Shoulder bursitis is a frustrating condition that causes pain when lifting your arm, reaching overhead, or even lying on your side. In this blog, we’ll explain what shoulder bursitis is, whether a cortisone injection is the right choice, why exercise therapy is crucial, why a combination approach often works best, and how ultrasound imaging plays a role in accurate diagnosis. What is Shoulder Bursitis? As with many joints in the body, even the Acromion Clavicular Joint (ACJ) is characterised by the presence of a bursa known as the subacromial bursa, which is a fluid-filled sac that cushions the shoulder tendons, specifically the supraspinatus tendon, but partially also other cuff rotator tendons, as per the deltoid tendon. When the bursa becomes inflamed and swells, it can lead to pain with overhead movements, night pain, and reduced shoulder strength. This presentation is often linked to rotator cuff–related shoulder pain, which is why treatment usually targets both the inflamed bursa and the surrounding muscles. What Can Cause It? Shoulder bursitis is often caused by repetitive movement with the arm above the head. This type of motion, indeed, is quite common in certain sports (basketball, cricket, volleyball…) but even in factory settings and other types of work environments. It is not gender predominant, but it is more common for older patients, due to the possibility of being exposed to those types of movement for a longer time. The compression of the bursa, in the longer term, is what leads the bursa to swell. The compression may happen while the space between the acromion and the humeral head reduces while the arm is moving, like in flexion and abduction movements. We also have to say that, given the anatomical differences that characterise each individual, someone could be more prone to this type of injury than others, given a wider or thinner space between the above-mentioned structures. Common Shoulder Bursitis Symptoms As per many conditions, even shoulder bursitis’ symptoms can vary from person to person. Here is a list of the most and least common ones: Pain on the outside or top of the shoulder; Pain that worsens when lifting the arm overhead or reaching behind the back; Sharp pain when lying on the affected shoulder (often disturbing sleep); Aching pain at rest or after activity; Shoulder stiffness or reduced range of motion; Weakness when lifting or rotating the arm; Tenderness around the shoulder joint when touched. Occasional swelling or warmth around the shoulder (less common). What treatment Options Are Out There for Shoulder Bursitis? In terms of treatment options, we are looking at mainly two approaches, and as science has proven so far, the best approach is the combination of both. Cortisone injection Manual therapy Should I Get a Cortisone Injection? Yes (sometimes). Cortisone (corticosteroid) injections can provide fast pain relief, especially if pain is stopping you from sleeping or moving. Considering rest and movement as activities that we can live without, it is important to find a quick therapy that can restore those activities. On the other hand, the relief is usually short-term. In fact, without strengthening exercise, pain can return. Injections also carry small risks such as: Temporary pain flare-ups Skin thinning A rise in blood sugar for people with diabetes Why Exercise Therapy is Essential If cortisone injections help with the pain, exercises are what fix the problem long-term. Research consistently shows that shoulder-strengthening programs improve pain, function, and quality of life over weeks to months. At my Fitzroy North clinic, as a Clinical Myotherapist, I can guide you through: Rotator cuff strengthening to support the joint Scapular control exercises for better shoulder mechanics Gradual load progression so your shoulder adapts safely The time frame of healing can range between 6 and 8 weeks, with continued strength gains over 3 months. During this time, it is important to maintain consistency with the exercises, 3 times a week, increase the load as necessary, and allow the body to rest when needed Why the Best Option is Both: Injection + Exercise As mentioned earlier, cortisone injection is a quick fix to restore the shoulder functionality and reduce pain drastically, but it works only in the short term, and most people receiving this form of treatment would experience pain again within a few weeks post-injection. Therefore, to have a better chance of settling the presentation in the long term, it is suggested to combine cortisone injection with a structured exercise program, which would result in better outcomes than either treatment alone. Here is a breakdown: Injection reduces pain → lets you move and exercise. Exercise builds long-term strength and function → prevents flare-ups. Together, they deliver both short-term relief and long-term recovery. This is the approach I often recommend at Melbourne Massage & Treatment, Myotherapy Clinic, in Fitzroy North. And for those who are keen to restore their shoulder functionality via exercises, I do offer a treatment plan specific to the Fitness Class. This way, you get to have a tailored program for your strength activity at a discount price. If you think this would work for you, book your next appointment now via the booking page. The Role of Ultrasound in Diagnosing Shoulder Bursitis Ultrasound scans for shoulder bursitis are a reliable method for confirming bursitis and guiding injections. Along with an ultrasound scan, it is not only possible to check the status of the bursa, such as thickened or inflamed, but it is also possible to see if another structure (like a rotator cuff tendon) is the source of pain. Lastly, studies also show that ultrasound-guided injections are more accurate than “blind” injections. Shoulder Bursitis Treatment at Fitzroy North Clinic At Melbourne Massage & Treatment, I combine hands-on myotherapy, targeted exercise programs, and collaboration with GPs to address a presentation like shoulder bursitis. Our approach is: Thorough assessment → sometimes supported with ultrasound imaging (for this, you will need a GP’s referral). Exercise rehab → first-line, tailored to your pain and goals – Starting with Isometric exercises, then step into concentric with load. […]
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Lymphoedema Self-Assessment – What To Do and How?
