As a Lymphoedema therapist, I often get asked what the difference is between Lymphoedema and Lipedema. In this blog, we will explore the differences, the similarities, and what can be done for prevention, management and treatment of those presentations. Furthermore, we will look into how Lipoedema can degenerate into a Lipo-Lymphoedema, and why this is not the case for everyone. What is Lipoedema? Lipoedema is a chronic adipose tissue disorder that primarily affects women. On a global scale, we know that about 11% of women are affected by this presentation, and it often runs in families as it has a strong genetic component. The major characteristics of Lipoedema are an abnormal and symmetrical accumulation of fat around the hips, buttocks, thighs, and legs, and upper arms. On the leg area, the fat appears in abundance in the medial side of the knee, too. Where feet are completely untouched by the fat accumulation, this fat is resistant to diet and exercise and is often painful to touch. The pain is due to the cutaneous nerve entrapped in the fatty tissue, and so delivers a pain response when stimulated. Other Lipoedema key features: Often triggered or worsened by hormonal changes Symmetrical fat distribution Soft, nodular, or lumpy tissue Pain and easy bruising – as per the pain, bruising is due to blood capillary compression from the fat, and so, is easily damaged by touch No skin thickening or pitting in the early stages Nowadays, there is increasing awareness about this presentation, and more and more women find benefit from a management protocol that is not only about cardio and exercise. Part of the Lipoedema management includes: Movement Compression stocking Antiinflammatory diet Skin care Where and if needed, cosmetic surgery intervantion What is Lymphoedema? Lymphoedema, on the other hand, is a condition where lymphatic fluid builds up in the tissues due to a malfunctioning lymphatic system, causing chronic swelling. Compared to Lipoedema, Lymphoedema is strictly related to the Lymphatic system. It can be primary (congenital or hereditary) or secondary (due to trauma, surgery, radiation, or infection affecting the lymphatic system). Lymphoedema characteristics: Unilateral or asymmetrical swelling (though it can be bilateral) Pitting edema – It consists of deep indentation (pitting) left behind on the skin when pressure is applied Skin changes over time (fibrosis, hyperkeratosis, papillomatosis) Affects feet and hands as well – primary lymphedema would start from the extremity Heaviness or tightness in the affected area – can potentially be pain-free, but the limb/s may feel very heavy It does affect men and women – only primary lymphedema has a genetic component Lymphoedema Management The management of Lymphoedema is more tricky than lipoedema, as everyone may react differently to the management, it can be related to other health issue which needs to be considered, and requires the patient to be active in the management side of things. At Melbourne Massage and Treatment, I treat different types of lymphedema, as per the upper and lower body, focusing on an initial reduction of the swelling via a combination of Manual Lymphatic Drainage (MLD) and compression with Combined Decongestive Therapy (CDT). The management of this presentation can take anywhere between 3 and 5 or more appointments, depending on the severity of the presentation. The treatments are better done in close proximity, 24 to 48 hours one after the other, so that we give no time to the body to accumulate fluid back under the skin. Once the combination of treatment allows us to achieve the desired result, which is bringing the limb/s to a thinner size, you will be scheduled for a custom garment wear compression, which will guarantee to maintain the results achieved. This is usually done at other clinics, like Sigvaris or Juzo clinics. Those clinics are specialised in the making of garment wear. Custom garments wear last about 6 months, so twice a year, you will need to change them, and if needed, because the limb/s may start swelling again (especially in summer, when there is a change of atmospheric pressure, due to the heat), a short series of MLD and CDT therapy may be needed. Key Differences between Lymphoedema and Lipoedema Feature Lipedema Lymphoedema Cause Abnormal fat metabolism Lymphatic dysfunction Gender prevalence Almost exclusively women Affects both sexes Onset Often at puberty, pregnancy, or menopause Can be congenital or triggered by injury/surgery Distribution Symmetrical, lower limbs and arms Can be asymmetrical; any body part Feet/Hands Spared Usually involved Pain Tender, painful fat Often painless, heavy feeling Skin texture Soft, nodular fat Skin thickens over time (fibrosis) Pitting Rare (early) Common (early) Response to elevation Minimal improvement Often improves with elevation (if early stage) Bruising Common Not typical Common Characteristics of Lymphoedema and Lipoedema As seen above, the characteristics of Lipoedema and Lymphoedema are different, but, both conditions share chronic swelling, potential functional limitations, and a need for long-term management: Both can cause leg discomfort, heaviness, and swelling Both may lead to reduced mobility Neither condition improves with calorie restriction or exercise alone – it is more about stop the intake of inflammatory food Compression therapy is often used for both Both can have a progressive nature if not managed properly – especially lymphoedema Misdiagnosis is common, often delaying effective treatment When Lipedema Becomes Lipo-Lymphoedema If we stick to a vision of Lipoedema progression, that is possible when no management is put in place, this presentation can degenerate into secondary lymphatic impairment, resulting in a combined condition known as Lipo-Lymphoedema. How this happens: As the fat keeps accumulating under the skin, and there is an increase in inflammation, the lymphatic vessels are put under major load and potential damage Over time, this leads to fluid retention and swelling due to the lymphatic system failing to do its job As the lymphatic system becomes overwhelmed, the person may start experiencing lymphedema symptoms (Example: swelling in the extremities, feet and or hands) Patients now experience both fat deposition and fluid buildup, making treatment more complex Signs that Lipedema has progressed: Swelling starts in the feet […]
