A pain response is a signal created by the brain to let you know that something within the body is not right, or at least, that something, potentially, is not right. This means that pain is a sensation that can also be there when no actual damage is present in the first place. But when you feel pain in the neck, in the shoulder, in the knee or somewhere, how can you differentiate if it is a pain given by muscles or by a joint? In this blog, I want to talk about the difference between muscle pain and joint pain. Muscle and Joint Pain: Let’s Start With Clinical History Intake When someone presents to the clinic in pain, the first thing I do is to track down their medical history, which includes their daily activities, previous injuries (old and recent), sports history, medications, quality of sleep, etc.. From there, I start to narrow down when they have been experiencing the pain, and what caused it in the first place, and where they feel it. Already, that information can give a good perspective of what we are looking at, in terms of muscle pain and joint pain. Knowing the time frame of the pain, the location of the pain can already give an answer. But before jumping to conclusions, we need to do some testing Active and Passive Movement: The Differences In Pain Response After an accurate intake of the clinical history, we would proceed with some testing, including active and passive range of motions. Active range of motions (AROM) are those movements that the patient would do on their own, like flexing the shoulder, rotating the hip, etc Passive range of motions (PROM), on the other hand, are movements that the therapist would do with the patient’s body. So you will be asked to keep your arm and shoulder relaxed, and it will be the therapist who moves the arm. Here is where things start to get interesting. If you respond with pain with AROM, we know that you are using both your muscle and joint to deliver the movement, so the pain response that you feel could be either from the muscle or the joint. But if you respond with pain with a PROM, then we know that the response is from the joint, because the muscle, in that specific motion, is not working. How about tendon? So, when delivering a PROM, we may push the movement to its limit, creating a stretch motion. This specific endpoint of movement, if it reproduces a really pinpoint specific pain, that is sitting right on to what we can recall as a tendon (the insertion point of the muscle), it is another differential tool to understand what the pain is caused by. So yes, to simplify, we use PROM to identify a joint pain, but in that joint pain, we include the tendon itself, not only the ligaments. Ligaments, per clarification, are the tissues that hold the bones together and make up the joint. Orthopedic testing: another tool for differentiating muscle pain from joint pain But the rabbit hole of understanding where that pain is from doesn’t stop here. That’s why we also use orthopedic testing when looking at a pain presentation. Ortopedic testing is a test that places stress on a specific structure, and can have a range of sensitivity and specificity. Sensitivity refers to the test’s ability to identify individuals who have the condition being tested for. Specificity refers to its ability to identify individuals who do not have the condition. Those two terms, that get evaluated in %, can tell us how valuable a test is. And most often, to validate a hypothesis of what can cause the pain, we have to use multiple forms of testing, from AROM to PROM to orthopedic testing and Clinical History. Neck Pain: Muscle Pain or Joint Pain – A case study Neck or upper shoulder pain is one of those common presentations, where the patient presents thinking that it is due to a muscle issue, but then, you prove to them that it is actually their joint that is the issue. Who is Peter, and with what pain does he present himself? Let’s examine a case study of Peter (name of fantasy), a 43-year-old office worker presenting with pain radiating from his right neck to the upper shoulder. Despite various stretches, the pain persists. He tried many pillows, he tried any sleep position, but this pain comes and goes, and has been on for years. Peter presents with a pain level today of 7/10, complaining that certain neck movements are limited and painful. It is hard, for example, to do a head check while driving. Clinical History So, first thing I would do is go through Peter’s clinical history and find out that his pain started about 10 years ago, after a whiplash accident, and that at that time, more than having a collar on his neck for a week or two, he hadn’t done much about it. Hi pain, which occasionally radiates to the neck, also