Lymphoedema is a chronic condition that affects men and women worldwide and is categorised into [...]
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Shoulder Bursitis – What You Should Know
Shoulder bursitis is a frustrating condition that causes pain when lifting your arm, reaching overhead, [...]
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Treating Sciatica and Back Pain with Myotherapy Techniques
Persistent back pain and sciatica can disrupt every part of daily life, from sitting comfortably [...]
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How MLD Can Help with Swelling, Edema & Post Injury Recovery?
After an injury or surgery, swelling and discomfort can slow recovery and affect mobility. Managing [...]
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How Myotherapy Can Help You With Functional Movement
Functional movement is all those types of movement that you may have been training at [...]
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Oct
Functional movement is all those types of movement that you may have been training at the gym, like a squat, but really, those movements are what we are designed to deliver daily. Per the squat, think about sitting. Now, if you are young and fit, you may not need a great deal of mobility to sit on a chair, but as we get older, if we don’t train to maintain this form of mobility, things can really get difficult, and the risk of injury would increase. That’s where Myotherapy can really help you to understand which joints need more work in terms of mobility, but also which muscle groups you need to train to keep your stability at doc, so that your functional movement, especially when done under load, is going to be safe and with less risk of injury. What Is Myotherapy? Myotherapy is a form of manual therapy that focuses on assessing, treating, and managing musculoskeletal pain and dysfunction. At Melbourne Massage and Treatment in Fitzroy North, I use techniques such as deep tissue massage, joint mobilisation, myofascial release, dry needling, and corrective exercise to restore normal movement and prevent pain from returning. What I love about being a Clinical Myotherapist is that when working with my clients, I have to deliver a tailored treatment plan, as everyone is different and everyone presents with a unique body, which may need a different approach to reach the same goal. All this, starting from joint mobility and stability. Why Joint Mobility and Stability Matter Let’s start by defining what mobility and stability are: Mobility: the ability to move through a full range of motion Stability: the control that keeps your joints aligned to the body plane and supported To move well under load and deliver safe exercises, you must have good mobility and stability where needed. For example, if your hips lack mobility, your lumbar spine might compensate, creating discomfort and increasing the injury. Furthermore, a lack of mobility, it means you can not fully engage your muscle fibres, as less movement means less contraction or elongation of the muscle fibres involved in that movement, so less power and less growth. On the other hand, lack of stability is given from your lumbar area, which is not able to support a heavy load, and that’s how you can hurt your back. How Myotherapy Enhances Functional Movement Here at my clinic in Fitzroy North, as a clinical myotherapist I focus on helping you restoring balance through a whole-body approach. Here’s how Myotherapy helps: Comprehensive Movement AssessmentLet’s start with assessing posture, joint range of motion, and functional movement patterns to identify restrictions or weaknesses. Addressing the Root Cause of PainPain is central nervous system response to something that doesn’t work at is best. It may be an injury, or it may be a sensitization of the area. As a clinical myotherapist I help you break the cycle of compensation and discomfort, allowing more efficient, pain-free movement. Improving Joint MobilityUsing targeted soft tissue therapy, myofascial release, and gentle joint mobilisation, we help reduce tightness and restore freedom of movement across affected joints and muscles. Building Joint StabilityOnce mobility is restored, we focus on improving control and strength. Personalised exercises activate stabilising muscles, enhancing balance and coordination to prevent re-injury. Long-Term Support and EducationAfter every appointment I ensure to leave a detailed PDF file with the exercises we look into, so that you are able to reproduce our work at home or at your gym. But for every question, and for your progressions, I am always here ready to help. Who Can Benefit From A Myotherapy Session? Myotherapy is suitable for people of all activity levels. At our Fitzroy North practice, I regularly help clients dealing with: Muscle tightness or restricted joint movement Neck, shoulder, or lower back pain Postural strain from office work Sports or exercise-related injuries Limited flexibility affecting daily performance The Takeaway on Myotherapy and Functional Movement To improve your functional movement starts working on the right balance between joint mobility and stability. Myotherapy offers a targeted, evidence-based way to achieve that balance, and I am here helping you move better, feel stronger, and prevent future injuries. If you’re ready to enhance your movement and reduce pain, book a Myotherapy session at Melbourne Massage and Treatment, Fitzroy North today. Let’s get your body moving the way it’s meant to. And if you have any question, please use the form below to reach me out:
