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 quadrants, 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. Some genetic variation, seeing the thoracic duct connecting to the right lymphatic duct. What does the watershed division look like? The main watersheds are four. A vertical one divides the body into two equal vertical halves. A horizontal one divides the body into the upper and lower body at the inguinal level. Other horizontal watersheds are parallel to each other and are located at: The clavicle line runs through the belly button on top of the iliac crest. In doing so, we have six quadrants: upper, medial, and lower. Other watersheds run vertically within the body. Those are located on the arms and on the upper leg. 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 them. The watershed division allows the liquid to be directed to a specific body area where lymph nodes are found. Indeed, the lymph nodes are the ones that clean up the lymph fluid, also called obligatory lymph load. When we treat a patient, we have to make sure where we direct the liquid because we want to ensure that the lymph fluid gets sent to the lymph nodes, where it will be processed and then transferred to the lymph/vein duct at the base of the cervical area. This is extremely important when we treat Lymphoedema, where we may bypass the watersheds, where the lymphatic system has been damaged or is missing, to transport the lymphatic fluid from a stagnant area to an active one. How to bypass a watershed To bypass a watershed and transfer the lymphatic fluid from one side of the body to the other side, we have to stimulate the anastomoses, which are the alternative pathways of the lymphatic system. Unless those pathways are stimulated, we can not transfer the fluid side to side along the horizontal or vertical lines. An example would be a person who went through a mastectomy and has a unilateral Lymphoedema. In that case, we need to stimulate the upper anastomosis to transfer the fluid side to side. In the drawing beside, you can notice the upper anterior and posterior anatomoses drawn in thick green lines. 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 drains into 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 Melbourne Massage and Treatment and Lymphatic Drainage Massage At Melbourne Massage and Treatment, Lymphoedema Clinic, I am specialised in Applied MLD and Lymphoedema management. I did train with the Vodder academy for my Lymphatic Drainage practice, and I have a clinical approach to this type of work. If you are in need of manual lymphatic drainage treatment, do not hesitate to book your next appointment now. A 15-minute Online free consultation is also available for those who suffer from Lymphoedema or Lipedema.
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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.
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.
Sep
The Psoas Muscle. The Psoas muscle is a muscle that seats in the Lumbar region of the body. It is palpable through the abdominal region when the client is in the supine position. Psoas Muscle is often related to and taken into consideration with iliacus muscle, as those 2 muscles share the insertion tendon and point. For this reason, they get called Iliopsoas Muscle. Origin, Insertion, and Action of the Psoas Muscle: Origin: Body and Transverse process of the Lumbar Vertebrae (L1-L5) Insertion: Lesser Trochanter of the Femur Action: with the Origin fixed: flex the hip externally rotate the hip with the Insertion fixed: flex the trunk towards the tight tilt the pelvis anteriorly flex the vertebral column laterally. Innervation is supplied from the anterior rami of spinal nerve L1-L3 Blood Supply from the lumbar branch of the iliolumbar artery The Psoas muscle has a reference pattern that involved the abdominal area but even the front of the tight. It is often tight for people who spend a lot of time seating on a chair, like office workers and or who drive for long hours. This happens because the muscle is in constant contraction when we spend time seating. On the other hand, the Psoas Muscle is often also related to emotional distress. This can happen because when we live with negative emotions we tend to contract the abdominal area and tight the muscle-up, especially for reaching out a fetal position, which recalls maternity safety. By analyzing the action of this muscle, it is easy to notice how is involved in assuming a fetal position, as it is a hip flexor. In fact, it contracts the 2 limbs, the upper and lower to gain one with each other. Treating the Psoas Muscle directly is not always recommended as direct work unless the person has been going through a series of treatments already. This is because where the muscle is lying it is a sensitive spot to access and as it holds a lot of tension, can be a bit sensitive to the touch. In need of a massage? Book now your next appointment, at Melbourne Massage and Treatment clinic. To treat the Psoas Muscle the client is lying in a supine position. Firstly we identify the muscle. For doing so after the client did lie in the supine position, the therapist will place her/his hands off the rectus abdominis, on its lat. border, and will create resistance on the client’s tight as it goes for active flexion. With the hand seating next to the rectus abdominal area, the therapist can feel the muscle activating. Once the Psoas has been isolated, the therapist can place both hands or one on the muscle, asking the client to breath-in deeply as is flexing the knee (foot running along the table) and as the client’s breath out (it is important here following the breathing wave) the therapist can apply a force straight down. Furthermore, to ensure that we can release tension from the Psoas Muscle, we have to work on the muscle surrounding it, like the other muscle that holds the same Origin/Insertion patterns, like: Erectus Spinae group, Quadratus Lumborum, Quods Hamstring In fact, the psoas muscle can be involved in presentations such as lower cross syndrome (LCS). Are you struggling with pain and or body ache? Book now your next massage appointment, at Fitzroy North clinic. Often as therapists, we would work on the surrounding muscle before doing direct work on the Psoas. This is because direct work in such a sensitive area can be too intense to start with and could make the client feel vulnerable or uncomfortable. A good exercise to keep the Psoas muscle in shape is a daily walk, even though for a nice and balanced walk we want to make sure to have a correct Extension Leg Firing Pattern.