gives him a headache. Sport history includes playing AFL from when he was a kid till his mid-twenties, and nowadays the occasional swim, yoga and pilates class. He spends most of his days working from home or at the office, sitting in a chair. In addition to this, we also know that: No pain radiating down the arms, no pins and needles in the hands; Pain is worst in the morning; Stretching gives an initial relief, but then it gets worse. Differential Diagnoses (DD) Differential diagnoses are the hypotheses we think of when someone presents with pain. Let’s say that is what we think we could find as a problem, given the patient’s complaint we received. And out of 3 or 4 DD’s, we will draw a line that connects all the results and get a Working Diagnosis (WD), which is the most plausible answer given the results we obtained. This said, this […]
Tag Archives: pain
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Aug
Modern life places ongoing pressure on both body and mind, leaving many Australians searching for natural ways to restore calm. Muscle tightness, fatigue, and poor sleep are often signs that stress has taken hold. At Melbourne Massage and Treatment, remedial massage is used as a practical therapy to release tension, regulate the nervous system, and support wellbeing, offering a balanced pathway to sustained relaxation and resilience. Key Takeaways Stress affects both body and mind Remedial massage releases tension and restores balance Circulation and sleep improve with regular sessions The nervous system resets during treatment Melbourne Massage and Treatment offers expert support What is Remedial Massage? Remedial massage is a form of therapeutic massage that targets specific muscles and tissues to relieve pain, promote healing, and improve function. It combines various techniques, including deep tissue work, trigger point therapy, myofascial release, and stretching, to address both acute and chronic conditions. Unlike relaxation massage, which focuses on general relaxation, remedial massage is tailored to treat specific problems in the body, such as muscular tension, joint pain, and postural imbalances. The key difference between remedial and other types of massage is that it aims to treat underlying physical issues and dysfunctions, which can, in turn, help to alleviate the mental and emotional effects of stress. Stress can manifest physically in the body in various ways, including muscle tension, headaches, poor posture, and fatigue. Remedial massage directly addresses these physical symptoms, creating a ripple effect that helps to calm the mind and restore balance. How Remedial Massage Reduces Stress? Stress doesn’t just impact your mind; it can manifest physically in the body, resulting in tight muscles, headaches, neck pain, back discomfort, and other ailments. When the body is under stress, it produces higher levels of cortisol harmone, a hormone linked to the body’s “fight or flight” response. This can lead to increased muscle tension, heart rate, and even digestive issues. Remedial massage works by targeting these physical manifestations of stress and promoting relaxation in several ways. 1. Reduces Muscle Tension One of the most immediate and noticeable benefits of remedial massage is its ability to reduce muscle tension. When we experience stress, we often unconsciously tighten our muscles, especially in areas like the neck, shoulders, back, and jaw. Over time, this chronic muscle tightness can lead to pain, discomfort, and restricted movement. Remedial massage helps to release this built-up tension by applying pressure to specific muscle groups, promoting blood flow, and encouraging the muscles to relax. Targeted Techniques: Techniques such as deep tissue massage and trigger point therapy can focus on areas where muscle tightness tends to accumulate due to stress. These methods help to break up muscle knots and reduce the overall tension in the body. Increased Blood Flow: By improving circulation, remedial massage enhances the delivery of oxygen and nutrients to tissues, promoting healing and relaxation. 2. Activates the Parasympathetic Nervous System The autonomic nervous system consists of two branches: the sympathetic nervous system (SNS), which triggers the ‘fight or flight’ response, and the parasympathetic nervous system (PNS), which manages the ‘rest and digest’ state. Chronic stress keeps the SNS activated, which can leave the body in a constant state of alertness. Remedial massage stimulates the PNS, encouraging the body to relax and return to a state of calm. Relaxation Response: When the PNS is activated, heart rate and blood pressure drop, and the body enters a state of relaxation. This not only helps with muscle relaxation but also reduces anxiety and promotes overall mental well-being. Lowering Cortisol Levels: By activating the PNS, remedial massage helps to lower cortisol levels in the body. This reduction in cortisol can help combat the harmful effects of prolonged stress, such as anxiety, poor sleep, and immune system suppression. 