When treating someone for neck pain, a common question I get asked is: “Should I change my pillow?” or “I slept badly, my pillow is not good”. In fact, there is a common belief that a pillow or a bad night’s sleep is the cause of constant neck pain. While pillow comfort matters, clinical experience in myotherapy in Melbourne shows that pillows are rarely the root cause of ongoing neck pain. At a clinical level, neck pain is usually driven by: movement dysfunction poor spinal cervical stability previous injury history and reduced muscular control Therefore, a good pillow can support symptoms, but it does not fix the underlying issues that drive your pain. Fitzroy North Myotherapy Insight: What Actually Causes Neck Pain? At Melbourne Massage and Treatment, a myotherapy clinic in Fitzroy North, I consistently see neck pain linked to five key factors. 1. Spine Mobility and Stability Dysfunction The neck’s vertebrae are part of a full kinetic chain involving the thoracic spine, shoulders, and rib cage. Under this aspect, indeed, we should look into the lack of thoracic mobility which may cause the stable portion of your cervical (C3-C7) to seek that mobility capacity. But as we well know, a stable joint can’t act as a mobile, and vice versa. In more detail, poor spinal mechanics lead to: muscle overload in the neck joint irritation tension during rest and sleep And about the pillow, it is an object that cannot restore spinal movement or control. Isn’t it? 2. Whiplash History and Incomplete Rehabilitation Other patients with chronic neck pain may have a history of whiplash that was never fully rehabilitated. Indeed, a whiplash accident, as a result of a car crash or even during a contact sport incident, can lead to chronic neck pain, especially if not rehabilitated correctly. This happens because during a whiplash, the cervical joints get put under extreme force and can lead to a torn ligament or laxation. However, without structured rehab, long-term changes in: deep neck flexor control proprioception postural endurance can persist for years, or even show up after years of post-injury. So again, no pillow can change these symptoms or help you recover from such an injury. 3. TMJ Dysfunction and Jaw Tension Temporomandibular joint (TMJ) dysfunction is another underlying cause of neck pain. By following the kinetic joint chain we discussed earlier, we see that the TMJ is the next joint in the chain, after the cervical one. Therefore, Jaw clenching and TMJ irritation can: increase suboccipital muscle tension contribute to forward head posture amplify cervical joint stress That’s where you may wake up with more neck pain than during the daytime. The clantching can be heavily responsible for that. This is why neck pain is often worse under stress or during sleep. 4. Hypermobility and Joint Instability Following the concept of a torn ligament, as per a whiplash incidence, joint hypermobility is clearly another underlying issue for neck pain. This happens because there is a lack of stability and control in those cervical ligaments. This leads to: reliance on passive ligament support early muscle fatigue poor tolerance of sustained sleeping positions A “supportive pillow” alone may not solve instability and can sometimes reinforce dependency on external support rather than active control. 5. Neck Strength and Motor Control (8–12 Week Rehab Window) In my experience, this is the big issue. Most people don’t even think about the strength of their neck or upper shoulder muscles, and this is where things can go really wrong. Indeed, one of the most effective long-term treatments for neck pain is a structured strengthening program that targets: deep cervical flexors scapular stabilisers postural endurance muscles As per many exercise programs that intend to strengthen the body structure, we look at 8–12 weeks of progressive exercise-based rehabilitation. This is why many patients searching for neck pain treatment in Melbourne benefit more from rehab than passive support strategies. What the Research Says About Pillows and Neck Pain To support with evidence, why a pillow is not going to change in the long term, your neck pain, we can look at a systematic review from Pang J. et al. (2021), which found: Some pillow designs may reduce symptoms But long-term structural or functional improvements are limited and inconsistent Therefore, pillows may improve comfort, but they do not fix the underlying cause of neck pain. And yes, the pillow consistency can make a difference, but, again, it does not fix the neck pain, nor would it cause neck pain. Melbourne Myotherapy Approach: What Actually Works At Mebourne Massage and Treatment – Myotherapy Clinic in Fitzroy North, I focus on evidence-based management of neck pain. Indeed, my approach to a client who presents with neck pain is structured as follows: Detailed analysis of clinical history – including previous history of injury and past/current sport activities Clinical assessment – active and passive range of motion, and neurological test where/when needed Outline your short-term and long-term treatment – what you want to achieve in today’s session and in the upcoming weeks/months, and what you are ready to do about it (exercise-wise) Treatment plan outline – what I believe could be a tailored treatment plan given the results of the above findings, including your short/long-term goals In all of these, Remedial Massage plays a crucial initial role to relax the nervous system, reduce initial pain and discomfort, promote healing and movement, but even techniques like mobilisation are ideal for treating neck pain and improving the initial outcome. But again, hands-on treatment is only the first step of the journey, and along with other myotherapy sessions that follow the initial consultation, exercises have to be the main focus. Exercises for the neck, for the shoulders and for your back. In summary, here is a dot point list of what a treatment plan aims for: cervical + thoracic mobility restoration deep neck flexor strengthening scapular control TMJ and jaw tension management (if needed) graded load tolerance programs These interventions address the true drivers of pain rather […]
Tag Archives: myotherapy
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When You Should Stop Running? And For How Long?
Here at Melbourne Massage and Treatment, Myotherapy Clinic in Fitzroy North, when treating patients who [...]
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Pillow For Neck Pain: What You Need To Know
When treating someone for neck pain, a common question I get asked is: “Should I [...]
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Femoroacetabular Impingement (FAI): What You Need to Know Before It Becomes a Bigger Problem
Hip pain can be frustrating, and not all hip pains are the same. I personally [...]
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Femoral Anteversion: Why Your Hip Anatomy Changes the Way You Squat
“Oh, I can’t squat that deep, ” is what I sometimes get told by my [...]
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Simple thing you can do for your Lymphatic System Well-Being. Go For A Walk!
As a therapist who offers Manual Lymphatic Drainage in Melbourne, I am blown away by [...]
