Knee pain is a common presentation for clients of any range of age and gender. Knee pain indeed is a vast topic. So in this post, we are going to go through how to identify the reason why we can experience knee pain. For doing so we are going to look at some special testing, that we use for the knee joints. Next, in a further post, we may analyse individual conditions. What about the Knee Joint? The knee is the strongest joint in the body. It takes a lot of pressure from the upper body and still has to handle the shock coming from the lower leg session, shock as walking, running and jumping. Indeed, whenever we do one of these actions, the knee plays a big role. Knee Anatomy Bond: Above: Femur Below: Medially the Tibia, laterally the Fibula. Patellar is the front “floating bond” Ligaments: Anterior Crucial Ligament Posterior Crucial Ligament Posterior Menisco-Femoral Ligament Fibular Collateral Ligament Tibial Collateral Ligament Transverse Ligament (this one is visible only from the front side of the knee, below the patella). In between the bonds we have: Medial Meniscus Lateral Meniscus If this post is talking to you, book your next massage session by clicking here. So, the knee joint can be divided into two parts: Tibiofemoral joint Connects through the collateral ligaments, cruciate ligaments and menisci; Patellofemoral joint Gives stability to the medial and lateral retinaculum and allows the extension mechanism through the tendons of the quadriceps f.. Now that we have a better idea of what the knee anatomy is, we can look into his functionality. Knee ROM are: Extension: 0° Flexion: 140° Internal Rotation: 30° External Rotation: 40° Abduction/Adduction: 15° Said so, we can see that the major movement that the knee can accomplish is, flexion. Even if the Internal and External rotation since to be a big move for the knee, in the reality, that’s not always the case. The older we get, easily this motion actively gets tighter. Indeed, one of the main reason for meniscus injury is the twisting of the knee, when the feet is holding the ground and the body rotates. But as previously mentioned in this post we would look into the knee special test. What knee functional test have to tell us? As we already mentioned in another post, a generic active, passive or resisted ROM tell us about muscle functionality. On the other hand, a special test for the knee can show us if a ligament or a meniscus is loose, in the case of ligament or injured. Furthermore, special tests, on the knee are essential to prevent further injury and reduce joint degeneration. To start with we have the drawer test: Anterior Draw test and Posterior Draw test. The Anterior one is to test the anterior crucial ligament, and the posterior, obviously, is for the crucial posterior ligament. Both these tests are done with the client lying supine on the table, with a hip and knee flexed, and foot on the table. The therapist will ensure that the foot doesn’t move and will place its hands around the knee, with the fingers (except the thumb) seating at the top of the calf and the thumbs seating on the patella. For the A.D. test, the therapist will lightly pull the knee joint away from the patient body. On the other hand, for the P.D. test, the therapist will push the knee towards the patient’s body. These tests are positive if there is a loose movement within the knee, in the direction of pull or push. If the client has a history of injuries, to the ACL or PCL the therapist wants to make sure not to push or pull with great effort, or injury could occur. Vagus and varus test. Those tests analyse the status of the medial and lateral ligaments. For the valgus test, the therapist places one hand above the knee laterally, and the other hand above the ankle on the medial side. By applying opposite pressure in the 2 directions we put the medial ligament under stress. If pain is reproduced, or there is a loose movement the test is positive. The same action is for the Varus test. In this case, the hands are placed still above the knee and ankle, but the bottom hand is placed laterally and the top one, is placed medially. Apleys Test This test is used to evaluate the state of the meniscus. The client, in this case, would be lying in a prone position, with the knee flexed. The therapist will be standing next to the client, on the side of the knee flexed and will apply pressure to the knee. If no pain is reproduced with pressure only, the therapist can gently apply a rotation movement to the flexed knee. The test is positive if the pain is reproduced. McMurray test. This is luckily the most efficient and most used knee test used by therapists in case of meniscus injury Here is how it works: The patient lies in the supine position with the knee completely flexed (heel to glute). Lateral Meniscus: the examiner then medially rotates the tibia and extends the knee. Medial Meniscus: the examiner then laterally rotates the tibia and extends the knee. McMurray is a positive test if the pain is reproduced. There are still a couple of tests that can be done for the knee, but so far we did cover the most important. About the therapy that I can offer for releasing knee pain, MLD is what I would suggest the most. Especially for acute pain and swelling or oedema reduction. Whereas, Myotherapy or Remedial Massage and Thai Massage can be used too but more to facilitate and or strengthen the muscle surrounding the area.
