery is appropriate, and how Myotherapy can play a supportive role in your rehabilitation journey. What’s the Nerve Structure In order to better understand nerve damage, let’s compare the nerve to an electric cable: Axon: This is the core wire that transmits electrical signals. It’s the long extension of a nerve cell (neuron) that communicates with muscles, skin, and other tissues. This structure is indeed the equivalent of the copper wire in the electric cable. Myelin Sheath: A protective, fatty coating that wraps around the axon and helps speed up the transmission of nerve signals. To ensure the signal can travel smoothly along the axon, the myelin sheath works as a coating layer that doesn’t allow dispersion. Endoneurium, Perineurium, Epineurium: These are connective tissue layers that bundle individual axons into fascicles (groups), and fascicles into full nerves, like insulation and support around an electric cable. Thanks to this multilayer organisation, the nerve’s structure is both efficient and delicate. Therefore, damage can occur to any part of this system, and based on the layers that are damaged, it will determine how the nerve recovers, including the need for external interventions (surgery) and the time of recovery. Symptoms of Nerve Damage Based on the type of nerve damage, you may experience different types of symptoms. Sensory Nerve Damage (affects feeling/sensation): Numbness or reduced sensation (especially in hands, feet, or limbs) Tingling or “pins and needles” Burning or shooting pain Heightened sensitivity to touch (even light touch feels painful) Poor coordination or balance (especially in the dark or with eyes closed) Motor Nerve Damage (affects movement/muscles): Muscle weakness or heaviness Muscle twitching or cramping Difficulty with fine motor tasks (e.g., buttoning a shirt) Muscle atrophy (wasting) over time Dropping objects or foot drop (inability to lift the front of the foot) Autonomic Nerve Damage (affects internal organs/functions): Dizziness or fainting when standing (due to blood pressure regulation issues) Abnormal sweating (too much or too little) Digestive problems (bloating, constipation, or diarrhea) Bladder dysfunction (urgency, incontinence, or retention) Heat intolerance or inability to regulate body temperature Other General Signs: Pain that follows a specific nerve path (e.g., sciatica) Delayed healing or tissue changes (e.g., in diabetic neuropathy) Sensory loss that makes walking or using limbs unsafe When reading those symptoms, we have to be aware that multiple symptoms can be present, and that some symptoms may be related to other pathologies, so that’s why consulting with a physical therapist or the GP is the best step to better understand what is happening. Types of Nerve Damage Nerve injuries are classified based on the severity of the injury. Neuropraxia (mild):A temporary block in signal transmission, often due to compression or stretching. The structure remains intact, and recovery is typically quick. Think of when sleeping with the arm in a funny position, or sitting for too long with one foot under the tight, and either the arm or the leg goes numb. Axonotmesis (moderate):The axon is damaged, but the surrounding connective tissues are preserved. The nerve can regrow, but it takes time. It is estimated that the axon can regrow 1 mm per day up to 18 months. This gives you the opportunity to regrow a nerve from head to toes. Neurotmesis (severe):The nerve is completely severed — both axon and connective tissue. Without surgical repair, recovery is unlikely. This is obviously the worst-case scenario, and it is more common in severe incidents, when an external factor may lacerate body tissues. Each type of injury presents differently, from numbness and tingling to complete loss of movement or function in the affected area. In fact, nerves not only transmit sensation, but also allow muscles to contract and move. So, a lack of strength, sometimes, can be due to a nerve compression and not from a lack of actual muscle load capacity. When Is Surgery Needed? As we just saw, surgical intervention is usually recommended when the damage is extended to the full nerve structure and: There is a complete nerve severance (neurotmesis). There is no sign of functional recovery after several months. Scar tissue or compression is impeding nerve signal transmission. There is associated structural damage (e.g., after fractures or deep lacerations). In order to restore nerve functionality, the surgeons may attempt nerve repair, grafting, or decompression, depending on the case. How Fast Can Nerves Regrow? Peripheral nerves (outside the brain and spinal cord) do have the ability to regenerate, but slowly. On average: Nerve regrowth occurs at approximately 1 mm per day, or roughly 1 inch per month. Recovery can take months or even years, depending on the distance the nerve needs to travel and the extent of the damage. During this time, muscles and tissues that rely on the nerve may weaken, which makes active rehabilitation crucial. Indeed, to ensure a complete recovery, we want to stimulate via hands-on treatment and exercises the needs of the nerve to regrow. So, by stimulating the structure like the muscles controlled by the damaged nerve, we can stimulate the nerve itself to regenerate. On the other hand, be aware that nothing can make your nerve grows faster, but we can ensure that the regrowth is stimulated. The role of Myotherapy for Nerve Recovery As a myotherapist, I focus on assessment, treatment, and rehabilitation of musculoskeletal pain and dysfunctions. Thanks to this approach, via the hands-on treatment and exercises skills learn during my Clinical Myotherapy training, I can help immensely someone who is suffering from nerve damage. Hands-On Therapy Assessment first A fundamental tool to ensure we […]