3. Improves Sleep Quality Stress often leads to poor sleep, whether through difficulty falling asleep or waking up throughout the night. One of the ways that remedial massage helps to combat stress is by promoting better sleep. Through its calming effects on the nervous system and muscle relaxation, massage encourages a deeper, more restful sleep. Relaxation Before Bed: A remedial massage session before bed can help you unwind from the day’s stress, allowing you to go to sleep feeling relaxed and at ease. Improved Sleep Cycle: By reducing tension and lowering cortisol levels, remedial massage helps to improve the quality of sleep, leading to more restorative rest and reduced feelings of stress the following day. 4. Reduces Anxiety and Enhances Mood Stress and anxiety often go hand in hand. While stress tends to be a response to external pressures, anxiety can become a persistent feeling that affects your mental health. Remedial massage has been shown to have a positive impact on mental health, particularly by reducing anxiety and boosting mood. Endorphin Release: Massage stimulates the release of endorphins, natural chemicals in the brain that promote feelings of well-being and happiness. This helps to counteract the negative effects of stress and anxiety, providing a natural mood lift. Emotional Release: For some individuals, massage can facilitate an emotional release, allowing pent-up emotions from stress to surface. This can be therapeutic and contribute to a feeling of emotional lightness and mental clarity. 5. Improves Posture and Reduces Pain Chronic stress can lead to poor posture, which, in turn, can contribute to musculoskeletal pain. When we’re stressed, we tend to slouch or hunch over, especially when working at a desk for long periods. This poor posture can lead to discomfort in the back, shoulders, and neck, further exacerbating stress. Remedial massage works by improving posture and reducing musculoskeletal pain. Postural Correction: Remedial massage helps to release tight muscles and realign the body, improving posture and reducing the discomfort associated with poor alignment. Pain Relief: By targeting specific areas of pain, remedial massage can relieve discomfort in muscles, joints, and connective tissue, contributing to an overall sense of well-being. Additional Benefits of Remedial Massage for Stress Relief In addition to the direct effects on the body and mind, remedial massage offers […]
Aug
Thai yoga combines assisted stretching with mindful breathing to restore mobility, release tension, and create deep relaxation. At Melbourne Massage and Treatment, this approach blends traditional techniques with professional care, allowing clients to experience greater freedom of movement and a calmer state of mind. With its unique mix of yoga-inspired postures and therapeutic massage, Thai yoga holistically supports both body and mind. Key Takeaways Thai yoga blends stretching, mobility, and relaxation It improves flexibility and posture Stress relief is a core benefit Sessions are fully guided and accessible to all Melbourne Massage and Treatment tailors each session to your needs What is Thai Yoga? Thai Yoga, also known as Thai yoga massage or Thai bodywork, is a traditional healing practice that originated in Thailand over 2,500 years ago. It combines elements of: Yoga-style stretching Acupressure Mindful breathing Meditative touch Unlike a regular massage or a typical yoga class, Thai Yoga is a partner-based practice. The practitioner gently guides you through yoga-like stretches and poses while applying pressure to specific points along the body’s energy lines, known in Thai tradition as Sen lines. The result is a deeply restorative experience that helps release tension, increase range of motion, and calm the nervous system, all without you having to lift a finger. At Melbourne Massage and Treatment, Thai yoga is offered as part of a tailored approach to mobility, posture, and recovery. Mobility: Loosening Up the Joints and Muscles One of the biggest benefits of Thai Yoga is improved mobility. Many of us deal with tight hips, sore backs, or stiff shoulders, whether from sitting all day, overtraining, or simply getting older. Thai Yoga works to gently open up these areas by: Stretching muscles in a passive and supported way Mobilising joints through guided movement Increasing circulation and blood flow to tight