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Jun
Hip pain can be frustrating, and not all hip pains are the same. I personally experienced Femoroacetabular Impingement (FAI) pain myself, and it is not fun. Indeed, this type of pain can stop you from training, affect your sleep, make sitting uncomfortable, and eventually impact your quality of life. Over the years, I’ve seen many active people spend months treating the symptoms without understanding the actual cause. If you’re experiencing groin pain, hip stiffness, pinching during squats, or discomfort after prolonged sitting, FAI may be worth investigating. What Is Femoroacetabular Impingement? In simple terms, Femoroacetabular Impingement (FAI) occurs when there is abnormal contact between the femoral head (the ball) and the acetabulum (the socket) of the hip joint. As with any tissue that gets overstimulated, this can result in irritation and inflammation, leading to damage to the labrum, cartilage, and surrounding tissues over time. In some cases, if left unmanaged, it may contribute to the development of early hip osteoarthritis. The symptoms that most people come up with when experiencing FAI are: Deep groin pain Hip stiffness Clicking Catching Locking sensations Pain when sitting for extended periods. Those symptoms are typically aggravated by activities involving Deep hip flexion Squatting Running Kicking Cycling Getting in and out of a car. The Different Types of FAI As we have already seen in the antirotated and retroverted hip presentations, we are all different, and even a Femoroacetabular Impingement can present differently. Let’s have a look at the different types of Femoroacetabular Impingement. Cam Impingement Cam impingement occurs when the femoral head is not perfectly round. During hip movement, particularly flexion and internal rotation, the abnormal shape creates increased pressure against the edge of the socket. This is the most common form seen in young athletic populations. Pincer Impingement Pincer impingement occurs when the acetabulum provides excessive coverage over the femoral head. The socket effectively “overhangs,” increasing the likelihood of compression during movement. Mixed Impingement Mixed FAI is the most common presentation clinically. In this situation, both cam and pincer characteristics are present simultaneously, resulting in a combination of abnormal contact from both the femur and the acetabulum. Who Is More Likely to Develop FAI? The common ground for an FAI presentation includes young and middle-aged active individuals. A higher prevalence is seen among athletes participating in sports that involve: Repetitive hip loading during adolescence Football Hockey Soccer Martial arts Dance Running. This evidence shows that sports activities play a crucial role in FAI presentation, but it is also important to consider that genetic factors could be involved. On the other hand, as per any physical structural presentation, not all the people who present with a FAI may experience pain. Many people have structural changes visible on imaging but remain completely symptom-free. Is a Scan Worth It? This is one of the most common questions I get asked when someone presents with some sort of ongoing pain or even acute discomfort. My answer is usually: it depends on your symptoms and how long they have been lingering around. Why I don’t recommend a scan as a first thing to go for (unless I am suspicious of something that I can’t treat directly) is because a scan may find an abnormality in the body, but that doesn’t mean that what we see is actually the source of the pain. In fact, many people may have a FAI presentation and have no symptoms at all. Therefore, a scan alone should never determine treatment decisions. Sp, a diagnosis of FAI should combine: Clinical history Physical examination Symptom presentation Imaging findings So yes, a scan should support the diagnosis, not create it, or it would be really chaotic to define why someone is experiencing pain, and create a treatment plan for it. If You Need Imaging, Which Scan Is Best? Step 1: X-Ray For most people, a standard pelvic and hip X-ray is the first and most appropriate imaging investigation. X-rays are excellent for identifying the bony shapes associated with cam and pincer impingement and are considered the primary imaging modality in the assessment of FAI. The downside of X-rays is that they involve radiation, so if possible, avoid them. Step 2: MRI If symptoms are there for a prolonged period of time, and exercise therapy is failing to restore functionality, an MRI becomes extremely valuable. MRI can assess: Labral tears Cartilage damage Joint degeneration Other soft tissue causes of hip pain Many hip specialists consider MRI the cornerstone investigation when assessing intra-articular damage associated with FAI, given the high definition of the image and results. Step 3: CT Scan CT scanning is generally reserved for surgical planning or when a very detailed understanding of the hip’s bony anatomy is required. CT provides excellent visualisation of bone structure, but it is not usually necessary as an initial investigation. So, When Should You Get a Scan? In my clinical opinion, based on current evidence, imaging becomes worthwhile when: Hip or groin pain has persisted for more than 6–12 weeks Symptoms continue despite appropriate rehabilitation The range of motion is progressively decreasing Mechanical symptoms such as catching, locking or giving way are present, and are painful Surgery is being considered The diagnosis remains unclear after clinical assessment If your symptoms are mild and improving with treatment and exercise, I would not bother to get an image taken. Exercises are a great way to maintain hip pain-free and keep your body going. Exercise Protocol for FAI This is where we need to put some focus: Exercises! So, first things first, when someone presents with a FAI, we want to take away or modify the habit that we can, in order to reduce discomfort and hip pain. An example could be removing squat from an exercise program or reducing the time spent in a seated position. Next, we would start looking into your mobility capacity at the ankle level, especially if you are someone who runs as part of a sports activity. And all of this is part of a protocol […]
May
As a therapist who offers Manual Lymphatic Drainage in Melbourne, I am blown away by how many people come and seek MLD for general wellbeing, and ask me questions like: “What about tapping my body?” “Should I do guasha?” “I have been told my Lymphatic System is sluggish” Indeed, if you’ve spent any time on social media lately, you’ve probably seen endless content about the lymphatic system, and of course, the more time you spend watching them, the more you will be offered. Dry brushing. Guasha. Detox teas. Essential oils. I call those “Social Media, Lymphatic hacks.” They belong only to social media, not to reality and/or science. As someone who practises Manual Lymphatic Drainage in Melbourne (MLD), I think it’s important to explain what the lymphatic system actually does, what MLD is really useful for, and why people often overcomplicate something that the body already does naturally. And honestly, for many healthy people, one of the best things you can do for your lymphatic system is simply go for a walk. What Is the Lymphatic System? To start with, the lymphatic system is part of your body’s immune and fluid regulation system. Its job is to: Help manage fluid balance Support immune function Transport waste products Assist with inflammation and healing It consists of: Lymph vessels Lymph nodes Lymphatic organs Lymph fluid Unlike the blood circulation, the lymphatic system does not have a pump like the heart, and another difference is that the lymphatic system is capable of absorbing substances