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Baker’s Cyst and Massage

A Baker’s cyst is an uncomfortable condition that most often occurs in adults over 55 or in children between around 4 and 7 years of age. It is estimated that around 20% of people with other knee problems may end up suffering from a Baker’s cyst. Generally symptoms of a Baker’s cyst are relatively slight unless the cyst becomes so large as to extend into the calf muscles or if it bursts. Massage therapy can assist those suffering from a Baker’s cyst by relieving the swelling and discomfort associated with the cyst.

Baker's CystA Baker’s cyst is a swelling at the back of the knee. The entire knee joint is enclosed within a capsule which is lined with a membrane and filled with synovial fluid that lubricates the joint. It is suggested that some people have a small pouch at the back of the knee with is created by extra tissue. When these people suffer a knee injury, then the body’s response is to secrete more synovial fluid into the knee which tends to accumulate and fill this pouch causing the Baker’s cyst.

Baker’s Cyst – Symptoms
In some individuals, a Baker’s cyst causes no discomfort or pain and has no obvious symptoms. When symptoms do occur then the most common ones observed are:

  • A round mass or swelling behind the knee joint which may be soft or hard and is most apparent when the person is standing.
  • A sense of pressure behind the knee which may go down into the calf muscle.
  • Pain in the knee and a restricted range of motion.
  • Persistent pain and tenderness post exercise.

Causes for a Baker’s Cyst
The most common cause of a Baker’s Cyst is after an injury when damage to the knee capsule results in a build-up of synovial fluid as referred to above. The specific injury can include a torn cartilage, arthritis or even an infection in the knee joint. For those children who develop a Baker’s cyst occasionally there may be no obvious reason for the cyst to have developed.

Diagnosis of a Baker’s cyst
Suitably trained medical practitioners use a number of tests that are used to diagnose a Baker’s cyst. These include:

  • A physical examination of the knee + medical history.
  • A popular easy diagnostic tool is to turn off lights and shine a flashlight through any lump. Presence of a red glow indicates that the lump contains fluid.
  • Magnetic imaging resonance (MRI).
  • X-rays of the knee do not show a cyst but can indicate other trauma or arthritis damage to the knee.

Treatment of a Baker’s Cyst
If there is little or no pain then there may not need to be any active treatment and a doctor will just monitor the cyst over time. If treatment is indicated then the options include:

  • Treatment for the underlying cause, such as medication for arthritis or surgery for torn knee cartilage.
  • Avoid doing anything that can aggravate the knee joint.
  • Injections of Cortisone.
  • Aspirating the cyst with a needle to drain off the fluid.
  • Surgery to remove the cyst entirely (extreme cases).

  
With any treatment plan for a Baker’s cyst then rest and elevation is generally recommended to reduce the chance of the cyst returning. For children then the approach of watching and waiting is recommended as the cyst often subsides spontaneously.

Massage Therapy and Baker’s Cyst
As the cysts are normally located in the popliteal region which is generally considered as an area contraindicated for most massage techniques then a massage therapist should not apply any deep pressure directly onto the cyst. The role of the massage therapist is more aimed at alleviating the underlying knee problem.

Massage to the area superior to the cyst can have therapeutic benefits i.e. balancing the muscles that influence the knee joint such as hamstrings and adductors. It is suggested that lymphatic drainage techniques may assist in reducing swelling and facilitating recovery through increasing the rate of absorption of the excessive synovial fluid.

By Richard Lane

Frozen Shoulder and Massage

The term “Frozen Shoulder” refers to a painful symptom of the shoulder that can severely limit its range of motion and so giving the impression that the shoulder is “frozen”. The condition affects women more than men, and occurs most frequently in women aged from 45-65. Health-care practitioners prefer to use the term “adhesive capsulitis” as while the term “frozen shoulder” is common, it isn’t entirely accurate.

There are several problems in the shoulder that may be painful and limit the range of motion in ways similar to adhesive capsulitis. An important method of distinguishing adhesive capsulitis from other shoulder problems is to evaluate the way in which motion is restricted at the shoulder joint.