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Mar
As already mentioned earlier MLD is a fantastic manual technique that can be used to improve the healing of many conditions. Along with the conditions that MLD is useful for there is bone fracture. Said so, in order to understand how MLD can help to speed up the recovery from a bone fracture we have to analyse what’s happening within the body when such trauma happens. A bone fracture is an injury that can happen at any age, due to an accident or trauma. The main type of bone fractures are: Displaced Angulated Shortened Rotate Symptoms of bone fracture Pain Swelling Bruising Deformity Inability to use the limb. The fracture so can be a crack side to side or in the middle of the bone. Eventually, the bone can crumble too, or break in multiple areas. At the worst, the bone can also cut the skin, and come out of the body. If this post is talking to you, book your next massage session by clicking here. Depending on where the fracture is, and what type of fracture it is, surgery could be required. Independently if surgery is required or not, still MLD can help to boost the recovery. Indeed, when a fracture happens the body recognises a trauma to its system. As long as the body won’t know exactly what the trauma is, and if the trauma does involve a skin crack or not, to prevent infections and external bacteria or pathogens to enter the body, the vein, capillaries and the lymphatic system around the trauma area get restricted. As per result, the body does swell. In fact, this explains why, when oedema happens the body does swell. It is an automatic body response to prevent further damage to happen. As the body then, realise what the issue is, slowly does reactivate the lymphatic system, and does fully reopen veins and capillaries, so that the blood can start circulating again freely. But the time that the body can reduce the swelling by itself, with a lymphatic system that works at regular speed (about 7 to 8 bits per minute) it would take a while to reduce the swelling. Furthermore, when I bone is broken that body part would have to stay still for a while, weeks or months. As per result, the blood and lymph flow would be slower than usual. And here is where MLD comes to be useful. If by reading this post, you feel like MLD is what you need now to recover from your injuries, click here to book now your next session. As MLD therapists indeed, we would check that there is no acute infection in the area where we want to apply MLD. If that’s the case, then, we can start our work. By boosting the lymphatic system, up to 3 to 4 times its normal ratio, we can quickly reduce the swelling. And what about if the area affected is covered with a plaster cast? Well, let’s not forget that the lymphatic system works as a vacuum and the area of loads is below the clavicle. So, stimulating the Lymphatic system at the top can actually already improve its suction ability till down the feet. For example, if the fracture is at the foot, initially MLD can be applied at the neck, to open the Lymphatic System duct that reverses in the veins, and secondly can be applied to the abdominal level and down the legs, just before the foot. Now, that swelling reduction, come’s with many benefits. For example, in the area treated, there is a transaction of extra oxygen, protein, vitamins, blood and other essential elements useful for the bone to heal. And occasionally, depending on the type of fracture is not only the bone the one that has to heal. In fact, along with a bone fracture, the body part fractured stays steel for weeks and months. That would create a weakness in the muscle that would then require rehabilitation. As a Remedial Massage therapist, I would have to refer the client to a Physiotherapist for rehabilitation. Even so, as a Remedial Massage therapist, I can still deliver massage services that can help in restoring muscle functionality. In conclusion, MLD can help with: reducing the swelling along a bone fracture; help in speeding up the recovery of the skin damaged by the fracture and or by the operation; Speeding up the healing of muscles and soft tissue around the fracture; Ultimately, by increasing relaxation, MLD is also useful to keep the humour of the person at ease, as often happens that after a trauma such as a bone fracture, the person can feel anxious and demoralised due to poor mobility and difficulties in moving.