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Why MLD Before Cosmetic Surgery Matters | Melbourne Massage and Treatment
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Aug
When we think of losing fat, the first action we picture in our head is to start running, walking, swimming or any form of cardio training. But is that actually the best fat loss solution? In this blog, we are going to look into why cardiovascular exercise has many benefits, but when it comes to losing fat mass effectively and sustainably, lifting weights deserves the spotlight. For fat loss, total body weight should not be your target: Focus on Body Composition Another go-to habit, when we focus on losing weight, is to check with a scale where we are at. But the reality of the fact is not as simple. When using a regular scale, you are looking at the total mass of your body, which includes not only your fat, but also your muscle mass, bone mass, etc… Indeed, losing weight isn’t the same as fat loss. Therefore, you should know that when you restrict calories, up to 50% of the weight you lose may come from muscle, not fat–unless you intentionally preserve it through strength training. Muscle is essential for more than movement – it’s a metabolically active tissue. That means it burns more calories at rest than fat. The more muscle you have, the higher your basal metabolic rate (BMR), making it easier to maintain fat loss long-term. Muscles Are Our Metabolic Engine When talking about muscles, we need to change the perspective on their functionality. The locomotive aspect of muscles, which means the ability of the muscles to move the skeletal system, is just one aspect of them, but not the only one. Therefore, when thinking about muscles, start considering that they are also glucose-hungry machines; indeed, they pull sugar out of the bloodstream and help convert it into usable energy. This process is critical for managing blood sugar and inflammation, which are two major drivers of fat storage and chronic disease. So to simplify it, less muscle mass means less body efficiency at using energy, therefore becoming more prone to storing excess calories as fat. Behind this mechanism lies the reason why losing weight without building muscle mass is not a long-term solution, as you will gain weight back. The Double Side of Cardio (When done on its own) When trying to lose weight, it becomes a combination of cardio and less energy intake (a certain type of diet), and to it you add the fact that muscles are not loaded, and by loaded I mean put under strength activities, it becomes easier to lose muscle mass. This happens because the body goes into a calorie deficit, and in order to keep functioning, it is going to take energy off the muscles themselves, reducing their size. This is an extra reason to ensure you are loading those muscles, to ensure the energy to burn is taken from fatty tissue. All of this does end up with yes, a weight loss, but also weakens the very system that helps keep fat off. It’s Never Too Late – Muscle Responds at Any Age This is a topic that we have seen in other blogs, and it is time to remember that age is only a perspective and not a mandatory fail. The body is designed to respond to stimulus, and get stronger and stronger under new and constant stimulus; it doesn’t matter the age. In fact, even older adults, including those in their 60s, 70s, and 80s, can gain strength and improve body composition with the right program. Muscle stem cells (satellite cells) remain responsive well into late adulthood. You don’t need to be a lifelong athlete – many people start lifting in midlife and see dramatic improvements in energy, mobility, and fat loss. How to Lift for Fat Loss As per all the forms of training, there are certain aspects that need to be respected to achieve the desired goal. For fat loss, then, you may want to look into: Focus on compound lifts such as Squats, deadlifts, bench press, and rows, so that you work multiple muscles and burn more calories. Train to near failure, which means from 4 heavy reps or 10 moderate ones, but with progressive overload. Lift 3–5 times per week as consistency beats intensity. And if a week you can do less, it’s ok, don’t be hard on yourself. Look into your eating habits, talk to your local GP about your eating habits and see if you need a referral to a specialist for improving your food habits. Add sprint intervals twice weekly: Brief, high-intensity cardio can enhance fat burning and insulin sensitivity without causing muscle loss. Fitness Class at Melbourne Massage and Treatment At Melbourne Massage and Treatment, in Fitzroy North, I got the skills and the equipment needed to help you achieve your goal, but also, help you learning how to deliver safe exercises for your wellbeing and your athletic preparation. Indeed, when talking about lifting weights, we always want to look at first where your training level is, what your abilities are, and with no judgment, take the first step from there and help you to achieve your short-term and long-term goals. If you are keen to learn more and want to have a chat about your goals, book a 15-minute free online consultation now, so that we can discuss how I can help you and where we can get you with your exercise routine. In Conclusion: Lift First, Then Move More In this blog, we emphasised how strength training is ideal for fat loss, and what we want to tell you with this is that cardio has a place for heart health and endurance, but it’s not the most effective path to long-term fat loss. Prioritising strength training, especially as you age, helps preserve muscle, boost your metabolism, and shift your body into a fat-burning machine. And most importantly, let’s stop chasing a number on the scale. Instead, start chasing strength, power, and metabolic resilience.