that are, molecularly speaking, bigger than what the blood stream can do, simply because the capillaries of the lymphatic system have a bigger aperture than those of the blood stream. Then, regarding how the lymphatic system pumps fluid around the body, it is based on the fact that the internal vessel contraction occurs. The more the vessel contracts, the more liquid moves. And those vessels are sensitive to their surroundings, in fact: Muscle contractions Breathing Changes in pressure Everyday movement Those are all factors that stimulate the lymphatic system to work faster. That’s why movement is so important. And consider that in the human Lymphatic System, contraction rates are typically around 1 to 2 times per minute, at rest, where when doing intense visceral activity, it can jump up to 15 contractions per minute. Why Walking Helps Your Lymphatic System Now, we can than easily understand that every time we walk, our muscles gently contract and relax, and specifically, the calf muscles are the ones that work the most, and are the ones responsible for assisting both the lymphatic and blood systems to push liquid upwards, against gravity. So, walking acts like a natural pump for lymphatic flow, and it can help with: Encourage fluid movement Support circulation Reduce stiffness Improve breathing mechanics Support general recovery and wellbeing Reduce stress Your body evolved to move lymph through normal human movement. Not through expensive “detox” products. Not through aggressive scraping tools. Not through viral wellness trends. Simple movement works remarkably well. What About Dry Brushing and Guasha? Ok, I will be honest on this one: this is where social media often exaggerates things. There is currently no strong scientific evidence showing that dry brushing or guasha creates a special lymphatic drainage effect in healthy individuals. And I want this message to be clear: we are talking about healthy individuals, who are the vast majority of us. That doesn’t mean people cannot enjoy those practices, because they still have a meaning and a use. Indeed, any skin gentle stimulation would still have a major impact on the nervous system, specifically the parasympathetic (rest and digest one), which means it can still have a relaxation effect. Therefore, dry brushing may: Exfoliate the skin Increase temporary circulation at the surface Feel relaxing Guasha may: Feel relieved of muscle tension – and again, this is a nervous system response Temporarily increase local blood flow But neither appears to “detox” the body or dramatically improve lymphatic drainage in the way social media often claims, and most importantly, none of the effects mentioned above last for a long time, nothing like or in comparison to a good walk or exercise time. So let’s be clear about what does what, and let’s remember that the human body already has highly sophisticated systems for managing waste and fluid balance: The lymphatic system The liver The kidneys The lungs The digestive system And again, most healthy people do not have a “blocked” lymphatic system. What science says about those tools? Interestingly, even some of the more positive research around guasha comes with important limitations that are often ignored on social media. Indeed, a study published by Sun‐hee A. et al (2025) that looked at facial roller massage and guasha found some short-term improvements in facial contour measurements, muscle tone, and skin elasticity. However, the researchers themselves acknowledged several limitations, including: The small sample size – only 34 participants The short 8-week duration – already longer than other studies They only looked at temporary aesthetic outcomes rather than meaningful health changes to the lymphatic system itself In fact, the study did not demonstrate that guasha “detoxifies” the body or improves lymphatic drainage in healthy individuals. In other words, while these techniques may temporarily affect appearance, circulation, tissue tension, or relaxation, that is very different from the dramatic claims often made online about “flushing toxins” or “resetting” the lymphatic system. Where Manual Lymphatic Drainage (MLD) Can Be Helpful Ok, if you got this far in the blog, it means you are actually serious about your wellbeing. Great! As a Clinical Myotherapist and Vodder MLD therapist, I am with you. Now, it is important to separate evidence-based treatment from wellness marketing. Manual Lymphatic Drainage (MLD) is a gentle, specialised treatment approach designed to support lymphatic flow and fluid movement. MLD can be beneficial for people experiencing: Lymphoedema Lipoedema Chronic venous insufficiency Post-surgical swelling Scar recovery Chronic inflammation Swelling after injury Sunburn recovery MLD may also support general well-being because it is deeply […]
Apr
Neck pain and or upper back pain often originates from a disbalance of mobility and stability joints along the spine, including poor scapula-thoracic joint stability and thoracic mobility. Indeed, a hypermobile scapula can lead to instability, muscular imbalances, and chronic tension in either the shoulder joints or the cervical. Therefore, assuming that neck pain is only a neck issue is a bit limiting. We need to look at the bigger picture and target the right reason why you are in pain. In this blog, we are going to look at how scapular stabilisation exercises can restore balance, enhance posture, and reduce neck pain. Understanding Scapular Stability and Hypermobility The scapula, or shoulder blade, plays a vital role in upper-body movement and stability. It acts as the foundation for arm motion, connecting the humerus to the thorax through the scapulothoracic joint. When control is compromised, which is common for those with general hypermobility or for those who have scapular hypermobility, the result can be excessive movement and discomfort. Consequences of having a hypermobile scapula are: Neck and shoulder pain Reduced athletic performance Increased injury risk Muscle fatigue and tension As is often recommended, we need to look at strengthening as a way to improve muscular control of the joint, and in this case, we would look at: rhomboids, trapezius (upper, middle and lower), and latissimus dorsi, which is essential for restoring balance and function. Mobility Comes First: The Foundation of Stability As already mentioned in so many other blogs, and as I educate my clients all the time, before introducing strengthening exercises, mobility must be addressed. A stiff thoracic spine forces the scapula to compensate for many shoulder movements, leading to muscles originating and or inserting in the scapula to be overused, leading to pain and discomfort. Essential Thoracic Mobility Exercises There are some really easy exercises that you can do to pick up on thoracic mobility. Here is a short list: Foam Roller Thoracic Extensions Open Book Rotations Thread-the-Needle Cat-Cow Mobility Drill Diaphragmatic Breathing Exercises Those exercises would help in restoring thoracic mobility, preparing the groundwork for effective scapulothoracic stability exercises. Key Muscles for Scapular Stabilisation Now we can look at the muscle that we would need to strengthen to create a better scapular stabilisation. Rhomboids Function: Scapular retraction and stabilisation. Importance: Provide postural support and control during pulling movements. Recommended Exercises: Resistance Band Rows Prone T Raises Seated Cable Rows All those exercises can be easily delivered at home, with some decent resistance bands, or with light weights. But don’t let the simplicity of these rhomboid exercises fool you, as prone T raises, to start with, are enough even with no weights, as the weight of your arm is already enough. Trapezius (Upper, Middle, and Lower) Function: Elevation, retraction, and