Jun
Cosmetic surgeries have become increasingly common, with procedures such as liposuction, tummy tucks, facelifts, and breast augmentations helping people achieve their desired aesthetic goals. However, while the surgical aspect gets most of the attention, what often goes under-discussed is the importance of post-operative care, especially Manual Lymphatic Drainage (MLD) in promoting faster, smoother recovery and reducing the risk of ending with fibrosis tissue build up underneath the skin. What Is Manual Lymphatic Drainage (MLD)? MLD is a gentle, rhythmic massage technique designed to stimulate the lymphatic system and encourage the natural drainage of lymph fluid. The lymphatic system plays a crucial role in immune function and fluid balance. After cosmetic surgery, lymphatic flow can become disrupted due to inflammation, surgical trauma, or temporary damage to lymph vessels. While the first few days post-surgery are dedicated to acute recovery and the taking of Antibiotic to reduce the risk of infection post-surgery, as soon as this risk is passed, that’s when you want to start your MLD journey. Why Is MLD Important After Cosmetic Procedures? Cosmetic surgeries often cause swelling, bruising, and fluid accumulation (known as seroma or edema). This is due to the body reacting to an invasive procedure and removing tissue beneath the skin. MLD helps: ✅ Reduce post-surgical swelling ✅ Accelerate the removal of metabolic waste and excess fluid ✅ Improve skin texture and reduce fibrosis (hardened tissue) ✅ Speed up visible results by enhancing contour definition ✅ Decrease discomfort by reducing pressure from trapped fluids As with any surgery, when lymphatic drainage massage is applied, no pain is to be experienced. While I treat someone with MLD I always pass this information up front, to ensure that if they experience any type of pain, I get told about it, so that I can go lighter with pressure. Which Procedures Benefit Most from Lymphatic Drainage? MLD is commonly recommended after: Liposuction (including 360 lipo or Brazilian Butt Lift – BBL) Tummy tucks (abdominoplasty) Facial surgeries (rhinoplasty, facelifts, blepharoplasty) Breast augmentation or reduction Body contouring procedures As a Lymphoedema therapist, I do get surgeons referring me patients to assist them with post-op management, especially when swelling or fibrosis is a concern. When Should You Start Lymphatic Drainage? As briefly explained above, the ideal time to begin MLD is as soon as you stop your antibiotic cycle, and is your surgeon or GP call to when you are safe to do so. On the other hand: Typically, MLD is started 3 to 5 days post-surgery, once acute inflammation has settled and the incision sites are closed or protected. A full course may include 6–10 sessions spaced out over a few weeks for optimal results. Always follow the advise of the surgeon about post surgery, but, when you safe to do, the more movement we add to Lymphatic Draiange, the better the recovery would go. Is MLD Safe post-cosmetic surgery? When performed by a qualified lymphatic therapist, lymphatic drainage is non-invasive, safe, and effective. It’s gentle enough for delicate post-op tissue and can significantly improve comfort and healing time. My qualification in Lymphatic Drainage was done with the Vodder Academy whicg holds the gold standards for MLD practice, and is worldwide well known for the quality of their practice. On the other hand, I also hold a qualification in Clinical Myotherapy, which allows me to help people recover from injury and stick to their fitness goals via training and exercises. When Can I Book My Appointment for Post-Cosmetic Surgery Recovery? My studio, Melbourne Massage and Treatment, is located in Fitzroy North, on the corner of St George Rd and Holden St. I work Monday to Saturday, and to book an appointment, you can just head online to the booking page and choose the best time/days that work for you. Given the number of session needed for this type of work, I always suggest to book a series of session in a raw, from to 3 session per week for the first 2 weeks. Session by session we do evaluate together the progress, and chose together what’s the next step. If you have any questions, please do not hesitate to contact me. FAQs – Cosmetic Surgery & Lymphatic Drainage
Jun