or stagnant areas This kind of assisted stretching helps lengthen muscles and fascia (the connective tissue that surrounds your muscles), which improves flexibility and reduces the risk of injury. And because you’re not doing the work yourself, your body can fully relax into each movement, allowing for a deeper and safer stretch than you might achieve on your own. Relaxation: More Than Just Taking It Easy Sure, we all love a good nap or a lie-down on the couch. But true relaxation goes deeper than just stopping activity, it’s about letting the body and mind fully switch off, so healing and recovery can happen. Thai Yoga encourages this state of deep rest through: Rhythmic, flowing movements that calm the nervous system Mindful breathing to slow the heart rate and promote stillness Gentle compression and touch that creates a sense of grounding and safety After a session, many people report feeling lighter, looser, and mentally clearer. Some describe it as a moving meditation or a “body reset.” If you’ve been feeling strung out, overwhelmed, or physically tight, Thai Yoga might be the reset button you didn’t know you needed. Who Can Benefit from Thai Yoga? Thai Yoga is suitable for a wide range of people, including: Office workers who sit for long hours and need to improve posture and mobility Athletes or gym-goers looking to aid recovery and reduce tightness Older adults want gentle movement and joint support People dealing with stress, anxiety, or sleep issues Anyone wanting to improve flexibility, body awareness, or simply relax The best part? You don’t need any yoga experience. Thai Yoga is fully guided, and each session can be adapted to suit your body, flexibility, and needs on the day. What Happens in a Thai Yoga Session? Here’s what you can expect during a typical Thai Yoga session: You stay fully clothed in comfortable attire (like gym or yoga wear) The session takes place on a mat on the floor, not a massage table The practitioner uses their hands, thumbs, elbows, knees, or feet to stretch, rock, and apply pressure Sessions can last anywhere from 60 to 90 minutes The experience is quiet, meditative, and deeply calming You’ll be gently moved through a series of postures, from seated twists to spinal stretches, hip openers, and shoulder releases, all while lying down and breathing deeply. For those seeking greater depth, advanced thai yoga practices may also be introduced, incorporating more complex stretches, dynamic flows, and breathwork techniques to further enhance mobility and relaxation. Thai Yoga vs. Traditional Yoga: What’s the Difference? While both practices aim to support flexibility, relaxation, and body awareness, the key difference is that Thai Yoga is done to you, not by you. Traditional yoga involves actively moving into and holding poses, while Thai Yoga is a passive, assisted experience. This makes it ideal for people who: Are you new to yoga or struggle with certain movements Are you recovering from an injury or managing chronic conditions? Prefer a more hands-on approach to bodywork and healing In many ways, Thai Yoga bridges the gap between yoga and massage, offering the best of both worlds. Bringing Thai Yoga into Your Life You don’t have to travel to Thailand to reap the benefits. Thai yoga practitioners are available in cities and regional areas across Australia. Many yoga studios, wellness centres, and massage therapists now offer Thai yoga classes as part of their services. If you’re interested in giving it a go, here are some tips: Look for a certified Thai Yoga practitioner with experience and good reviews Wear loose, comfy clothing (like leggings and a tee) Stay hydrated before and after your session Speak up during the session if any movement feels uncomfortable Approach it with an open mind and no expectations, every session is different Conclusion Thai yoga is more than stretching, it is a practice that restores balance, enhances movement, and promotes deep relaxation. Combining mindful breathing with guided mobility creates space for the body to release tension and recover naturally. Ready to experience the benefits for yourself? Contact us today and book a session designed to improve both mobility and relaxation. FAQ
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
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 […]
May