I did stop counting the number of times I hear patients say that their hamstrings are tight, and that’s why they can’t bend forward. And I did stop counting, because this happens so often that it is really hard to find someone who actually knows what tissue is limiting their movement. In fact, most of the time, what is happening is not hamstring tightness, but rather a lack of hip hinging and associated hip mobility, or neural tension (in this case, the sciatic nerve neural tension). What Is Neural Tension? When we discuss neural tension, we refer to the lack of mobility of the nervous system’s connective tissues, so the actual nerve as a fibre or tissue, when it’s put under mechanical stress (like tension, compression, or stretch). Here is an example: When we bend forward, the sciatic nerve (the largest nerve in the body) runs from the lower back (Ventral rami spinal nerve L3-S1), through the buttocks (below the piriformis muscle most of the time), and down the back of the leg (right between the hamstrings muscles). When doing such an action, the nerve needs to glide freely, and if any where along its journey, there is a compression, due to other tissue tightness or inflammation, or even a physical outer pressure (a belt from the pants) it becomes irritated, compressed, or “stuck” ending not moving well. That’s where you may experience a pull on the back of the leg. That is neural tension. More specifically, your symptoms can be: A deep pulling or burning stretch in the back of the thigh or calf. Tingling or numbness (especially if holding the stretch for a longer time) A sensation of “snapping” or “tugging” deep in the leg when stretching Limited range of motion that doesn’t improve with traditional hamstring stretches How Is Neural Tension Different from Muscle Tightness? While neural tension and muscle tightness may feel similar, they are fundamentally different in their causes and treatments. Muscle Tightness Neural Tension Origin Muscle fibres are shortened or tense Nerve or nerve sheath is restricted or irritated Sensation Broad stretch, fatigue, cramping Sharp, burning, electric, or pulling sensation Area Felt Localised to the muscle belly Along a nerve pathway (e.g., back of the leg) Improved by Stretching and massage Nerve gliding/mobilisation, reducing irritation Common in Athletes, post-exercise, poor posture Sciatica, herniated discs, hipo-mobility, and a sedentary lifestyle Now, Let’s Talk About Forward Bending When bending forward with the upper body, aiming to reach the toes or the floor with the hands, we may experience a stretch in the back of the leg. That stretch it may not be only your hamstrings but also the sciatic nerve. When this nerve lacks mobility, as expressed earlier, due to things like disc issues, facet joint irritation, piriformis syndrome, or general irritation, it can feel like your hamstrings or calf or back are tight, even when they’re not. A good way to understand if the feeling of tightness is from your nerve or not is to perform a Slump Test. How to perform a Slump Test? Below is a step-by-step guide on how to perform the slump test: Sit on a chair or table, where both feet are off the ground; Slump your body forward, while looking straight ahead, and your arms are crossing behind your back (which means your spine rounds backward, your shoulder drops forward); Now, start lifting up one leg, while the other one is bent at the knee at 90°; While you lift up the leg, start noticing if you feel any pulling sensation from the lower back going down to the back of the leg or calf (it could be anywhere along the lower back to the feet); If you manage to reach full leg extension, now, start looking down (you may notice tension arising or increasing); If nothing happens yet, then bring your toes (of the leg raised) backwards (ankle dorsiflexion); If, along any step of this process, your pulling sensation increases (more intense) or becomes longer (like from only the back of the leg, it now feels even in the back or in the calf), this is neural tension. Indeed, the tension would feel like a long rope pulled across multiple joints (lumbar, hip, knee) with a burning sensation and maybe some pins and needles. Next, to experiment further with the neural tension, start looking up with the head, go if you can in full cervical extension, and you should feel relief in the back of the leg tension. This last step is proving to you how, by releasing the central nerve (that travels in the central canal of your spine), the neural tension slows down. You are stopping the nerve’s pull from its origin, the brain. Should You Stretch a Nerve? No, not really. Nerves aren’t designed to be stretched like muscles. In fact, if you keep stretching a nerve aggressively, you may end up irritating the nerve and worsening the symptoms. Instead, use nerve gliding or joint mobilisation exercises, which are gentle, rhythmic movements that help the nerve move through its surrounding tissues without overstressing it. And to stay in the loop, let’s look at the sciatic