Oct
Exercise is the ultimate medicine for longevity and well-being. That said, there are different ways to exercise, and you should choose which one based on your goals and needs. Ultimately, even if you will prioritise one type of exercise over others, training in different ways, it is the best option to build resilience, strength and obtain the best results. But what are these main ways of training? Well, in this blog, we are talking about Strength Training and Hypertrophy. At Melbourne Massage and Treatment in Fitzroy North, I help people achieve this goal, with tailored injury recovery Myotherapy plans that may start with hands-on treatment but aim to get the person moving and moving under load. What Is Strength Training? Strength training, in its pure form, is a type of training that aims to improve the body’s ability to produce maximal force. This is possible by optimising the nervous system’s capacity to communicate to the muscles what action has to be delivered when placed under load. In fact, the goal isn’t necessarily to make muscles bigger, but to make them stronger. Here is a breakdown of what a strength training session would be like: Typical rep range: 1–6 repetitions per set Load: Heavy (80–100% of your one-rep max) Rest periods: Longer (2–5 minutes) Primary outcome: Improved neural efficiency — your brain and muscles learn to work together more effectively. This type of training benefits everyone, from athletes to everyday movers, by: Enhancing joint stability Improving bone density Increasing functional power for daily tasks. What Is Hypertrophy Training? Now, we will examine another form of training that aims to increase muscle size. Indeed, hypertrophy focuses on creating controlled muscular fatigue that stimulates growth in the muscle fibres. Here’s how it works: Typical rep range: 6–12 repetitions per set Load: Moderate (60–80% of your one-rep max) Rest periods: Shorter (30–90 seconds) Primary outcome: Increased muscle cross-sectional area (growth). Hypertrophy is popular for aesthetic goals, but it also has significant benefits for: Joint support Posture Injury prevention, especially when paired with proper mobility and recovery practices like myotherapy. Who Would Benefit from Strength and Hypertrophy Training? Let’s be clear that both styles of resistance training can benefit a wide range of people — not just athletes or bodybuilders. But here is a clearer breakdown of which training belongs to which goals: You’ll benefit from strength training if you: Want to improve performance in sports or daily activities that require lifting, pushing, or pulling. You are seeking to increase bone density and joint stability, especially as you age. This is a big one for menopausal women. Need to enhance posture and core control to reduce the risk of back or shoulder pain. Are recovering from injury and looking to restore functional movement patterns safely under guidance. You’ll benefit from hypertrophy training if you: Want to build muscle mass for aesthetics, strength, or body composition. You are addressing muscle imbalances or weaknesses identified during myotherapy assessments. Need more joint support and stability through improved muscular structure. Aim to boost metabolism and energy expenditure through increased muscle tissue. At Melbourne Massage and Treatment, I often integrate tailored exercise advice with fitness class sessions, helping clients find the right balance between strength, mobility, and recovery for their individual goals. Massage Therapy, Dry Needling, and the Role of Passive Treatment Massage therapy, dry needling, and other forms of passive therapy are valuable tools during the recovery phase of an injury or when pain and tension are high. They help by: Reducing muscle tension and spasm Improving blood flow and assisting with tissue healing Calming the nervous system and reducing protective muscle guarding Restoring short-term mobility to prepare the body for movement At my Fitzroy North clinic, these treatments are often used early in a client’s recovery journey to reduce pain and restore comfort. However, while these therapies are excellent for short-term relief and acute