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.
Jul
What is, Upper Cross Syndrome? Upper cross syndrome (UCS) is a common posture imbalance that affects many people nowadays and it is caused by repetitive poor posture habits. The body‘s muscles work in coordination with another one to keep our posture erected along the Plumb Line. The Plumb line is an imaginary line that runs from the top of the body down to the foot, passing by the: Mastoid process of the skull Middle Acromion (shoulder joint) Centre of gravity of the body (pelvis) Greater Trochanter (GT or Head of the Femur) Side of the Knee Down to the Malleolus. The head and shoulders are protracted compared to the plumb line, for someone that suffers from UCS. This happens when there is an unbalance between the anterior and posterior portions of the cervical area. So, to better understand what UCS is, let’s go through which muscles are involved in this condition, and the muscle’s role. Let’s start by drawing a diagonal line from the shoulders down to the upper chest area of the pectoralis (). The diagonal line would cross first the Upper Trap (UT) and Levator Scapulae (LS) for then cross the Pectoralis Major (PM). What do these muscles have in common? Tightness. The tight pectoralis would protract the shoulders. On the other hand, UT and LS would elevate the shoulders and scapula and accentuate the shoulder protraction. Indeed, this force applied bilaterally would place the muscle that is attached from the spine into the Scapula (or Shoulder Blade) under constant stretch, as for the muscle that keeps the neck erect, like the Deep Flexor Muscles (Longus Colli, Longus Capitus, Rectus Capitus and Longus Cervicus). Do you feel like you need help with your neck pain? Book now your next appointment, at Fitzroy North clinic. Now let’s draw a second diagonal line, in the opposite direction of the first one . This line would start from the anterior side of the body. From the neck area and go towards the posterior inferior side of the body. Therefore, would cross first the Deeper Flexor Muscles of the neck and then the Rhomboids (RH) and Middle Trap (MT). What this muscle got in common? As mentioned before because those muscles are placed under constant stress, they get weak, and can’t hold the neck and the scapula in place. How massage therapy can help? Massage therapy is a great way to create balance in the body structure. So, along with a massage session, either Thai Massage, Remedial Massage and or Myotherapy, we would start by doing a series of postural assessments and Range of Motion (ROM). This would allow me, the therapist, to pint point out what muscle needs more attention, and if there is more presentation to add to the UCS. From there then, we may start working on releasing tension from the Pec area and the UT, using gentle strokes that involve stimulating blood flow and heat in the area. Where per areas like rhomboids we would use techniques that may recreate some pain, so to stimulate the muscle to be activated. Said so, depending on the massage therapy I am offering, the approach can be slightly different. In conclusion, there is to say, that massage therapy by itself, would not be enough, if the person, at the end of the treatment, would go back to their routine life. It would be important that the patient follows the exercises that they would give at the end of the massage session. Exercises for UCS