Mar
TMJ or Temporomandibular joint is bilaterally located on the side of the human head. TMJ and Movement Upper Compartment Protrusion Retrusion Lower Compartment Lower the Jaw Raise the Jaw Lateral Deviation Said so: the opening is the combination of Protrusion plus Lowering the Jaw closing the mouth is Retrusion plus Raising the Jaw. TMJ and Pain When TMJ is in pain, we can find it hard to talk, eat and sometimes even rest, as the pain can be pretty strong. Moving forward, not everyone knows that deep under TMJ we have what we call Parotid Gland. The Parotid Gland is a salivary gland, and if gets infected, it can swallow up and be quite painful. What can happen at the Parotid Gland is an accumulation of calcium in its duct, and saliva can’t be expelled. Even though viruses or bacteria can also be responsible for TMJ infection. What also most people are not aware of is that in the Parotid Gland, there are lymph nodes. TMJ and MLD. The fact that the gland can be swollen is an indication that fluid is stuck in it. MLD, thanks to the boosting of the lymphatic system, which is responsible for reducing swelling in the body, can be the perfect technique to reduce the swelling and so restore the functionality of TMJ. If this post talks to you, book your next massage session by clicking here. The Parotid Gland lymph nodes unload their Lymph Obligatory Load into the cervical nodes. So as per usual, at the start of the MLD treatment, we will work along the upper neck, medial neck and then the terminal (just between the clavicle and the upper trap). In addition, what makes a difference with MLD is that is a pain-free technique. That would allow the client suffering from TMJ pain to receive a treatment that would not aggravate the pain feeling and would end up giving a deep relaxation too. Other work techniques can be used, such as Myotherapy and Remedial Massage trigger point, or dry needling for Myotherapy treatment. The Remedial Massage TMJ treatment is a valuable technique but would not resolve the problem at the root cause. In conclusion, MLD is probably the best manual, not invasive treatment that can be done for TMJ. Talk to your dentist about this option, and if they are not aware of what MLD is, don’t be surprised, it is, yes an excellent technique, but it is still not well known by many practitioners, dentist included.
Mar
Range of Motion is the movement of a joint within a 3-dimensional space. For each joint, we expect a minimum and a maximum degree of movement. When to use a range of motion evaluation. Before performing a Myotherapy, Remedial Massage, or a Thai massage session, we check for a Range of Motion, also know as ROM. Checking for ROM is to establish the functionality of the joint and the muscles that surround it. For example, when a client walks in complaining of cervical pain, the first thing we look in too after the postural assessment is the ROM. A postural assessment is an evaluation of the skeletal structure. After that, we ask the client to do specific movements with their head. Like, Rotation side to side, flexion, extension, and lateral flexion. Indeed, these are the basic range of motion for the cervical area. What this range of motion can tell us? Well, depending on the essential mobility of the person, we expect a minimum and maximum range. Let’s say that the client has average mobility; we expect the range of motion of their cervical to be: Flexion (able to flex the head forward and leave a gap of 3cm between the chin and the sternum) Extension, we look in too 70° of movement Lateral Rotation we look in too 80° of rotation (the chin is nearly in line with the shoulder) Lateral Flexion we look in too 45°. If this post talks to you, book your next massage session by clicking here. Are the range of motion movements the same for everyone? A person with a hypermobile joint range may have a 10° about less ROM than this. Indeed, a person that has a hypermobile joint range can reach 10° furthermore. That’s why every person needs his evaluation. Moving forward, if the range of motion is limited, it could be a muscle tightness or a joint mobilization issue. The best approach for improving joint mobilisation is the Myotherapy treatment or Thai Massage. Both techniques relieve muscle tension and improve muscle tone and joint mobility. The release of tension from the muscle would improve the ROM. On the other hand, when we ask a client to do a ROM, we don’t look only for the length of movement. Quality of movement. For the quality of movement, we refer to how smooth the movement is. Is the client trying to compensate for the cervical rotation by flexing the head? Is the client compensating for the flexion by shrugging the shoulder? Indeed, the movement of a joint is the key to understanding what muscle is responsible for the pain, discomfort or limited ROM. Once we individualise the key muscle/s, we can address the issue. Different types of ROM. In conclusion, the ROM can be active, passive and resisted. The