Knee replacement surgery, or knee arthroplasty, is a transformative procedure designed to alleviate pain and restore function in patients suffering from severe knee damage. While the surgery is a crucial step toward improved mobility, the journey doesn’t end in the operating room. The rehabilitation process is vital for ensuring a successful recovery and regaining your pre-surgery quality of life. A key component of this recovery is Manual Lymphatic Drainage (MLD) and a tailored exercise program. Understanding Knee Replacement Surgery Knee replacement surgery as the name says, is basically the replacement of a damaged knee joint with an artificial one. There are two type of knee replacement surgery: a total knee replacement (TKR), which replaces the entire knee joint, or a partial knee replacement, which targets only the damaged part of the joint. Nowadays, the decision to undergo knee replacement surgery is often made when conservative treatments, such as medications and physical therapy, have failed to provide relief. This is because, we are more aware now than ever, of how surgery are complex intervention that can yes, give pain relief and benefit, and save life, but occasionally can come with complications and leave the person with other permanent damage. The Rehabilitation Process As in any surgery, the rehabilitation process is extremely important to ensure that the patient returns to the best of their functions. What the rehabilitation involves are physical therapy, exercises, and, where needed, even mental support. Immediate Post-Surgery Care: Pain Management: Right after your surgery, you will be given pain relief medications and antibiotics, which will help in managing the pain response and keep you free from infection risks. Initial Movement: As a few days are pass, is super important to start moving. Initially would be a matter of few mm or cm, passive and active movement, but as days goes by these movement has to be increased, in order to avoid further muscle atrophization and to increase the blood flow to the area. Exercise: Isometric Exercises: As per discussed in many other blogs, those exercises are the first step in the recovery process. An isometric exercise consists of muscle contraction and barely any limb movement. This allows for maintaining a connection between the muscle and the Central Nervous System (CNS), which is essential to ensure muscle engagement for more complex tasks. Initially, those exercises can be achieved with only 25% of your strength, and within 10 days post-surgery, you may start pushing at 50% of your strength or more. Strengthening Exercises: This second step in the exercise journey can start in week three or four after surgery. The process focuses on strengthening the muscles surrounding the knee joint. These exercises are essential for supporting the new joint and improving overall stability. Strengthening exercises may look different from person to person, in terms of load, but they all aim to increase the load to which the knee joint is placed, to stimulate muscle growth, blood flow, and restore all tissue damaged along the surgery. Plyometric Exercises: Lastly, along the rehabilitation process, there are the plyometric exercises, which consist of loading the tendon like a spring (that’s what their function is) and releasing that loading in a fast motion. For a knee joint, think of explosive squat-type exercises. These type of exercises would start around week 8 to 10 post surgery. This is a step-by-step guide of what a rehabilitation process may look like. Each individual then may have a different journey to follow, given their clinical history, and other factors, including genetics and return to daily activities. In addition to the exercises, physical therapy Consistency: Adhering to a home exercise program is crucial for maintaining progress during therapy sessions. Monitoring Progress: Regularly perform your home exercises and track your progress. If you encounter any issues or experience increased pain,get in touch with your physical therapist to discuss what you are presenting with and what can be done about it. Monitoring and Follow-Up: Your surgeon and physical therapist will evaluate you on an ongoing basis to ensure that your recovery is progressing as expected. Any complications or concerns will be addressed promptly. The Importance of Manual Lymphatic Drainage (MLD) Manual Lymphatic Drainage (MLD) is a gentle, hands-on therapy designed to stimulate the lymphatic system and reduce swelling, which can be particularly beneficial following knee replacement surgery. Here’s how MLD supports recovery: Benefits of MLD in Knee Replacement Recovery: Reducing Swelling: Fluid Management: Swelling or edema is a common issue after knee replacement surgery. MLD helps move excess fluid away from the surgical site and reduces overall swelling, which can enhance comfort and mobility. Enhancing Circulation: Improved Blood Flow: By promoting lymphatic flow, MLD also improves blood circulation, delivering essential nutrients and oxygen to the healing tissues, which supports a faster