upward rotation of the scapula. Each fibre group has a different role regarding the scapula movement.Importance: The lower trapezius is essential for shoulder stability and posture. Recommended Exercises: Prone Y Raises Wall Angels Face Pulls Shoulder Shrugs Again, those exercises don’t require a full gym set-up, but some strong resistance bands and light weights would do. Latissimus Dorsi Function: Shoulder extension, adduction, and thoracic stability.Importance: Connects the upper limbs to the trunk and supports efficient movement. Recommended Exercises: Straight-Arm Pulldowns Lat Pulldowns Assisted Pull-Ups Resistance Band Pulldowns Scapular Stabilisation Exercises for a Hypermobile Scapula Now that we have looked at which exercises are ideal for what muscle or muscle group, we can look at a combination of those based on generic fitness levels. Those exercise lists are obviously a generic recommendation, and unless we have already done some work and assessment, I would not suggest picking and choosing an exercise routine and trying your best to sort out your pain. Beginner Level Scapular Setting Exercises Wall Slides Isometric Holds Against a Wall Serratus Anterior Punches Intermediate Level Prone Y and T Raises Resistance Band Pull-Aparts Face Pulls Incline Dumbbell Rows Advanced Level Landmine Presses Farmer’s Carries Overhead Carries Pull-Ups with Controlled Scapular Movement Furthermore, these exercises for scapular stability enhance neuromuscular coordination and are particularly beneficial for individuals with hypermobility. How Scapular Stability Reduces Neck Pain While we can’t directly associate hypermobility of the scapula with neck pain, we also know that poor scapular control often leads to overactivation of the upper trapezius and cervical muscles, contributing to neck pain. By strengthening the stabilisers of the scapulothoracic joint, mechanical stress on the neck is reduced. Therefore, here is a list of the benefits of scapular stabilisation exercises: Improved posture Reduced neck and shoulder pain Enhanced thoracic control Increased muscular endurance Better movement efficiency Lower risk of injury How We Support Scapular Stabilisation at Melbourne Massage and Treatment At Melbourne Massage and Treatment, in Fitzroy North, the treatment of scapular stabilisation starts from a tailored assessment of your presentation, looking at: Overall hypermobility Your clinical history Past and present sports activities Site of pain Pain time frame That and more information are essential to understand what your experience is, and what we can do about it. Hands-on treatment, like remedial massage or myotherapy, would be the first step to relax the body and allow you to feel and move better. The next step from that would be guiding you throughout exercises that you can deliver at home or at the gym, at your own time, so that you can take control of your pain and your presentation. All of this can be easily delivered along a treatment plan. And to simplify the whole process, I also offer a FREE 15-minute Online Consultation, where we can start looking into your presentation and understand what has been done till now and what needs to be done at this stage.
Apr
If you have been at the clinic most recently, you may have heard me talk about LLLT (Low-Level Laser Therapy). LLLT is one of those tools that quietly adds a lot of value to any treatment modalities I get to offer, without making a big fuss, and without increasing the service fees. So yes, in this blog, we are going to look into why I use it, what the science says, and, most importantly, what it can do for you. First Things First: What Is Low-Level Laser Therapy? The simplest explanation I can share is that LLLT (also called photobiomodulation) uses specific wavelengths of light to stimulate your body at a cellular level. Indeed, LLLT is not a hot or burning type of laser, but it is a low-intensity, non-invasive light that interacts with your tissues to encourage healing and reduce pain. This is possible because LLLT stimulates the cell in producing more ATP energy (cell energy) which than can be used for the cell to replicate. Simply, it helps your body do what it’s already trying to do, just more efficiently. What Does the Science Say About Low-Level Laser Therapy? As a practitioner who offers his service based on scientific recommendations, I’m very particular about what I bring into the clinic. If it’s not backed by solid research, it doesn’t stay. Therefore, here’s what recent PubMed evidence tells us: Pain Reduction In a systematic review by Diaz et al. (2025), they looked at 44 randomised clinical trials and found that LLLT can reduce pain by 60–70% in certain musculoskeletal conditions (in this case, TMJ) while also improving function. When a systematic review shows such results, it is considered strong evidence. Supports Injury Recovery & Reduces Inflammation When looking at Lawrence J. Sorra K., (2024) review, that did focus on Low-Level Laser Therapy (LLLT) for Acute Tissue Injury or Sport Performance Recovery the highlighted facts about LLLT are: Modulate inflammation Improve tissue repair Support recovery after injury All with minimal risk or side effects. That said, in this review, it is also highlighted how, in acute injury, there is a lack of evidence for LLLT effectiveness. In conclusion, than, is shown how no side effects are present and how LLLT is a safe therapy to be add to other modalities, especially fitness classes. Works Best as an Add-On (Not a Replacement) About this last statement, that LLLT is not a substitute for other modalities, we have a meta-analysis by Awotidebe A. et al. (2019), which shows how LLLT can provide additional short-term pain relief when combined with exercise or therapy, even if it doesn’t always change long-term function on its own. And this is the key point most people miss. LLT is not magic; It’s a multiplier. Exercises are the medicine. Why I Use LLLT at Melbourne Massage and Treatment? I decided to invest in the usage of Low-Level Laser Therapy SymbyxBiome DuoCare 904, which operates in a wavelength range consistent with what research suggests is effective (typically around 800–900nm), as it can be an effective treatment modality to help my patient feel better, reduce their inflammation and pain, so that they can move better and be able to deliver exercises without bein in too much pain. And here is another important part: I don’t charge extra for it. Why? The answer is simpler than you may think. LLLT is not a “standalone service” in my philosophy; it’s a value-add. If it can: Reduce your pain faster Help your tissues recover better Improve your overall outcome Then, as with any other therapy, it belongs inside your session, not on top of your invoice. What LLLT Does Feel Like? When telling people what LLLT feels like, I respond with: “Drop your expectation”. In fact, you will feel: No heat No discomfort No downtime And yet, underneath the surface, your cells are being stimulated to: Produce more energy (ATP) Improve circulation Reduce inflammatory markers That’s where the real magic happens. It is a way to make your body do what it does normally, only faster. And there is no side effect. What Condition Can Benefit Best From LLLT? Conditions where LLLT is recommended for are: Persistent muscle pain Tendinopathies Jaw pain (TMJ) Post-injury recovery Fibrosis Scar tissue Any presentation would need treatment that lasts 10 to 20 minutes, and the frequency of treatment can be 2 to 5 times a week, with results of pain relief after 3 to 6 weeks. Those numbers vary depending on the type and location of the injury. What we know is that for the early stage, it is better to have more frequent treatment, and after week 1, the treatment can drop from 4 to 5 times a week to 3 times a week, till once