nerve glide: Lying on your back, lift one leg while keeping the knee slightly bent. Slowly extend the knee and flex the foot back toward you, then release. Repeat in small, pain-free ranges. This can help restore nerve mobility without aggravating the nerve. If this is not the case, and you still experience pain and discomfort, then it is probably time to book an appointment (myotherapy) to ensure there is not significant entrapment along the nerve pathway, and see what can be done to relieve that compression. How Myotherapy Can Help with Neural Tension? As a Clinical Myotherapist, I specialised in assisting people with any sort of musculoskeletal issue. Neural Tension is one of those. During a Myotherapy session, we would address, via a detailed clinical history and a series of assessments, what may be the cause of the neural […]
Jul
When the space between the collarbone and first rib gets tight, during movement or even at complete rest, it can lead to Thoracic Outlet Syndrome (TOS). Between the two structures mentioned above, we have the passage of the thoracic plexus (nerves) and blood vessels. The compression of those structure, can result in pain, weakness and numbness radiating down the shoulder, arm, and hand. Because TOS has multiple causes and presentations, effective treatment depends heavily on accurate assessment and an individualised approach, and that’s where myotherapy can play a crucial role. What Causes Thoracic Outlet Syndrome? As there are different tissues passing by this space, the nature of TOS can be broadly categorised into three types: Neurogenic TOS: Compression of the brachial plexus (nerves). Venous TOS: Compression of the subclavian vein. Arterial TOS: Compression of the subclavian artery. But not only can different tissues be compressed, but different structures can be responsible for the compression. Indeed, the compression can be due to the scalene muscle, pectoralis minor or bone. And here are some common causes: Muscle imbalances that lead to poor posture (forward head/rounded shoulders); Repetitive overhead activities (which lead to constant compression of the tissues); Trauma (e.g. whiplash or clavicle fracture); Anatomical variations (such as a cervical rib). The Role of Myotherapy in TOS Assessment As a myotherapist, when treating someone with suspicious TOS, we go for a series of assessments that we compare to the clinical history and symptoms. The test itself would aim to reproduce the patient’s symptoms and guide us on what potential structure is compressed. If we are suspicious of TOS, we can aim to reduce tension in soft tissue and give exercises that can reinforce those structures to alleviate any compression in the area. Orthopedic Testing & Myotome Assessment Some common assessments include: Adson’s Test (for scalene involvement) – It consists of reproducing a drop of heart bit in the wrist (affected side) by asking the patient to abduct and extend the arm while rotating (same side) and extending the neck. This would add extra compression on the suspected structures. Roos/Elevated Arm Stress Test (to reproduce vascular or neural symptoms) – It is about asking the patient to lift the arm at 90°/90° and start closing and opening their hands repetitively for 30 seconds to 1 minute. A drop of strength or symptom reproduction would lead to a positive test. Costoclavicular Maneuver (to assess space between clavicle and first rib) – It is delivered by having the patient with depressed and retracted shoulders. The positivity of this test is given by the reproduction of symptoms or a reduction in the distal wrist. Wright’s Hyperabduction Test (for pectoralis minor tightness) – The patients get asked to lift their arm (affected side) above their head while the therapist stands behind and keeps count of the wrist heartbeat. Any symptoms, reproduction, or drop in bit is considered positive. In addition to those tests, we would use: Myotome testing: which assesses the motor function of specific spinal nerve roots; Clinical history: Any history of previous injury, surgeries, work and sport loads; Type and timing of symptoms: When and how those symptoms are reproduced on daily life. All this said, we always have to consider that as therapists, myo or physio as per osteo exc… we can assume that the positivity of many of those test leads to a positive or negative conclusion regarding TOS. Hands-on treatment and exercises in combination can be the easy steps to take to treat the presentation, but can not always guarantee the best outcome, due to each individual’s unique presentation. Hands-On Treatment and Exercise Prescription Once we have more understanding of what is potentially happening in terms of compression, a myotherapy treatment focuses on addressing the underlying causes: Manual Therapy Myofascial release of the scalene, pectoralis minor, and upper trapezius muscles. Trigger point therapy to reduce local and referred pain patterns. Joint mobilisation to improve scapular movement and rib mechanics. Neural gliding techniques to