Shoulder MassageIn the glenohumeral joint, the capsular pattern for motion to be limited is first in external rotation, then in abduction and finally in medial rotation. Thus if a client has difficulty bringing the arm up in abduction but has no problems externally rotation the shoulder then it is unlikely that the client has adhesive capsulitis.

The glenohumeral joint has the greatest range of motion of any joint in the body. When the shoulder is in a neutral position (with the arm by the side), there is some slackening of the glenohumeral joint capsule on the underside which is necessary to allow full range of motion of the joint. When the arm/shoulder is moved to other positions, the underside of the capsule becomes taut.

Adhesive capsulitis develops when a portion of the joint capsule adheres to itself and prevents full movement of the joint. As the capsule is highly innervated, it is extremely painful when the adhesions pull on the tissues of the capsule.

Adhesive capsulitis is generally categorized into primary and secondary. In primary adhesive capsulitis there is no obvious cause for the condition – clearly frustrating for practitioners. There may be some correlation between a significant emotional trauma and the development of primary adhesive capsulitis.

Secondary adhesive capsulitis will often develop as the result of rotator-cuff tears, arthritis, shoulder trauma, surgery, bicipital tendinosis, etc. With these injuries, there appears to be a process of fibrosis that is initiated by these other conditions. As such, the individual is usually limiting motion in the shoulder at the same time the fibrosis is occurring and the fold on the underside of the joint capsule is never fully elongated. Thus begins a vicious cycle as the adhesion causes limitation to shoulder movement and pain, thus worsening the problem.

Subscapularis trigger points have also been suspected of causing secondary adhesive capsulitis. This may result from irritation of the attachment site of the subscapularis which is close to the capsule. Local inflammation at the attachment may then cause fibrous adhesion in the capsule.

Frozen shoulder is often divided into three stages:
Freezing. Onset is usually between 2 to 6 months and this period is characterized by a gradual decrease in range of motion and an increase in pain.

Frozen.This stage occurs for between 4 and 12 months after initial onset. Motion will remain extremely limited although there may be a gradual decrease in pain levels.

Thawing.In the thawing period, there is a gradual return of range of motion and decreased pain. This stage can vary from a few months to several years.

Treatment and Massage of Frozen Shoulder

Treatment should always be directed by a trained health-care practitioner who is suitably qualified to diagnose adhesive capsulitis. Most treatments begin with a relatively conservative approach aimed at increasing the range of motion of the glenohumeral joint. Simple movements such as letting the shoulder hang like a pendulum may encourage a gradual increase in range of motion. With adhesive capsulitis, if exercise is too vigorous then further damage and inflammation of the joint capsule may occur.

Massage techniques used to treat frozen shoulder should encourage relaxation of the muscles surrounding the shoulder. Simple effleurage and broad cross-fibre sweeping strokes are often used to assist in restoring proper movement to the joint. As discussed above myofascial trigger points in muscles such as subscapularis may also play a role in adhesive capsulitis. These may be treated with static compression or compression with active movement.

  
Another area that massage therapists may wish to consider is to encourage the elongation of the adhered capsular tissues. This is achieved by gentle stretching motions such as a passive stretch in lateral rotation where the client is taken to the point where discomfort begins and then held there. The client is encouraged to breathe deeply and relax the shoulder as much as possible. After holding the stretch for up to 30 seconds, the client is returned to the neutral position before repeating the procedure a few times.

If conservative treatment is not successful, a more aggressive stance may be taken of forced manipulation of the shoulder joint whilst the shoulder is anesthetized. Whilst this can produce dramatic improvements in the range of motion, it is extremely painful.

By Richard Lane

Stretching and Injury Prevention

Does Stretching Prior to Exercise Reduce the Risk of Injury?

We are all told that we should stretch before undertaking vigorous exercise but does scientific research support this. Pre-workout stretching seems to be a logical thing to do as tight muscles/tendons probably have a greater susceptibility to strain during exercise (when compared with relaxed-flexible soft tissues). However if we stretch are we less likely to get injured? The research evidence is contradictory.