a week for major injury if the treatment has to go on for 5 to 6 weeks. Why Frequency Matters As mentioned above, LLLT works by stimulating your cells, particularly the mitochondria, to produce more energy (ATP), which helps with: Tissue repair Reducing inflammation Pain modulation But that effect doesn’t last forever; cells need a more frequent stimulation to obtain the best results. Therefore, if sessions are too far apart, you lose momentum, but if they’re too close without reason, you’re not adding extra benefit. So that’s why, in the initial phase of an injury, we work more often to boost the recovery, and once the recovery is nearly optimal, and you are doing your exercises and structural strength, then the LLLT session can be placed further apart. What Is The Bottom Line Regarding Low-Level Laser Therapy? After so many years in the massage industry, and after all the research and studies of different modalities, there is one thing that I have learned. There’s no single “miracle treatment.” But, on the other hand, there are combinations that work extremely well together. Hands-on therapy + movement + the right adjunct tools, that’s where results happen. And LLLT is one of those tools. So drop your expectation of magic and no effort […]
Mar
Neck pain is such a common presentation, and often I have to hear from my clients that it is due to them storing stress in their neck or shoulder. I can’t think of how many times I heard this, and how many times I than have to ask questions like: “When was the last time you did some neck-strengthening exercises or movement for your neck?” “If you work in an office, how many screens do you have in front of you, and which one do you look at more often?” “Have you ever had a whiplash? And if yes, have you done anything about it?” As you would imagine, the answers are anticipated by a moment of silence, thinking and then in order of question: “I never do neck strengthening exercises, at best I do some stretching”. “2 or 3 screens and I look at the one on one side most of the time”. “Yes, but it was xx years ago, and I haven’t done anything about it, as I was too young to care about it”. Now, I believe that those answers are already going to give you an idea of where that pain may come from. In fact, the neck isn’t just tight, it’s often weak and poorly controlled. To fix that, we need to understand how the neck actually works and how we can strengthen it. Why Neck Strengthening Matters (Mobility vs Stability) Each cervical spine is unique, and we can all present with different needs and capacities for movement. Indeed, a hypermobile person may find their neck to be really mobile and easy to twist and turn. Hypermobility, as discussed many times, is an advantage for flexibility, but it comes with the cons of joint weakness and a higher risk of joint injuries. So, when looking at the cervical area, we may notice that it sits at the top of the joint chain, meaning everything from your shoulders to your lower back influences it. Specifically, the cervical is made of 2 joint sessions: The upper neck (C1-C2) is built for mobility (turning, nodding) The lower neck (C2-C3) is built for stability (supporting your head) When that balance is off, you’ll often notice: Neck stiffness Headaches “Poor posture” (forward head position) Ongoing discomfort Fortunately, those statements are backed up by recent research that shows how strengthening deep neck muscles improves pain, posture, and neuromuscular control, especially when mobility and stability training are combined. Chin Tucks (Deep Neck Flexor Strengthening) Chin Tucks are simple and effective neck strengthening exercises that I often prescribe for neck pain. Let’s then look at a series of progressions for this type of exercise: Chin-Tuck in all four: Position yourself in all four, with hands under the shoulder, and knees under the hips You will be looking at the floor where you have placed an object, right between your hands. Now retract the chin, while you keep looking at the object between your hands. Release the chin and repeat. This version of chin tuck is ideal for: Early rehab. People with pain or poor control. Learning correct movement without compensation. Chin-Tuck in sitting or standing position: Sit or stand upright (standing is the ultimate progression). Gently pull your chin straight back (like making a double chin). Keep your eyes level. Anyhow, you are going to do these exercises, ensure to do them slowly, and take your time doing them. 4 to 5 second tempo. Why Chin Tuck Works for Your Neck Strengthening This exercise activates your deep cervical flexors, which are the stabilising muscles that support your neck. Those muscles can be defined as stabilisers as they go from the thoracic vertebrae to the upper cervical vertebrae, for the longus capitis, which originates in the lower portion of the cervical (C3-C6) and inserts at the basilar portion of the occipital bone. When these muscles are weak: Your head shifts forward Larger muscles overcompensate (SCM) Pain builds over time Isometric Neck Exercises (Build Stability in All Directions) Isometric exercises are an optimal exercise that places major focus on tendons and ligaments, and are ideal for acute symptoms and warm-up pre-training. How to do it: Place your hand on your forehead and gently push into it (no movement) Repeat on: Back of your head Left side Right side Hold each for 5–10 seconds Perform 5 reps per direction This form of exercise can be applied in any direction of movement, such as flexion, extension, lateral flexion, rotation and mixed movement, like flexion on the diagonal side. Why it works: Isometric exercises are applied to pain-free range of motions, so while you move and contract the tissues, you are not experiencing pain, your brain gets triggered to be safe while the body moves, and your musculoskeletal tissues get looked after as they get activated and contract. This would help in improving joint stability and control. Shoulder Shrugs – Let’s Make Those Muscles Work Shoulder shrugs are a simple but effective way to build neck stability through the upper trapezius, which plays a key role in supporting the cervical spine as part of the broader joint chain. How to do it: Take in your hands a pair of weights, or an elastic band, which would you make pass under your feet. Gently lift your shoulders up toward your ears, pause briefly, then lower them with control. Why it works: Shoulder shrugs exercise does work by placing shared-load capacity between the neck and shoulders, reducing the strain on the cervical spine. On the other hand, when working on the cervical joints, it is ideal to intervene also on joints that are muscle-connected to the cervical itself, by adding global muscular support, which is essential for everyday loads. How These Exercises Fit Into the Joint Chain Your neck doesn’t work alone. As mentioned in many other blogs, all the body’s joints are part of a bigger system, the joint chain of mobility and stability. Therefore, if you present with: Tight shoulders A stiff thoracic spine Lack of movement […]
Mar