encourage nerve mobility and reduce irritation. Exercise Rehabilitation Postural re-education, particularly strengthening the deep neck flexors and lower trapezius. Scapular stabilisation exercises to improve shoulder mechanics. Breathing retraining is necessary if dysfunctional patterns (like apical breathing) are contributing to compression. Neurodynamic stretches are appropriate for nerve mobility. Together, these interventions help reduce symptoms, improve function, and support long-term recovery. The time frame for improvement, if not complete reduction of the symptoms, can be different per individual, but we can estimate a period of time that goes between 12 and 16 weeks. If no changes are reproduced within this time frame, that’s where we would refer the patient elsewhere for further investigations, like a scan. When Is Surgery Needed for Thoracic Outlet Syndrome? Surgical intervention is typically reserved for cases where conservative care fails or in cases of vascular TOS, where there’s a risk of thrombosis or embolism, but also where anatomical variations, like a cervical rib is present. Surgical procedures may include: Scalenectomy (removal of the scalene muscles) First rib resection Clavicle decompression or repair if there’s previous trauma These operations aim to create more space in the thoracic outlet, thus relieving the compression. Post-Surgical Recovery and the Role of Myotherapy In case of surgery, as a myotherapist, we can still help and ensure a correct recovery post-intervention. Treatment like MLD can help in flushing excess liquid out of the surgery area, but again, we would look into exercises as a form of recovery and rehabilitation of the area affected by the surgery and or affected by the lack of strength that is a consequence of a prolonged period of muscle weakness. More broadly, myotherapy treatment can help with: Pain management Scar tissue Muscle guarding or weakness Neurological symptoms that may persist or reappear Do You Need a Scan if we’re suspicious of TOS? Imaging, as discussed in other blogs, may be recommended when we are suspicious of other presentations, or if standard method are not creating any difference. For example: To rule out cervical disc herniation, tumours, or other causes of neurovascular symptoms. When […]
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 […]
May
The Star Excursions Balance Test (SEBT) is a fabulous functional test that can tell us a lot about the mobility and stability of the ankle, knee, and hip joints. On top of being a functional test, the star excursion can also be used as an exercise, and via a series of progressions, which we will discuss in more detail later, can help you train for better running performance and injury prevention. Why is the Star Excursion Balance Test Important? The importance of the Star Excursions Balance Test lies in its ability to assess, with one motion, the capacity of your ankle to remain stable on the surface of support (the floor) and how this stability is transmitted to the knee first and, consequently, to the hip. This is possible because the transfer of vertical pressure is applied to each joint while you are aiming to get the movement done. The movement required is to keep the feet of the anchor down to the floor, from the toes to the heel, while with the other foot, you aim to reach the furthest point away within the eight cardinal directions (like a star *). Along those movements, then, we also get observational data about your: Proprioception: The ability to sense the position of the body and its parts in space. Balance: The ability to control the body’s centre of mass over a stable base of support. Functional Movement: How well the body can perform multi-directional movements, such as stepping, reaching, and stabilising. The Role of the Star Excursion Balance Test in Lower Limb Injury Recovery So, if you are someone who has sustained lower limb injuries, particularly around the ankle, knee, or hip, these capabilities are often compromised. By using the Star Excursion Balance Test, we can: Assess any deficits in these areas, which might increase the risk of re-injury or limit recovery progress. But not only that. Indeed, that information will shape the recovery program, allowing us to understand better which muscle group or joint we need to focus more on with the exercises. Help runners, as running is a dynamic activity that places high demand on the lower extremities. Even minor imbalances or weaknesses can lead to conditions such as IT band syndrome, shin splints, and knee pain. The Star Excursion Balance Test helps in identifying these early warning signs before they evolve into more serious conditions. What Does the Star Excursion Test Measure? The primary purpose of the SEBT is to evaluate a person’s capacity to control body movement while standing on one leg. In rehabilitation, the Star Excursion Balance Test trains and improves: Ankle Stability and Control: It challenges the ankle to support the body’s weight while shifting through various