recovery, they must eventually be paired with movement under load to create lasting change. Why Movement Under Load Is Essential for Long-Term Wellness Passive treatments can help you feel better, but loaded movement enables you to function better. When you progressively load muscles, tendons, and joints, your body adapts and becomes stronger and more resilient. This is what keeps pain away in the long term. Here is a practical and simplified explanation: “You have to think that the body, while it does age, it does slow down in any form of its metabolism, including the regeneration of tissues, which gets worn down, and finds it difficult to be regenerated. This is where movement under load plays a crucial role. Movement under load indeed, it is the stimulus that the central nervous system needs to maintain the body’s regeneration active and effective”. A further breakdown of why movement under load matters beyond recovery: Builds tissue resilience: Strengthens muscles and connective tissue to handle daily demands. Supports nervous system retraining: Teaches your body to move efficiently and safely. Improves joint health and posture: Strengthens stabilising muscles that protect joints. Reduces recurrence of pain: Prevents the same issues from returning by addressing root causes, not just symptoms. Another way I would express the difference between passive therapy and exercises (under load) to my patient is: “Massage and needling help you feel good now, but movement under load helps you stay good later.” That’s why our approach combines hands-on therapy to relieve pain with movement education and strengthening to keep you moving well long after your treatment. How Myotherapy Complements Strength and Hypertrophy Training Myotherapy is a form of manual therapy that aims to improve the performance of any individual who has gone through an injury or someone who wants to maintain functionality and wellbeing. In a Myotherapy session, we would start with some form of testing to evaluate the person’s capacity in mobility and strength and from there we create a treatment plan that aims to improve the current presentation. A treatment plan may include: Soft tissue therapy Corrective exercise Movement assessment Goals of myotherapy: Address muscular imbalances […]
Aug
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 […]
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: […]
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 […]
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 […]
Jun
Bone fractures are a common injury, but with proper care and rehabilitation, bones can heal and regain strength. Strength exercise is a crucial component of this healing process, aiding in bone regeneration and restoring mobility and function. How can a bone fracture? Bones can fracture when placed under a load or force that they can’t tolerate. The load tolerance is subjective, person to person, and can vary based on the individual medical presentation and clinical history. Age it is only a circumstance that at the current moment in our society is seen as an increase the chance of fracture, but if we learn to age by keeping our feet via strength training, age would not be anylonger a risk component. Indeed, during the aging process, the bone can become weaker if not stimulate to positive stress, such as load active loads. The less load they received, the less the bone would keep regenerating, due to a slower metabolism. Therefor, as explained in other blogs, strength training is a key to longevity and better health. How can bone fractures heal? When a bone fractures, the body initiates a complex healing process involving several stages: Inflammation: Immediately after the fracture, blood clots form, initiating the healing process. Soft Callus Formation: Fibrocartilaginous tissue begins to bridge the fracture gap. Hard Callus Formation: The soft callus is replaced by a hard bony callus made of woven bone. Remodelling: The bone gradually remodels into its original shape and structure. This process can take several weeks to months, depending on factors like age, overall health, previous clinical history, medication intake and the severity of the fracture. Even though there is nothing that can speed up the recovery, as this is a body’s natural process, there are things that can be done to assist the recovery and ensure that the healing happens as smoothly as possible. Exercises are one of those factors that are part of the healing journey, but have to be incorporated under supervision, to ensure not to aggravate the presentation. The Role of Exercise in Bone Regeneration As mentioned above, and in other blog exercises, specifically strengthening exercises are a positive load for the body tissues, including bone, which can help stimulate the regeneration of those tissues. Obviously, different phases of healing require and can accept different