While I guide my client during a 1:1 fitness class at Melbourne Massage and Treatment, a Myotherapy clinic in Fitzroy North, on how to learn using bands or a single-column pulley machine to practice KLT (Kinetic Link Training), I often get asked how someone should or shouldn’t do a lunge. “Should my knee go ahead of my toes?” “Should my knee stay on top of my ankle?” “What about my back? Should I hinge or stay straight?” The answer to those questions lies in a simple fact: what part of the body are you trying to train? Are you aiming to build more glut (posterior chain) or quads (anterior chain)? No, because there is no perfect lunge, as either right or wrong. As per the squat, there is the lunge that works for you, for your presentation and for your goal. The Two Main Lunge Strategies (And Why They Matter) So, when we talk about lunges, most people are really debating between two variations: Knee Travels Forward (Past the Ankle Line) When going for this variation, we have to conceptualise that the knee is going into a deep flexion, right? Now, if the knee has to come out of flexion, the quads are the muscle that needs to be engaged. (Quads are the knee extensors). The deeper the knee flexion, the more quads fibres are engaged to do the reverse to get the extension done. In fact, what this type of lunge does is: Increases knee flexion Increases quadriceps demand Places more load through the patellar tendon Furthermore, research shows that when the knee moves forward, quadriceps force and knee joint stress increase significantly. In a super summary: This is a quad-dominant lunge. Vertical Shin (Knee Stays Over the Ankle) On the other hand, when delivering a lunge movement and the knee stays on top of the ankle, within a vertical shin line, there is a max of 90° knee flexion; therefore, the amount of fibre engaged for the quads is less, and what is than the primary mover for the ascending action, is the gluteus maximum, the biggest glut, which is going to help with the hip extension. So, in this variation, what we are going to achieve is: Shifting the load away from the knee Increases contribution from the hip extensors Encourages more posterior chain involvement Therefore, this will be a glute-focused lunge. What Biomechanics Actually Tell Us About The Lunge Exercise While we look at this movement, we may get triggered into thinking that the lunge exercise is knee-dominant because the knee does a lot of movement, right? Well, if we break it down a bit more, as Riemann et al. (2012) did, we find that yes, the knee moves a lot, but what really takes the load during the lunge movement is the hip. So this is how we can break it down: The knee moves more (kinematics). But the hip produces more force (kinetics). Why this is a thing, then(?) you may ask. Well is tru that the knee move a lot, it can flex up to 90° and still this can be a hip dominant exercises, but, we have to think that the knee, while it is moving that far, is not placing much load on the lower fibers of the quads, and the joint that has to push against gravity, in the ascending phase, are indeed the hip. That’s where all the load actually is. The weight of the upper body. The Lunge Game-Changer: Add a Hip Hinge And here is where we can add a twist to the lunge, by going into hip hinging. What happens if we do so? The glutes are placed under greater stretch at their origin. This increases mechanical tension. You get better glute recruitment and carryover in strength. In fact, this is not just theory, but it’s basic muscle physiology: Muscles produce more force when stretched under load. Therefore, by hinging at the hip, you are not only going to feel more burning sensation in the glutes, but you are going to train them even more effectively. Why Toe Mobility Is the Missing Piece Now let’s talk about something almost no one considers: Your toes. As often happens, the toes and feet are not taken into consideration when looking at functional movement. Even though every leg movement starts from there. In a proper lunge, especially for the rear leg, your toes need enough mobility (extension) to: Accept vertical load Stabilise the movement Prevent your body from shifting forward Indeed, if you lack toe mobility: The movement gets projected forward Load shifts into the front knee and quads You lose posterior chain contribution To support those statements, a study by Harato et al. (2019) examined how foot and toe positioning directly affects knee mechanics and load distribution. So to clarify, the mobility-stability joint chain must always be taken into consideration when we look at functional movement. In this case, your toes aren’t just along for the ride; they’re controlling where the force goes. So… Which Lunge Is Best? I hope that by now, you have an idea of what answer is coming up: Neither. There is no best lunge, as there is no best squat. The forward knee lunge is not “bad”; it’s a tool for quads. The vertical shin lunge is not “safer”; it’s a tool for glutes. The mistakes are thinking that: One can replace the other one. Having an injury in the knee, and thinking that lunges are not your thing anymore. That’s why, at my clinic, Melbourne Massage and Treatment, here in Fitzroy North, I always emphasise to my clients to understand that: “Don’t chase perfect technique — chase the right stimulus.” And to get to a better technique, better than what your body can deliver for now, is a step-by-step journey. And when there is an injury, we have to be confident in the tissue’s healing timeline, and exercises with load are the best tools to help with that. How I Use This With My […]
Mar
At Melbourne Massage and Treatment in Fitzroy North, as a clinical Myotherapist, I am enthusiastic to offer 1:1 fitness class that aim to improve your wellbeing and body strength. And one thing that I will never stop surprising my clients with is that it is never too late to start working on their strengths, no matter their age, gender, and capacity. Whether you’re recovering from injury, managing persistent pain, navigating age-related changes, or simply want more energy and confidence, personalised fitness is transformative. Why Starting Now A 1:1 Fitness Class Matters? Strength Training Improves Physical Health at Any Age Have you ever heard an older person wishing to be weaker? No, don’t you? That’s why strength and resistance training aren’t just for elite athletes or bodybuilders; they’re essential for everyone. As we age, our body’s natural capacity to regenerate, including regenerating muscle mass and strength, bone density, and other body tissues, naturally declines, which can affect balance, mobility, fall risk, and independence. Resistance training reverses this decline and improves functional outcomes. A systematic review by Kashi K. S. et al. (2023) found that resistance training significantly improved muscle strength, physical function, and reduced symptoms of depression in older adults. Exercise Matters for Mental Health Too Exercises are not only the best way to maintain physical health but also have an immense impact on our mental health. And that is a 1:1 fitness class or a group class, regular exercises can really change how you feel within your head. Infact, we have plenty of evidence from Recent Research that looks into this: A review by Ayaz A. et al. (2026) highlights how aerobic, resistance, and mind-body exercise modalities have psychological benefits, from improved mood to reduced stress and anxiety. Study by Ma Y. and Mumtaz S. (2025) finds that structured exercise programs improve mental well-being by activating neurobiological and psychosocial pathways. Meta-analysis by Rossi E. (2024) showed that strength training has moderate and significant antidepressant effects in adults with depressive symptoms. So yes, your workouts aren’t just changing your body, but they’re changing your brain. Why 1:1 Fitness Classes Are Especially Effective While training is beneficial for everyone, for physical and mental health, personalised training, like a 1:1 fitness class, makes a huge difference, and here’s why: Training Tailored to You Everyone has different goals when starting a fitness journey, or while they are training, and everyone has different needs and capacities, on which the goal is shaped. Therefore, a 1:1 fitness class session allows for customised programming that matches your goals, health history, injury status, and movement patterns, which generic videos or crowded group classes rarely provide. Expert Guidance Prevents Injury At Melbourne Massage and Treatment, I am