planes of motion. Knee and Hip Joint Function: By demanding strength and flexibility in the lower limb, it helps retrain the kinetic chain, especially after joint injury. Balance and Proprioception: The test improves your ability to sense where your body is in space, which is essential for both preventing and recovering from injuries. Postural Awareness: Training balance also trains your ability to maintain proper posture, which can reduce stress on your joints and muscles during exercise. In fact, the test consists of reaching with one leg in multiple directions (anterior, posterior, medial, and lateral and a mix of those directions) while maintaining balance on the other leg. This shows their neuromuscular control and postural stability. It mimics the demands placed on the body during dynamic activities like running, cutting, and jumping. The Progression of the Star Excursion Test The beauty of the Star Excursion Test is its flexibility. It can be adapted based on the individual’s injury level, fitness, and goals. The test itself involves several variations, which I implement depending on the stage of recovery or the individual’s needs: Softer Ground: For those in the early stages of rehabilitation, we may perform the test on a softer surface, such as a foam pad or balance disc. This reduces the stability of the base and forces the individual to engage more stabilising muscles, which aids in proprioceptive training and can be beneficial for rebuilding ankle and knee control. Weight on the Ankle: For those who have had ankle injuries, I often modify the test to place more weight on the injured ankle. This helps rebuild strength and functional control, as it forces the injured area to bear load and engage in movement patterns that may have been avoided during the healing phase. Eyes Closed: To increase the challenge, I sometimes ask my clients to perform the test with their eyes closed. This removes visual input, forcing the body to rely more on internal feedback (proprioception). This is especially important in the latter stages of rehabilitation, as it helps to refine neuromuscular control and reduce reliance on external cues. Using the Star Excursion Test with Lower Limb Injury Recovery and Runners The SEBT is a functional test that I like to use, with all its variations, to assess the progress of patient recovery. Whether you present with an injury, or you want to improve your form and body functionality throughout exercises, the SEBT allows us to look in depth at what we need to work on, too. For example, after a sprained ankle, I’ll often use the SEBT to check whether an individual is able to move without compensation, ensuring that their body has regained sufficient control and strength before returning to activities like running or sports. And this, don’t be surprised, is something that I do and has to be done whenever someone presents with complaints about knee or hip pain, too. Again, an unstable ankle would transmit that instability up the chain. On the other hand, for runners, the test helps evaluate areas of weakness that might predispose them to injuries such as Achilles tendinopathy, patellofemoral pain, or iliotibial band syndrome. Since running places repetitive stress on the lower limbs, identifying and addressing weaknesses early can prevent long-term problems and improve overall performance. Myotherapy and SEBT […]
May
Muscle tension headache and migraine are two different types of presentation that have in common a pain, which can also be debilitating, in the head area. Back in 2019, in Australia, 3 million people were estimated to suffer from migraine (Wijeratne et al., 2023), where, define how many people are suffering from muscular tension head-ache is a bit more tricky, as is not a presentation that can be easily tracked, due to self managed protocols, and other miss data counting. That said, they have different origins, symptoms, and treatment options. In this blog post, we will explore the key differences between muscle tension headaches and migraines, helping you understand how to identify and manage them. What Are Muscle Tension Headaches? Muscle tension headaches, or tension-type headaches, are the most common. This type of headache originates from cervical or facial muscle tensions, which recreates a pattern of pain on the head of facial area. As with all muscles, but even joints, the pain that we can experience can be local or in an area around the tense spot. These headaches are often linked to stress, lack of good posture, anxiety, and even sleep disturbances. They can be chronic or occasional, but compared to migraine, they lack neurological symptoms. Symptoms of Muscle Tension Headaches: Dull, aching pain or pressure around the head, especially in the forehead, temples, and back of the head. A sensation of tightness or “band-like” pressure around the head. Mild to moderate intensity (usually not as severe as a migraine). Pain can last from 30 minutes to several hours, sometimes even days. Tenderness or tightness in the