recovery. Reducing Pain and Discomfort: Pain Relief: The gentle massage techniques used in MLD can help alleviate pain and discomfort associated with swelling and inflammation, contributing to a more comfortable recovery experience. Facilitating Faster Recovery Helping the Healing: By reducing swelling and improving circulation, MLD can lead to a more efficient recovery process, enabling more effective physical therapy and exercise. Incorporating MLD into Your Rehab Routine Timing: MLD can be introduced a few days to a week after surgery, depending on your surgeon’s recommendations and your individual healing progress. How can I help? At Melbourne Massage and Treatment, as a Clinical Myotherapist I am trained in helping people recovering from knee surgery or other major surgeries, either with Fitness Class, which can be part of a Myotherapy treatment plan, but even via treatment like Manual Lymphatic Drainage. So if you are about to get a surgery, that is a knee replacement or any other surgery, and you are looking for someone that can assist you with your recovery, get in touch now to discussed your needs and I can give you a rund down on how I will be able to help you. Knee replacement surgery and lymphoedema. As mentioned earlier, we can all have different outcomes from the […]
Jun
Biomechanics is a branch of biophysics, and it studies the structure, function biomechanics is a branch of biophysics, and it studies the structure, function and motion of the mechanical aspects of biological systems using mechanical methods.d motion of the mechanical parts of biological systems using mechanical methods. Why is Body Biomechanics important? The way we move is a crucial component of injury prevention. Ensuring we are moving using our advantage, forces like gravity and body weight can help us reduce the chance of injury and improve the load capacity. To do so, we must train with a specific protocol that ensures excellent mobility to achieve muscular strength. What is a force? We can define a force as an influence that can change the motion of an object. Gravity is an acceleration that becomes a force when applied to a body. This concept was well explained by Netwon, with the announcement of Newton’s second law that can be summarised with F=m*a. F is the force, m is the mass, and a is acceleration. In the case of acceleration of gravity, it does measure 8.91 m/sec2. Said so, this means that we are constantly accelerated towards the ground. That’s why we don’t float in the air. And to better use this acceleration to our advantage, we have to move weight using the right angles. To better understand body biomechanics, we must introduce the idea of Moment Arm, Vector and Torque. What are Moment Arm Vector and Torque? And why are they essential for understanding human body biomechanics? The moment arm is the distance between the force and the joint that hold that force back. Think of yourself holding a water bottle up with your arm extended out. The joint holding up is your shoulder, the force is the combination of the bottle per the gravity a. (F=m*a). A Vector is the direction in which a force is applied. In this case, the direction is 90° downwards. Lastly, the Torque is the rapport between the Force and the Moment Arm. So, the shorter the moment arm, the easier it would be to lift an object. Understanding this concept would make your body biomechanics application much more accessible. Body biomechanics at the gym. When training at the gym, body biomechanics are fundamental. I often get clients in post-gym injury who don’t know much about mobility training, its importance, and body biomechanics. For example, keeping the weight so the bar is as close as possible to the leg is essential when doing a deadlift. This is because the weight has to be close to the Centre Of Gravity of the body, or the moment arm would be increased, so the torque required to lift the weight would increase too. In this case, the centre of gravity corresponds to the area where the actual torque is required, the lumbar area. Indeed, it is easy to hurt yourself on the lumbar when you bring that bar too far from your body. Body Biomechanic and Thai Massage Traditional Thai Massage, as offered at Melbourne Massage and treatment, tends to use the body biomechanics at its best. Even Thai Yoga exercises are based on the biomechanics principle, using lever and gravity as an advantage to create pressure on your body and reduce tension and heal aches. This, indeed, is what makes Traditional Thai Massage so unique. It is a technique of work where you don’t need great force, it is enough to use your body weight. And because it is delivered on a ground mat, it is easier to apply the biomechanics principles.