client itself does active ROM. Passive are ROM done by the therapist with no assistance in controlling the movement by the client. Reisted is ROM active done by the client, with a resistance force applied by the therapist again the client’s movement. Each of this ROM can tell us something different about the joint. Active is about muscle lengthening. Passive is about joint mobility (ligament and tendon) Resisted is about the strength of the muscle. We can’t use the Resisted if Active or Passive reproduces pain. That would not be safe. Regarding the Resisted ROM, the resistance is applied in 3 different levels. When the pain gets reproduced, we stop the test. Occasionally, an orthopaedic test can be performed too. Orthopaedic tests are specific tests to evaluate in specific the muscle involved in the limited ROM.
Mar
As Massage Therapist, I often see people who come in for treatment due to pain and discomfort. Indeed, I am more than happy to be that person who, by manual therapy, can alleviate others’ agony. Exercises post-treatment. At the end of the treatment, I tend to show the client a series of corrective exercises and, most of the time, a straightforward one. Those corrective exercises must be done to help maintain the change we created in the body along the massage session. Massage treatments like Myotherapy, Remedial Massage, Thai Massage or MLD can be a good starting point to change the musculoskeletal unbalance of the body. Even though the changes we created will not last long unless there is constant work done on it. So, when the client returns to routine life, those change tends to disappear quickly. That’s why we give clients exercises. How can exercises help? Exercise can help address everyday muscle weakness, joint stiffness and or painful presentation on your own time. And yes, I understand it’s hard to find the time to do exercises, but would you rather live a life in pain or find a way to feel better about yourself? It’s part of our behaviour to want the fast, quick and immediate change we want. Isn’t it?! But nothing comes easy in life. We must learn that changes take time, and along this time, we must work hard for it. Said so, I am more than happy, and I feel honoured to treat people. I feel like Massage skill is one of the skills that can change people’s life. And when I do run a Thai Yoga class and teach people the exercises, I feel even more accomplished as a massage therapist. Book your next massage session by clicking here if this post talks to you. In conclusion, postural exercises are the key if you are willing to get rid of the body ache and pain. Then, working at the gym or doing sports activities is still as important. But those activities, if not monitored by a coach or done professionally and with full awareness, can lead to injury and pain. Indeed, when doing strengthening exercises, you want to ensure you correctly use the body biomechanics. But not only that. Indeed, you want to make sure that your joint has enough range of motion to deliver that action correctly. Following this link will give you access to the Thai Yoga Class videos.
Jan
Water after a massage. Have you ever noticed that after a massage you feel thirsty and depending on the treatment you may have an urgency to go to the toilet? Well, massages are diuretics, that’s why. Indeed, independently of the type of treatment that you receive, whether is MLD, Remedial Massage, or Thai Massage, the body fluid gets pushed and pumped around the all body. As per consequence, all these substances moved around need to find their way out. So, after any session, you wanna make sure to rehydrate your body. Drink water after a massage. Why water and not orange juice? Or an energy drink? Or coffee? Water is what is recommended after a massage because it’s what can at the best re-oxygenate the muscle and re-hydrate the body. Drinking a sugary drink, or a really acid beverage as it can be coffee will just dry off the body even more. Furthermore, water is quicker to be absorbed and can help the stomach to keep its natural PH balance. If this post is talking to you, book your next massage session by clicking here. Another effect of the massage can be the deep relaxation of the body, which can affect the stomach and abdominal feeling. Indeed, adding sugar or other substances to the PH of a stomach that feels so relaxed, may not work at the best. What about the water temperature then? Cold or warm? Well, let’s take down the myth that cold water makes you feel fresher. Sorry, it doesn’t. Drinking cold water brings the body temperature down, increasing then the difference in temperature between within the body and outside the body. That will make you feel even hotter. But I do understand that hot water unless is herbal tea, doesn’t feel so nice. Even though, warm water would be ideal, as its temperature would be the same as one of our inner organs. So, temperature-wise just drinks water at room temperature if you can’t stand hot water.