neck, shoulders, and scalp. Causes of Muscle Tension Headaches: Stress: Emotional and mental stress is one of the primary causes of muscle tension in the neck and scalp muscles. Lack of good posture: Sitting or standing with poor posture and lack of strength in the musculoskeletal system, especially for long work, can strain muscles and trigger headaches. Sleep issues: Sleep deprivation or poor-quality sleep can exacerbate muscle tension and lead to headaches. The body recovers from the fatigue of the day before during sleep, especially in the early morning hours. Sleep deprivation would increase the chance of a headache. Dehydration: Not drinking enough water can lead to tension and headache symptoms. The body withdraws water from the brain to keep the organ functioning, causing physical brain shrinkage, which leads to headaches. Recent studies have indicated that chronic tension-type headaches (CTTH) are often exacerbated by environmental stressors, and poor posture in daily activities can cause muscle imbalance and contribute to the frequency of these headaches (Bendtsen et al., 2018; Grazzi et al., 2016). Treatment Options: Pain relief: Over-the-counter pain relievers, like ibuprofen or acetaminophen, can help ease the discomfort. Heat pack: Applying a warm compress to the neck and shoulders can help relax tense muscles. Keep always in mind that heat application should be limited to 10-15 minutes, once or twice a day. Massage: Gentle massage of the neck and shoulder muscles can reduce tightness and alleviate headache symptoms. Stress management: Practising relaxation techniques such as deep breathing, thai yoga, and meditation can reduce stress and prevent muscle tension headaches. Strengthen muscles: Strengthening the muscles around your cervical and shoulder area can help reduce the chance of suffering a headache by reducing the inflammatory response that the muscle would activate due to a lack of strength. What Are Migraines? As I mentioned above, the significant difference between headaches and migraines is due to neurological symptoms, a unique characteristic of migraines. Migraines are neurological events that involve complex brain activity. They are characterised by intense, throbbing pain, usually on one side of the head. They are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are more debilitating than muscle tension headaches and can last a few hours to several days. The intensity of the headache doesn’t have to be severe. Symptoms of Migraines: Although many people experience nausea, vomiting, and light sensitivity, migraine symptoms can vary, with some individuals experiencing dizziness or visual disturbances without significant head pain. Throbbing or pulsing pain, usually on one side of the head. Nausea and vomiting. Sensitivity to light, sound, and sometimes smells (aura). Visual disturbances such as flashing lights or blind spots (this is known as an aura, which can occur before or during the headache). Dizziness or feeling lightheaded. Migraines are understood to be primarily driven by neurovascular changes and neuronal hyperexcitability (Feng et al., 2021). A review by Wagner et al. (2021) found that the pathophysiology of migraines involves alterations in neurotransmitter systems, notably serotonin and CGRP (calcitonin gene-related peptide), which contribute to the vasodilation and pain signaling pathways. Causes of Migraines: Genetics: Migraines tend to run in families, suggesting a genetic component. Hormonal changes: For many women, changes in estrogen levels, such as during menstruation, pregnancy, or menopause, can trigger migraines. Environmental triggers: Bright lights, strong smells, certain foods (like chocolate, cheese, or caffeine), weather changes, lack of sleep, and allergies that cause sinus issues are common migraine triggers. Neurological factors: Migraines may involve changes in the brain’s nerve pathways, chemicals, and blood vessels, which cause inflammation and pain. Treatment Options for Migraines: Prescription medications: Triptans and anti-nausea medications are commonly prescribed to treat the acute pain of migraines. Preventive medications: For frequent migraine sufferers, medications such as beta-blockers, antidepressants, or anti-seizure drugs may be prescribed to reduce the frequency and severity of attacks. Lifestyle changes: Regular sleep, a healthy diet, and consistent exercise can help reduce the frequency of migraines. Cognitive-behavioural therapy (CBT): Managing stress through therapy can help alleviate migraine triggers. Alternative therapies: Acupuncture, biofeedback, and massage therapy are sometimes used as complementary treatments for migraine management. Recent studies support preventive treatments for chronic migraines, such as CGRP antagonists (Kundera et al., 2020) and neuromodulation techniques like transcranial magnetic stimulation (Lefaucheur et al., 2017). Key Differences Between Muscle Tension Headaches and Migraines Although muscle tension headaches and migraines involve head pain, they differ […]