types of strength exercises. So yes, you would not start with a single-leg jump on a broken tibia Stimulates Bone Formation: Mechanical stress from exercise promotes osteoblast activity, leading to new bone formation. Enhances Strength and Flexibility: Regular movement prevents joint stiffness and muscle atrophy. Improves Balance and Coordination: Reducing the risk of future falls and fractures. A systematic review by Kuijlaars et al. (2019) highlighted that physical therapy exercises, whether home-based or supervised, significantly improve functional mobility and strength post-fracture. Recommended Exercises for Recovery At Melbourne Massage and Treatment, I offer assistance with bone fracture recovery exercises throughout the Myotherapy and Fitness class treatment plan. What I would focus on, too, when aiming for recovery, would be: Weight-Bearing Exercises: Including walking or gentle jogging (if we are talking about lower limb injury), to stimulate bone growth; Resistance Training: Using bands or light weights to strengthen muscles supporting the bone, or the joint to which the bone is attached. Flexibility and Balance Exercises: Again, using weights and machinery, we aim to strengthen the muscles that control your overall equilibrium and stability to prevent further falls and reduce the risk of injury. Plyometrics which is most often towards the end of a recovery process from anytype of injury, where we focus on motion that are more close to return to daily activity, and we load your tendon as springs, as per can be doing jumping on the spot or repetitive explosive motions with arms. Clinical Evidence Supporting Exercise in Recovery from Bone Fractures Research, as already mentioned in the Kuijlaars et al. (2019) systematic review, shows the benefits of incorporating exercise into fracture rehabilitation, and below we look into more details about what exercises have to offer in terms of recovery: Improved Healing Rates: Patients engaging in structured physical therapy often experience more robust bone healing (Song, 2022). Reduced Complications: Regular movement decreases the risk of complications like deep vein thrombosis or joint stiffness (Ruan et al., 2023). Enhanced Quality of Life: Maintaining physical activity levels improves overall well-being and independence (Mahindru et al., 2023). What to consider when doing exercises post-bone fractures. While exercise is beneficial, it is always important to approach the recovery process with care: Follow Medical Advice: Always adhere to the guidelines provided by healthcare professionals. Avoid Overexertion: Pushing too hard can hinder healing or cause re-injury. Going hard or going home is not how recovery works. Monitor Pain Levels: Some discomfort is normal, but sharp or persistent pain should be addressed immediately. Pain-wise, on a scale of 0 to 10, we usually aim to get you to experience a comfortable discomfort, based on your worst pain experienced as a maximum threshold. Recovery from an injury, including a bone fracture, is a personal journey, and therefore is unique to everyone, in terms of how quickly it can be and what considerations to take into place during the exercise recovery. FAQs – Bone Fractures Recovery and Strength Training 1. How do bones fracture?Bones can fracture when exposed to forces they cannot tolerate. This tolerance varies from person to person, depending on factors like health history, bone density, and physical condition. While age is often seen as a risk factor, it’s more about reduced activity levels. With consistent strength training, the risk of fractures can be lowered significantly, regardless of age. 2. How does a fractured bone heal?Bone healing occurs in four key stages: Inflammation: Blood clots form to protect and initiate healing. Soft Callus Formation: Fibrous tissue bridges the fracture. Hard Callus Formation: New bone begins forming. Remodelling: The bone reshapes to its original form.This process varies in duration based on the severity of the fracture and individual health factors. 3. Can exercise speed […]
May
As a Clinical Myotherapist, I often work with patients who perform back squats as part of their exercise routine, and at the question: “What’s your goal with a back squat?” the answer is often vague and not specific to what this exercise is for. The reason why the answer is not specific is simply because they don’t know what the difference is between high and lower bar squat, and don’t know that the back squat, as long as it is an amazing functional movement, doesn’t train all the lower body muscles at the same level. That’s where, to prevent injury, to perform better squats, and to strengthen more evenly all the lower body muscles, I would suggest them to do exercises like: Quads curl, Hamstring curl, Cable Machine Adduction and Diagonal Extension (Glute Medius). Back Squat: The Foundation of Strength