Jan
Massage and music at Melbourne Massage and Treatment Studio. Music is such an important part of receiving and giving a massage. As our body gets stimulated from the touch of the practitioner, music can tune in with the healing touch and create a different atmosphere. Said so, I never found it too hard to choose what music to play. Lately, I did decide to step away from platforms such as Spotify or Youtube. Why? Well, starting with YouTube, there is way too much publicity, and I don’t really use it as much that I would need an account for it. In regards to Spotify, I just can’t stand their politics. The artists get paid nothing for each time we listen to their music, and I found it really unfair. So, more recently, I discover a really nice French Radio called FIP. FIP stands for France Inter Paris. The concept behind FIP has scarcely changed since its founding: commercial-free music interrupted only by occasional announcements about forthcoming cultural events. Why did I choose FIP? If this post is talking to you, book your next massage session by clicking here. I choose Fip as it has a broad range of music styles and is commercial-free The last thing you want to hear during a massage is publicity, isn’t it? Furthermore, I use it all day long in the house, it has a really massive range of music choices. During the treatments, I mostly play Jazz music as is the one that best suits the environment. In regards to MLD, though, I don’t play music during those sessions. Why? Well, MLD is a light touch treatment that doesn’t have to follow a bit. In fact, having music, for us MLD therapists can be distractive. Along with the MLD treatment, I have to be so focused that I can’t get distracted by the music’s rhythm. That would change the rhythmic of my touch and massage speed, interrupting the healing purpose of MLD. In conclusion, I never received a complaint about the Music choice, so I guess your customers appreciate the choice and respect the idea that under pay an artist, is just not fair.
Aug
Muscle Firing pattern Muscle firing pattern is the sequence in which muscle should get activated to complete an action or movement. Whenever we move a joint, is not just 1 muscle to do that action there are multiple numbers of muscles that allow the action to happen, and other multiple numbers of muscles counterbalance that action. So, the muscles that control the action are called agonist muscles and the antagonist are the muscles that counterbalance that action. The antagonists are usually the muscles that do the opposite action to the one played. Said so we have also to introduce another term, that in the massage industry is known as synergetic muscles. Synergetic muscles work together to make allow a joint to complete an action. But let’s look into an example. Leg extension firing pattern. Leg extension is controlled by the synergetic muscle: gluteus max (GM) hamstring (HM erectors spine (Esp o) (opposite side of the leg) erectors spine (Esp s) (same side of the leg) The antagonist in the leg extensions are the Quadriceps. So, let’s focus on the agonist of this action for now. If the GM is weak or inactive, when we go for leg extension the Hm gets overpowered. As the Hm gets overpowered the ES starts firing too early to stabilize the pelvis abandoned from the weakness of the gluteus. Moving forward with this unbalance, the ES on the same side could end up to start being the first muscle that gets fired for doing the action of leg extension when it should be the last one. And this could happen because the Esp o is holding the body still to get the action done. Lower back pain or hamstring tear can be often a consequence of these unbalances. Lower back pain can happen when the firing pattern is like: 1st Erectos Spine (opposite or same side) 2nd Hamstring 3rd Gluteus Max (because if weak or inactive) Hamstring tear can happen when the firing pattern is like: 1st) Hamstring 2nd) Eroctos Spine (opposite or same side) 3rd) Gluteus Max (because if weak or inactive) But nothing is lost, and the firing pattern can be reorganised. For doing that we have to look into exercises for firing pattern reestablishment. For the leg extension, for example, the exercises would be: Lying in a prone position (face down) Tugged the toes under the feet Squeeze the gluteus one against the other With the gluteus, squeeze and extend the knee Still with the gluteus squeezed to release the knee The final step, release the gluteus. Repeat 30 times for 6 weeks every day. To don’t fall back into an incorrect firing pattern, make sure to strengthen the gluteus. Massage would help to release the trigger point in the GM. Thanks to the release of trigger points the muscle can start to be trained to get stronger. Are you struggling with pain and or body ache? Book now your next massage appointment, at Melbourne Massage and Treatment. Also, massage can help in fastening the process of firing pattern reestablishment, by reducing tension in the hamstring and or reducing pain in the lower back by flashing out the tensions that have been accumulated over time.