Temporomandibular Joint (TMJ) disorders are a common source of jaw pain, clicking, and discomfort that can impact anyone at any age. At Melbourne Massage and Treatment in Fitzroy North, I see many clients presenting with TMJ clicking and associated symptoms. One of the key factors behind the painful symptoms is retrodiscal tissue compression, a condition that not only causes joint noises but may also lead to chronic jaw pain. What Causes TMJ Clicking? Let’s start understanding why TMJ clicks. When looking at the TMJ, we can see that between the two bones that make up the joint, there is a disk, called the articular disc, which is made of cartilage and is meant to keep the bones apart (the temporal bone and the mandibular condyle). In a healthy joint, the disc moves smoothly with the jaw during opening and closing. But when the disc is out of alignment, the condyle may snap over it, creating that characteristic “click.” For reference, a condyle is a rounded protuberance at the end of a bone, which in this case, fits into a cavity. The Role of Retrodiscal Tissue Compression in TMJ Clicking and Pain Right behind the disc lies a tissue known as the retrodiscal tissue, which contains blood vessels, nerves, and connective tissue. When the disc is displaced anteriorly, the condyle may compress this sensitive area during jaw movements. This compression can lead to: Inflammation Persistent pain Increased joint stiffness Neurovascular irritation This is possible because the tissue, as mentioned earlier, is innervated, whereas the disk is not. Therefore, the disk compression on its own is not going to replicate any pain, as there is no nerve to pick up any stimulus in there. Forward Head Posture Would Not Help. Forward head posture is a common presentation linked to TMJ clicking. Forward head posture is characterised by the head sitting forwards compared to the midline of the body, and is often due to a lack of strength in deeper neck flexor muscles. This presentation can make the TMJ presentation worse because of the excessive load placed on the muscles that surround the TMJ (masseter and temporalis muscles). Other reasons include the misalignment of the teeth, which can make the chewing action more difficult and over time, create strain along the TMJ tissues (muscles, ligaments and tendons), but also referral pain from the cervical joint tension can lead to manifest stress in the jaw and face muscle due to constant pain and discomfort. How Myotherapy Can Help At Melbourne Massage and Treatment, I offer a combination of evidence-based manual techniques and exercise therapy to address the root causes of TMJ dysfunction, aiming not just to manage symptoms but to promote long-term recovery. 1. Joint Mobilisation Gentle mobilisation techniques to the jaw, cervical spine, and upper neck can reduce joint restriction, improve mobility, and relieve the pressure on retrodiscal tissue. Mobilisation helps restore normal disc-condyle mechanics, reducing clicking and improving range of motion. 2. Dry Needling Dry needling of trigger points in the masseter, temporalis, and lateral pterygoid muscles can reduce hypertonicity and relieve pain referred to the jaw and head. Targeting myofascial restrictions can also indirectly reduce stress on the TMJ itself. 3. Targeted Exercise Therapy Specific exercises for jaw control and cervical strength are crucial for maintaining results between sessions. Jaw isometric exercises are ideal for pain management and quick relief. Resistance bend exercises for jaw opening. Relaxation techniques for parafunctional habits like clenching Over time, these exercises can enhance joint stability, reduce overloading, and in some cases improve mild degenerative changes by promoting better joint mechanics and tissue resilience. 4. Deep Tissue Massage Massaging the muscles surrounding TMJ and the cervical muscles can help reduce tension, stimulate the nervous system to relax and give a break from pain and discomfort, while improving mobility. As always, there is not one solution for the common presentation of many. Each individual is different, and the treatment results can be different. But what we can expect is that, if we balance the usage of hands-on treatment and exercises, we can create some real change with some great benefits. TMJ Clicking and Menopause Menopause is a topic I have already spoken about in my blogs. Briefly, we can refer to menopause as the period of 12 months or more of missing menstrual periods in a woman’s life cycle. Before that is called perimenopause, and after that, we talk about post-menopause. This step is achieved when a woman has no more eggs to release, and her menstruation has stopped. While it is not the same journey for each woman and there are many changes that women can go through, a common one is stiffness of ligaments. Again, this is not happening in one day, but is a change that comes with time and is different person to person. This is possible because of the lack of estrogen. Indeed, estrogen, along with controlling many other aspects of the biological life of a woman, is also responsible for the elasticity of the ligament. Put: less estrogen, less elasticity. This can explain why, during this phase, women start experiencing more TMJ pain and potentially TMJ clicking. On the other hand, we have no yet enough evidence to say that Hormonal Replacement Therapy is effective for establishing this presentation (Robinson et al., 2019). FAQ – TMJ Clicking 1. What causes the clicking sound in the TMJ?The clicking occurs when the articular disc in the jaw joint becomes displaced, and the mandibular condyle snaps over it during jaw movement. This is often due to disc misalignment. 2. Why does retrodiscal tissue compression cause TMJ pain?The retrodiscal tissue contains nerves and blood vessels. When compressed due to disc displacement, it can lead to inflammation, pain, and stiffness in the TMJ area. 3. Can TMJ clicking happen without pain?Yes. If the articular disc is displaced but the retrodiscal tissue isn’t compressed or irritated, the joint may click without producing pain. 4. How does forward head posture affect TMJ?Forward head posture strains neck muscles […]