The back squat is such a great form of exercise because it trains multiple joints and multiple muscles all at once, but also allows us to use our innate capacity of squatting, which is a functional movement, to move high loads, therefore achieving more strength gains. However, this leaves us with more responsibility to train smartly. So let’s start to break down the two main types of back squat: High-Bar Back Squat (Upper Bar Position) The bar rests on the upper traps The torso remains more upright Greater emphasis on the quadriceps muscles Ideal if your goal is quad strength and knee-dominant movement patterns Ideally, you are standing with your heels elevated from the ground The fact that the bar is sitting on the upper traps, and that the torso sits straighter, would lead to a descending movement where your back thigh (hamstrings) would lean on calf muscles, and from there you will stand back up. This is why you put more force throughout the quads. Indeed, the combination of a higher bar, a straighter torso, and a reduced descending position allows the weight to sit in the middle of the centre of gravity, which is placed more posteriorly than in a lower-bar back squat. Low-Bar Back Squat (Lower Bar Position) Bar rests lower on the rear deltoids Torso leans forward slightly more Greater load on the glutes and posterior chain Favoured by powerlifters Best for developing hip strength and glute activation Ideally, your feet are nice and flat on the ground from heel to toes. On the other hand, the lower-bar back squat, as anticipated, is more for the posterior chain muscles, like the gluteus max. This is possible because the bending forward of the trunk stretches more muscle fibres in their origin point (the posterior aspect of the ilium (the pelvic bone), the sacrum, and the coccyx), allowing more fibre contraction in the ascending movement. Also, the lower position of the bar and the bending of the torso maintain the weight in the middle of the centre of mass, which is pushed forward at this time. How about if I cannot squat deep? The depth of a squat is the distance that you can cover from a standing position to the lowest point you can reach. How deep you can squat will definitely change which muscle groups you can activate, but not everyone can squat deep —and that’s absolutely ok. Each of us has biomechanics that are different, due to differences in how the skeleton is shaped. Without going into many details in this blog, we can definitely say that those who have a longer femur would have a harder time going for a deep squat, compared to those who have a shorter femur. The femur’s length is compared to that of the torso. But this is not all, indeed, there are also other femur and hip characteristics that can limit how deep you can squat, such as an anteverted or retroverted femur head. Other conditions that can get in the way while you squat are hip impingement. Accessory Work for a Complete Lower Leg Program So, knowing when and why to use each back squat variation can help tailor your program toward specific goals or help rehab muscle imbalances through focused intent. No squat is right, no squat is wrong; it is all about your goal. However, we need to add work more specifically with other exercises for strength symmetry, muscle activation, and injury prevention. Quad Curl (Leg Extension) Isolates the quadriceps Improves knee tracking and squat depth Essential in rehab for knee pain or quad weakness Quads curl can be done in many ways, with a cable machine or on a bench with a quads curl attachment, but even with a kettlebell or resistance band. It all depends on your setup. As per all the exercises, be consistent with your set-up and progressions. What I prefer most for my training, and what I offer to my patients during the fitness class, is to do quad curls on a bench with the attachment for quad curls. The advantages of this set-up are: Confort Easy progressions Easy set-up Inclination of the back at about 45° to 65° and slight elevation of the quads. The last point is essential to ensure we engage both ends of the quadriceps femoris, which is one of the four quads, that crosses both the hip and knee joints. Hamstring Curl Focuses on the hamstrings, which during a squat are often undertrained Strengthens the back of the thigh and supports knee stability A must-have for runners and athletes prone to hamstring strains As per the quad curl, even the hamstring curl can be done with different variations; there is never one way to train those muscles, but again, it is all about the efficiency and the amount of load that we can put through the muscle, which makes a difference. And again, what I can offer at Melbourne Massage and Treatment, in Fitzroy North, is to do these exercises on a bench, using this time a lower inclination for the upper body (which is now in a prone position) so that the origin of […]