Some studies have found support for the hypothesis, others no difference (and some that stretching prior to a work-out can actually increase the prevalence to injury!). For example in a study of 1543 athletes who ran in the Honolulu Marathon, 47% of all male runners who stretched regularly were injured during a one-year period while only 33% of male runners who didn’t stretch were hurt (1).

ExerciseEven when the research accounted for the fact that the strongest predictor of a future injury is a past injury and excluded runners who had taken up stretching after a previous injury, the stretchers had a 33% greater risk of injury. The stretchers did not run any more miles than the non-stretched individuals.

However, this study also concluded that stretching after workouts reduced the risk of injury. The conclusion was made that stretching must be carried out when muscles are warm (and thus less resistant to being stretched out) to be protective.
In a similar stduy (2) 159 runners were instructed how to warm up, cool down and stretch effectively while a second group of 167 similar runners received no instruction at all. Over a few months, the injury rates of the two groups were identical so the instructed warm-up, cool-down and stretching provided no protective benefit.

However, other studies have found that stretching may be beneficial. A study of military recruits who practised a series of static stretches before and after training were compared to a control group who performed no stretches (3). The stretching group demonstrated a significantly lower rate of muscle-related injuries but no difference in the rate of bone or joint injuries.

In a review of the literature, Thacker et al (4) stated that “There is not sufficient evidence to endorse of discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes”.

  
(1) Lally D. ‘New Study Links Stretching with Higher Injury Rates’, Running Research News, Vol. 10(3), pp. 5-6, 1994
(2) van Mechelen W, Hlobil H, Kemper HCG, et al. Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993;21:711-19.
(3) Amoko et al. “Effect of static stretching on prevention of injuries for military recruits.”
(4) Thacker et al. “The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature”. Medicine & Science in Sports & Exercise. 36(3):371-378, March 2004.

PNF Stretching

PNF stretching is considered to be the most effective way to increase static flexibility and is a combination of static passive stretching and isometric stretching. PNF stands for Proprioceptive Neuromuscular Facilitation and was first developed as a treatment for paralysis patients.

PNF stretching is usually carried out with a partner who provides the resistance for the isometric contraction although it can be done without a partner (but generally will be less effective). If using a partner, then it is important that the partner be attentive and focused.

Pnf StretchingThe most commonly used PNF technique is the “Hold-Relax” which is sometimes referred to as the “Contract-Relax”. The muscle is stretched passively towards the limit of its range of motion and then the muscle being stretched is isometrically contracted for 5-15 seconds after which the muscle is relaxed for a couple of seconds before being subjected to a passive stretch which should be greater than the initial passive stretch. This stretch is held for around 10-15 seconds before repeating the PNF stretch one or two more times.

PNF Stretching Examples: Hamstring Stretch
For an example of a PNF stretch, then the person being stretched lies flat on their back with one leg bent at 45 degrees and the other leg extended straight. The partner lifts the straight leg until a comfortable stretch is felt through the hamstring (nb partner just supports the stretched leg and does not push). This stretch is held for 15 seconds.

The stretchee should then isometrically contract the hamstring against partner’s resistance for 5-15 seconds, relaxes and the partner gently guides the hamstring to a deeper stretch. This is repeated a few more times until there is no further increase in range of motion.

Brief PNF Physiology of Stretching
Muscles spindles cells located within the muscles, protect the muscle from injury. They sense how far and fast a muscle is being stretched and when activated produce a stretch reflex. This reflex causes the muscles to contract to prevent overstretching the muscle.

Located within the muscle tendon is another sensor called the golgi tendon which senses how much tension is being put upon the tendon. When the golgi tendon is activated then it relaxes the muscles (unlike the muscle spindle).

A voluntary contraction during a stretch increases the tension on the muscle, activating the golgi tendon organs more than the stretch alone. So when the voluntary contraction is stopped the muscle is inhibited from contracting against a subsequent stretch. PNF stretches uses this to take advantage of the sudden vulnerability of the muscle and its increased range of motion by using the period immediately following the isometric contraction to train the stretch receptors to get used to this new, increased, muscle length. This is accomplished by the final passive stretch.