Aug
Exercises for Upper Cross Syndrome As previously mentioned, the UCS is caused by a constant habit of poor posture, to achieve a correct posture on top of massage therapy, we would need to do exercises for Upper cross syndrome. So, there are 2 main groups of muscle that we want to target. 1st group, the tense muscles: Levator Scapulae Upper Trapezius Pectoralis Major Second group, weak muscle Deeper Neck Flexors Rhomboids Middle Trapezius. Now, let’s go through some exercises for Upper cross syndrome. Brugger exercises for Neck deep flexors. This exercise is going to focus on improving the strength of the deep flexors. Stand straight with feet apart ; Place 2 fingers, one on each sternocleidomastoid and start gently and slowly flexing the head forward. The fingers seating on the Sternocleidomastoid (SCM) would allow you to keep those muscles deactivate and so would place all the strength of flexion on the deeper muscle that we are trying to train in gaining strength. If you are not sure where the SCM is, place a hand horizontally between the neck and the upper chest, along the Clavicle line. Rotate your head gently right and left and those 2 muscles that pop up below your hand when you rotate the head are the SCM. Just be aware that the L SCM will activate when you rotate right and vice versa; 3 repetitions for 10 head flexion. Do you feel like you need help with your neck pain? Book now your next appointment at Fitzroy North Clinic. Strengthening the Rhomboids and Middle Trapezius. For this exercise, we would need an elastic rubber band for exercises. · Stand straight, feet apart, and wrap the elastic band on your fist, thumb facing out. · As you breathe in flex the elbow at 90, breathe in and bring the rubber band in tension. As you breathe out extend the elbow out. · Release and start again. 3 repetitions of 10. All those exercises have to be done daily for 6 weeks in order to be effective to change the UCS. Self Massage for Pectoralis/Upper Trap/Levator Scapulae. Pectoralis Self Massage exercises: Lie down in a prone position with the arms along the body; Place a tennis or a spiky ball right between the Pectoralis and the floor; Keep the foot’s toes anchored on the floor; Gently push yourself forward and back by breathing in (from the nose) and out (from the mouth). If you would like more pressure, is enough to open the arm at 90 and lightly extend the arm, by lifting the hand from the floor. Upper Trap and Levator Scapulae Thai Yoga exercises: Start by lying in a supine position and the ball will be seated between the shoulder and the floor. Place the ball right next to the upper angle of the scapula. This time keep your shoulder flexed at 90 degrees, so with the hand facing the ceiling. Start gently a slow rotation movement at the shoulder, by drawing a circle with the hand. 3 series of 6 repetitions for each rotation movement. With Thai Yoga, you wanna make sure that each exercise is done slowly and gently. Those exercises often work on the delicate area of the body and can reproduce massage pain. Moving the body slowly and gently and having constant breathing in and out would allow you to live Thai Yoga at its full potential.