proud of the studies I done (a Bachelor in health science clinical myotherapy, and following courses like the KLT training) and the effort I put in place to improve my fitness and communication skills, which led me to offer a tailored program for any of my clients. For people with pain, past injuries, or chronic conditions, this is crucial. Motivation and Accountability I often come across clients who don’t feel confident enough in themselves, who don’t like the gym and think that strength training for them is not a thing. And that’s when I can’t stop thinking about how powerful it is to change their mind by showing them how a few minutes of well-done movement, either with or without load, can change everything. That’s when I get them in for Fitness Class here in Fitzroy North, and I help them achieve their goals. Personalised Follow-up On top of a tailored 1:1 fitness class in person, what makes the difference in terms of service here at Melbourne Massage and Treatment, when I show some exercises, I will send you a PDF file with the picture and the description of the exercises, to ensure you will be bale to replicate those exercises anywhere you are ay your own time and comfort. Fitness Class Comes With An Added Bonus — Better Bone and Cardiovascular Health The action of lifting weights and lifting heavy is seen from your body as a positive stress, which creates a concatenation of benefits. Along those we find: Bone regeneration – increase of bone density Maintaining metabolic health Improving markers related to heart disease and diabetes Improve or maintain optimal equilibrium – poor equilibrium is the major cause of falls. And more… All the benefits a fitness class can deliver are crucial as we age. No one, as they age, wishes that their health gets more and more compromised, isn’t it? Start Where You Are — It’s Not About Perfection Whether you’ve never stepped foot in a gym before, you’re returning after an injury, or you’re trying to break a cycle of inactivity, the best time to start was yesterday. The next best time is now. It is never too late to start working on your strength, and this is the most important message I find myself passing on to my clients. The body can always adapt to load. And no matter if you have just started or you are a pro, you will always have to face some challenges. Therefore, start working on your mobility, improve the way your body can move, let’s than load it a little at the time, and build your own journey into wellbeing day by day, fitness class after fitness class. Final Thoughts You don’t need to be “fit enough” to start a 1:1 fitness class, and it’s absolutely never too late. Here’s the truth I’ve seen in across many clients: People in their 40s, 50s, 60s, and beyond see meaningful gains, both physically and mentally. Individualised guidance accelerates progress safely. Strength and structured exercise improve both quality of life and mental well-being. If you’ve been thinking about starting a fitness journey, come and talk to us at Melbourne Massage and Treatment, Fitzroy North. For those who decide to commit to a change, a positive change, for their well-being, there are 5 or […]
Feb
Here in Fitzroy North, at my Myotherapy Clinic and 1:1 fitness class studio, I get to work with a wide range of clients, and what I notice is that there is a lack of knowledge and awareness on how to deliver a Glutes Strengthening. And why I believe that a squat is important is simply because squatting is an action that we do so often throughout the day that we all should be good at it, and it is the best functional movement that allows you to reinforce the full body structure. Therefore, when I come across those presentations, I ensure to educate my patients about the basic mechanics of a squat, including mobility, stability, and glutes strengthing. Are You Looking Into Glutes Strengthening? Let’s Check Your Joint Mobility and Stability First In order to deliver effective training for your glutes, including delivering an efficient squat, you will look at: Adequate ankle mobility A well-coordinated hip hinge Stability in fee tarsals and knee joints Those are regular things I would look at during a myotherapy treatment and 1:1 fitness class in Fitzroy North, to improve glute activation, movement efficiency, and injury resilience. Ankle Mobility Exercise to Improve Squat Depth and Lower Limb Mechanics As discussed in greater depth in the mobility and stability blog, before we start looking at strength and start working on functional movement, like the squat, we want to ensure that the mobile joints are mobile enough to deliver the right mechanics. In fact, limited ankle mobility often results in compensatory strategies such as: Excessive forward trunk lean during squats Early heel lift Increased stress on the knees or lumbar spine Clinical Importance of Ankle Mobility Adequate ankle dorsiflexion allows improved tibial progression during squatting movements, enabling more effective hip and glute loading. Exercise: Knee-to-Wall Ankle Dorsiflexion Drill Position the foot flat on the ground, facing a wall Aim for a 10 cm distance between the big toes and the wall Maintain heel contact with the floor Drive the knee forward toward the wall under control Perform slow, controlled repetitions Your aim is to teach the wall with the kneem, with a big toe-wall distance of min. 10 to 12 cm Clinical application:This exercise is commonly prescribed in myotherapy sessions to improve squat mechanics, reduce compensatory loading, and support long-term joint health. Hip Hinge Drill for Posterior Chain Activation and Spinal Control The hip hinge is a fundamental movement pattern required for safe and effective loading of the gluteal muscles, but not only that, indeed, poor hip hinge mechanics often present as excessive lumbar flexion or extension during deadlift-based movements. Why Hip Hinge Mechanics Matter Efficient hip hinging can help with: Increases glute and hamstring activation Reduces lumbar spine strain Improves RDL and deadlift performance Exercise: Wall-Assisted Hip Hinge Drill Stand approximately 20–30 cm from a wall Push the hips posteriorly to make contact with the wall Maintain a neutral spine and rib position Return to standing using glute contraction (squeeze those glutes) Clinical focus:This drill is a key component of both rehabilitation and performance-based programming at Melbourne Massage and Treatment. It is also a fundamental movement pattern taught in my glute-focused fitness classes, ensuring clients build strength safely and efficiently. Stability Starts From Your Feet Foot stability is a crucial part of delivering a good squat, especially during a low-bar squat, when feet are flat on the ground. Imagine your feet unable to give a stable direction to whatever is above, like the ankle, knee and hip. This would lead to knee shaking during squatting, and once the squat load increases, the risk of injury rises. So for foot stability, we look at: Even weight distribution of your load along the plantar of the feet, not only on your toes or on the heel. All toes, grabbing the floor, throughout the squat performance Lower-bar squat, feet flat on the floor (be barefoot or use gambaletto type of shoes) and feet wider than hip, stand in slight external rotation High-bar squat, feet open wide as hip stand (so a narrow stand) and heel well elevated. In both my clinical work and my strength-based fitness classes, foot stability is always assessed first. On the other hand, more about the high and low bar squat is available from this blog. Squats for Functional Glutes Strengthening In my glute-strengthening fitness class sessions, the squat is one of the primary movements we refine. Keep in mind that when we talk about squat for glut strength, we always refer to the lower-bar squat. Therefore, when