Some General Recommendations for PNF Stretching

•Leave 48 hours between PNF stretching routines
•For each muscle group complete 2-5 sets of the chosen exercise
•Each set should consist of one stretch held for 10-15 seconds after the contracting and relaxing phases
•PNF is not recommended for anyone under 18 years old
•A 5-10 minute thorough warm up is recommended before performing PNF stretching as a separate exercise session.

While most of us could obtain benefit from the improvement in flexbility that PNF stretching can bring, there is some conjecture amongst sports professionals about the effective of stretching in general to reduce the risk of injuries and to improve performance. Although there is some conflicting evidence reported, on balance research literature reviews such as reported by Thacker et al (1) support the hypothesis that routine stretching has little impact on reducing total injuries amongst competitive or recreational athletes.

  
However, research has also found that pnf stretching may lead to improvements in running mechanics. Caplan et al (2) concluded from studying rubgy league players that stretch training at the end of regular training is effective in improving running mechanics during high velocity running.

As with all stretches, only take a PNF to the limit of what feels comfortable. Pain is an indication that you are overstretching.

In addition, there are advantages and disadvantages of PNF stretching and it may be worthwhile discussing these with a suitably qualified sports therapist.

(1) Thacker SB, Gilchrist J, Stroup DF, Kimsey CD., Jr. “The impact of stretching on sports injury risk: a systematic review of the literature”. Med Sci Sports Exerc. 2004;36:371-378
(2) Caplan N, Roggers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res, 2009, 23: 1175-1180

By Richard Lane

Subscapularis Massage

I recently posed an online question to other therapists about what muscles they believe do not receive sufficient attention from bodyworkers. My suggestions was the SCM (sternocleidomastoid) muscle at the front of the neck. Other suggestions included the gluteal muscles, the pecs and abs which didn’t surprise me too much. However, a few therapists included the subscapularis muscle in their lists which I have to admit, is not a muscle I would normally spend a great deal of time on.

Their comments inspired me to have a look at subscapularis, what it does and why it may be important for some shoulder conditions.

Now the subscapularis muscle is part of the rotator cuff group, along with the teres minor, infraspinatus and supraspinatus muscles. These muscles work together to stabilise the humerus in the glenoid fossa of the shoulder. From a massage therapists terminology it attaches to the anterior surface of the scapula at the subscapular fossa and the lesser tubercle of the humerus. It’s action is to internally rotating and adducting the humerus (along with it’s stabilisation role).

Pain and dysfunction in the subscapularis muscle often manifests as an inability to lift the arm above the shoulder (although it should be mentioned that not being able to lift the arm above the shoulder does not necessarily indicate that there is an injury to the muscle as there are other conditions which have the same impact on lack of shoulder mobility). It is often the case that someone who spends a lot of time in front of a computer may very well have some dysfunction of the subscapularis, such as trigger points (this applies to anyone who works with their arms out in front of them including massage therapists!).

Pain that is due to dysfunction of the subscapularis can manifest in a number of different ways, it can be sharp and located in the shoulder, deeper or at the top of the shoulder. It can refer down the arm. There can be impingement of the brachial nerve which can lead to numblike sensations or tingling down the arm. The pain can gradually appear over time or, in the case of an acute incident, it can happen at an instant (throwing or pitching a ball is commonly cited as a major contributer to subscapularis injuries). Subscapularis therapy is often indicated when a client is recovering from frozen shoulder.

Massage for the Subscapularis
Access to the subscapularis is limited particularly when a client is lying prone and most therapists prefer to do their subscapularis bodywork with the client either supine or in a side-lying position. Examples of supine and sidelying subscapularis massages are shown in the videos below.

Supine Massage

Sidelying Massage

Dr Ben Benjamin advocates using friction treatments to address subscapularis tendon injuries and claims that it can be a remarkably effective treatment for most muscle, tendon and ligament injuries. Friction massage for the subscapularis can be mildly unpleasant and should be performed from 5 to 15 minutes and is demonstrated on the video below.