“I was lifting the box from the floor, and then, ouch I did my back”! How often have you heard this? What’s going on here? Lower back pain is a common presentation that affects many people all around the world. But hurting your back when picking a box, or even a lightweight as the key, or tightening the shoes, is an injury that doesn’t affect only those with lower back pain. So to explain the mechanism behind these incidents, we have to look into what we call “proprioceptors”, specifically “muscle spindle”. Proprioceptors are body receptors within the skin, muscles and joints that reveal information about the body’s movement and send this information to the brain. How that information is transmitted to the brain is by different types of a pathway that we will see in a future post. In specific, today, we are going to look at the “muscle spindle”. So muscle spindles are proprioceptors that can tell the brain how the body is moving, specifically a muscle, and a proprioceptor that can tell a muscle to relax and change to stretch. Indeed, muscle spindles are different from other proprioceptors, as they can alter their sensitivity as needed. What did Muscle Spindles have to do with my back then? As mentioned above, a muscle spindle can alter muscle consistency. So, when banding forward to pick up the key or do the shoes lase, the back muscle must relax, as they have to stretch. But, if the muscle spindle doesn’t tell the back muscle to relax as you bend, those muscles will stay contracted, and guess what happens next? “Ouch, I did my back.” How to prevent the injury then? To prevent an injury as such, movement is the answer. Movement, as simple as a cat and cow exercise, would create that feedback response between your lower back area and the brain that, in the long term, would ensure your brain knows that when bending, the posterior portion of the body needs to be told to relax. Said so simple movement can prevent the injury, but further exercises, like a deadlift, can help your entire posterior chain to get stronger and get you to the next level of strengthening. But before lifting heavy weights, let’s not forget the importance of looking into mobility. In conclusion, to prevent this injury from happening, start moving. Incorporate regular breaks from your seating at the desk. Have a timer on your desk that, every 45 minutes, remind you to stand up, have a stretch and short walk, a water sip and get back to work. Book your next massage session at Melbourne Massage and Treatment if this post talks to you. How can Massage help? Massage therapy can help in different ways. First, it can help reduce the muscular tension within the lower back area. Second, the massage touch can help increase that body awareness, preventing further injury. The recovery process from an injury does depend from person to person. But within a few sessions within 1 to 2 months, using a mix of techniques, like MLD, Myotherapy and or Thai Massage, there is a good chance of good recovery and injury prevention. Exercises play an important role too in this recovery phase. How Many Sessions would I need? As already mentioned, everyone is different. Based on my experience, to help someone recover from an injury, initially, it can take up to 5 sessions spread over two months to achieve a good result. And again, this is not only about Massage but also about corrective exercises. Therefore, I offer a treatment plan allowing you to uptake five sessions of any treatment type at a discount rate of 10%. This offer is valid for returning clients who already had an initial consultation. This would allow me, as a therapist, to ensure I am the right therapist for you and that we can create a treatment plan that works for you and that you can use for your benefit.
Jan
Here is a list of services available at Melbourne Massage and Treatment: Myotherapy Exercises Rehabilitation Remedial Massage Thai Massage MLD Thai Yoga What are these services about? First, any of those services are holistic services, so they can’t be official diagnoses for medical conditions, and Giovanni can’t prescribe any medications. What to expect is guidance on how muscularscaletol conditions, such as plantar fasciitis, tight muscle, muscle tear and more…can be looked after and overcome with manual therapy and exercises. As Myotherapist, Giovanni can guide you on how possibly the pain manifests and how with massage and specific exercises, the pain can be placed at ease. Part of the process of pain management is the change in habits. This can include posture at the workstation, but not only, but other changes can also include your training program, which maybe is too intense for your body and needs to be adjusted. How is the massage delivered? Any massage is delivered in total respect of the patient and the therapist. No nudity or sensual massage are available. Only the body area that needs attention would be exposed. The rest of the body is covered in a towel. Undress level is down to bra and underwear when need it. If we are working on your shoulder, there is no need to remove the pants. Regarding individual massage sessions, like myotherapy treatment, remedial massage, and/or Thai massage, an assessment of the muscular scale of the system would be delivered before the treatment. This assessment included a series of ROM. These assessments would help Giovanni understand what muscle or groups of muscles needs more attention during the treatment. What should I do before the massage session? Treatments such as myotherapy, remedial massage, and MLD include exposing the body parts that need to be worked on. Said so, having a shower before the treatment would be much appreciated. You don’t need to wear any perfume, a deodorant is enough. Should I shave? No, you don’t need to shave. If rock tape needs to be used, the rock tape can be placed over body hair. When you have to remove it, make sure to roll it downwards. Do not pull it off like it is a wax treatment. That could lead to ripping hair and skin off. Where does Giovanni work? Melbourne Massage and Treatment services are available at the Fitzroy North studio on Holden St. Book now your next appointment. If this post didn’t answer all your questions, don’t hesitate to message Giovanni through the Contact Page.