performed with appropriate technique, this exercise is the most effective exercise for developing functional glutes strenghtening and improving lower-limb coordination. Below, you will find the most common Clinical Faults in Squatting Limited ankle mobility restricting depth Poor hip control resulting in lumbar compensation Reduced gluteus contribution due to motor control deficits So this is what you need to focus on to for a Optimal Glute Engagement while squatting: Maintain even foot pressure throughout the movement Maintain spinal alignment and controlled descent Drive upward through the heels and mid-foot Clinical note:Squat depth should be dictated by movement quality rather than arbitrary range targets. Romanian Deadlifts (RDLs) Another Glutes strengthening Exercise The Romanian deadlift, in comparison to the conventional deadlift, is a partial movement, where the load never touch the ground throughout the exercise (once it gets picked off the ground). This type of lift is ideal for exercising the posterior chain, particularly in the gluteal and hamstring musculature. Benefits of RDLs in Myotherapy and Strength Training Enhances glute and hamstring load tolerance Improves hip-dominant movement capacity Reduces injury risk through controlled eccentric loading RDL Execution Guidelines Maintain close bar or weight proximity to the body Initiate movement via hip hinge, not knee flexion Maintain spinal neutrality throughout the range Terminate the movement when pelvic control is lost Clinical relevance:RDLs are regularly integrated into rehabilitation and strength programs for clients with lower back pain or who are returning to lifting after injury. But are also ideal to build […]
Jan
Once you have been diagnosed with lymphoedema (also known as lymphedema), you will soon learn that compression therapy plays a vital role in long-term management of this chronic condition, and one of the most common questions I hear in my clinic is: “What’s the difference between circular knit and flat knit lymphoedema compression garments?” In this blog, I will explain the difference between these two types of lymphoedema compression knit, so that it may help you understand better how your lymphoedema can be managed in the long term. Why Is Lymphoedema Compression Essential? As discussed in many more blogs, lymphoedema is a chronic condition caused by an impaired lymphatic system, which leads to the accumulation of lymph fluid and persistent swelling in one or more body parts. If not correctly managed, lymphoedema can progress and cause: Increased limb size – elephant leg Tissue fibrosis (hardening) Skin changes – including numbness Higher risk of infections – cellulitis is a common one Compression therapy is a cornerstone of CDT (Complete Decongestive Therapy), alongside: Manual Lymphatic Drainage (MLD) – ideal to boost your lymphatic system drainage capacity Skin care is essential to avoid skin cracks and infections Exercise and movement – especially if wearing circular knit compression Long-term compression – So in short, lymphedema compression supports lymphatic flow, helps maintain limb volume reduction, and prevents the worsening of lymphoedema. What Is Circular Knit Lymphoedema Compression? Circular knit compression refers to the method by which garments or bandages are made. In this case, the knit is made using a continuous circular weaving method, creating a seamless and highly elastic fabric. Benefits of circular knit compression: Lightweight and smooth texture Greater elasticity and stretch Often available off-the-shelf More discreet under clothing Circular knits are ideal for those lymphoedema patients who can and should move with the limb affected by lymphoedema. Indeed, the circular knits are designed to allow the lymphedema patient to move; therefore, while the limb is compressed, the lymphatic system is simultaneously boosted by compression and movement. When circular knitting may be suitable: Mild lymphoedema Early-stage lymphedema Limbs with minimal shape distortion Well-controlled swelling However, due to their elasticity, circular knit garments often lack the containment needed for more advanced lymphoedema, especially when fibrosis or limb shape changes are present. What Is Flat Knit Lymphoedema Compression? So, even in the case of Flat-knit compression, the name refers to the way the fabric is produced, like flat fabric and stitched together with a seam. This allows for higher stiffness and customised shaping. Benefits of flat knit compression: Firmer, more supportive structure Superior containment of swelling Custom-made to individual limb measurements Better control of irregular limb shapes Flat knit is usually recommended for: Moderate to severe lymphoedema Long-standing or progressive lymphedema Skin folds or lobes Fibrotic tissue Swelling that rebounds quickly A lymphoedema patient is unable to move much Therefore, based on the severity and lymphoedema stage, we would suggest using flat knit compression for more severe presentations or for someone who is unable to move the limb(s) affected. Compression Garments and Complete Decongestive Therapy (CDT) At Melbourne Massage and Treatment, in Fitzroy North, I offer Complete Decongestive Therapy (CDT) as part of lymphoedema management, which is internationally recognised as the most effective approach to lymphoedema treatment. Here is a list of things that I would offer during a lymphoedema management appointment: Comprehensive lymphedema assessment Manual Lymphatic Drainage Swelling reduction during the intensive phase of CDT Preparing limbs for compression garments Education on long-term self-management To simplify the process of lymphoedema management, at Melbourne Massage and Treatment, I do offer a free 15-minute online consultation, where I can answer your questions and go through an initial assessment about your clinical history. Compression After CDT After we manage to reduce the swelling in the limb(s) affected by lymphoedema, via MLD and CDT, which can take 3 to 5 appointments, or more, depending on your presentation, we can then look into getting garment wear that can fit your limb(s), so that the swelling can be managed for a longer time. While I do not supply compression garments directly, I refer patients to Sigvaris in West Melbourne, specialists in medical compression for lymphoedema, ensuring accurate fitting and high-quality garments. Circular Knit vs Flat Knit: Which Is Right for You? The correct compression garment depends on several factors, including: Stage and severity of lymphoedema Limb shape and tissue texture Presence of fibrosis Skin health Lifestyle and daily activity This is why coming for an appointment and getting your lymphoedema assessed and treated, where needed, is essential before selecting compression. Lymphoedema Treatment in Fitzroy North Living with lymphoedema can be challenging, but with the proper care, education, and treatment plan, it can be effectively managed. At Melbourne Massage and Treatment in Fitzroy North, I focus on: Evidence-based CDT Individualised lymphedema management Clear guidance around compression therapy Collaborative care with trusted garment providers Therefore, if you are in need of professional lymphoedema treatment in Melbourne or need clarity around compression options, I’m here to support you. About myself: a Myotherapist specialised in Lymphoedema Management My name is Giovanni, and I run Melbourne Massage and Treatment, a Myotherapy and Lymphoedema clinic in Fitzroy North. I trained with the Vodder Academy in lymphoedema management, and I provide Complete Decongestive Therapy (CDT), the gold standard for lymphedema treatment. My approach is tailored to each individual patient, to achieve objective results, and to help you enjoy more your life while dealing with Lymphoedema management.