  

Pain Between Shoulders

Although there are any number of reasons that people call for remedial massage, probably one of the more common is for pain between the shoulder blades. This can be an isolated pain or it can be in conjunction with neck pain and stiffness or headaches. The pain can be persistent and chronic or it can appear acutely after a particular activity or movement.

Many people will believe that the root cause of the problem lies in the muscles between the shoulders blades, namely the rhomboids. If they book in for a massage then they will expect that the therapist pays particular attention to these muscles and the muscles around the area to reduce the tightness and tension.

MHowever, often the problem is not associated with tightness in the area but weakness. Tightness in other muscles is causing the muscles such as the rhomboids to become irritated because they are over-stretched not because they are overly tight. A massage therapist that tries to eliminate the tightness by stretching and adding length to the muscles may even be adding to the problem.

Often postural professionals will refer this condition with terms such as forward head posture or upper cross syndrome. The pain between the shoulders actually results from the complex interaction of the muscles around the shoulder girdle. It comes about from an increase in tightness in the muscles at the front of the neck and upper chest and weakness with the upper back and back of the neck (technically muscles such as the levator scapula, pectoralis major, suboccipitals, SCM and upper trapezius tend to be tight whereas the lower trapezius and rhomboid muscles tend to be weak).

Typically when you have your posture checked, a therapist would notice that the shoulder blades (the scapulae) are depressed lower than they should be and they are spread apart towards the sides of the body. When the shoulder blades are in this position, the traps and the rhomboids are stretched to their maximum and they struggle to hold the weight of the arms. The force of gravity leads to a constant pulling on the muscles and nerves in the area. The results is pain in and around the neck, between the shoulder blades and even down the arms.

Postural awareness is the first starting point for reducing the impact of upper crossed syndrome or forward head posture. Left untreated it can lead to degenerative changes in the upper back and result in constant neck pain, back pain and contributes to the formation of the Dowager’s Hump and be implicated in TMJ dysfunction.

  
Being mindful of when you are performing repeated tasks with you arms extended in front of you (such as typing on computers or driving) is a good starting point. However, restoring the balance between the muscles of the shoulder girdle is of prime importance and this can often be quite a challenge as normal movement patterns may have been compromised by persistant pain.

Massage can help to address some of the issues associated with these problems, in particular by releasing those muscles that are pulling the shoulders blades forward and down. Your therapist can also suggest stretching exercises for the upper chest and strengthening exercises for the upper back.

Massage and Back Pain
– Research Findings

There are many reasons why people book in for a mobile massage in Sydney with us. It can be purely to de-stress and wind down. It can be as a reward for working hard. It can be part of a sportsman training regime to include a regular sports massage. However, the majority of people that we see are suffering from physical discomfort and they are looking for remedial therapy to help them reduce the pain and tightness they are experiencing.

Massage for back pain reliefNeck /shoulder pain and headaches are probably the top of the list for the reason why people book in for a remedial massage and many people know that massage is a great way to deal with these problems. The next most popular reason for getting a remedial or deep tissue massage is for lower back pain and there is some good news that recent research has found that massage may very help is dealing with the pain and suffering that lower back pain can cause.

When suffering from lower back pain many people seek out medications from their doctor to treat the pain. Others try exercise regimes from physiotherapist. However, a significant proportion of experiencing and secondly as a form of preventative maintenance once they are relatively pain-free. Researchers set out to ascertain whether massage compared favourably against usual medical intervention for treating lower back pain.

In the study (1), carried out by researchers from the Group Health Research Institute, Seattle, Washington, the study participants were randomly assigned to receive either a relaxation massage, a structural (remedial/deep tissue) massage or usual medical care without massage. Their symptoms had been assessed and also recorded was the impact of the back pain on their daily life.

Those in the massage groups had a one hour session weekly for 10 weeks.

The symptoms of those in the study were recorded after completing the massage program, at six months and finally a year after they initially began the massage.

The results obtained were encouraging for the massage industry. After the 10 week assessment, the researchers found that those who had received massage had lower levels of pain and they were able to perform daily tasks better than those who had only received the usual medical care. These results were similar regardless of which type of massage they received, be it relaxation or structural.

Whilst the benefits did not remain after one year, there was still a significant difference with the results obtained after 6 months and so it may be reasonable to conclude that massage can be an effective treatment for those who are suffering from lower back pain.

(1) Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA. “A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial.” Ann Intern Med. 2011 Jul 5;155(1):1-9.

By Richard Lane

Carpal tunnel, pregnancy and massage

Carpal tunnel can be an extremely painful and uncomfortable condition that can affect anyone. However, during pregnancy the chances of suffering from carpal tunnel syndrome are greatly increased, particularly in the latter stages of pregnancy. The reason for the greater incidence of carpal tunnel syndrome during pregnancy is that there is greater retention of fluid (due to varying hormones during pregnancy) and that relaxin can soften the ligaments that form part of the carpal tunnel.

Carpal tunnel and pregnancy massageCarpal tunnel syndrome will normally manifest in the form of pain, numbness and/or tingling in the outside three fingers of either hand. In more extreme cases, the compression on the nerve through the carpal tunnel can lead to the forearm feeling numb. The fingers and the hands will feel weak and have poor grip strength and pain may radiate up the arm as far as the shoulder.

For pregnancy induced carpal tunnel syndrome the symptoms will be worse either during the night or first thing in the morning due to greater fluid retention as the arm is relatively inactive.

There are a number of steps to you can take to reduce the impact of the condition. These include:

  • Avoiding any task or action that causes pain
  • Elevate the affected arm to attempt to reduce the amount of oedema and swelling
  • Be aware of your posture. There is a tendency amongst pregnant women (+ office workers + people who drive a lot etc) to have their neck protracted ie their chin juts out. Even a little can add compression to the lower cervical vertertae so try to keep your chin back in a more neutral position.
  • Try to keep your wrist in as neutral a position as possible (some physiotherapists recommend the use of splints to maintain a neutral wrist while you sleep. If you are suffering from carpal tunnel from breast feeding then remember to bring the baby to the breast rather than move the breast to the baby and again be aware of your wrist position.
  • Some professionals may suggest modifying your diet (and/or lifestyle) to reduce your body’s general propensity for swelling

Massage for Carpal Tunnel Syndrome During Pregnancy
An effective massage for carpal tunnel syndrome is primarily aimed at reducing the amount of swelling in the arm through lymphatic drainage techniques and, when performed by a therapist who has a good understanding of the condition, it can be a highly effective treatment.

Routine for Carpal Tunnel Pregnancy Massage
This routine can be considered as being relevant for during pregnancy and also post-partum when the new mum can have wrist problems when breast feeding.

Start at neck with little or no lubrication and work very and gently. The movement of lymph at the level of the skin is the objective for the routine. Always proximal to distal with the order of the strokes but work each individual stroke in a distal to proximal direction. Stretch the skin and work down the arm all the way down to the hand. Again need to reiterate that the pressure should be very light as working deeply can be ineffective.
Repeat this series of strokes a few times.

  
Perform a lymphatic compression on the arm – scooping up and then hold each compression for a count of about 10. Pressure is still very light.

Compressive tissue release – keep wrists neutral and stroke down the forearm (both top and botton of the forearm) using thumb and fingers whilst applying traction to the wrist. This stroke can free up the nerve sheaves through the carpal tunnel.

If you feel that you need to stretch the fascia of the palm make sure that you keep the wrist in neutral. Work the joints of adjacent fingers in opposite directions.

By Richard Lane

Positional Release

Most people who have regular remedial or therapeutic massage in Sydney would probably prefer to have the therapist to get stuck into the muscles and the soft tissues. Certainly with our Sydney mobile massage business, deep tissue and deep pressure massage are more popular than Swedish or relaxation massage.
However, not all clients necessarily respond best to a stronger massage and recently I’ve some good results with incorporating positional release techniques within a session (particularly when the deep tissue techniques have not yielded the benefits that I would like to have seen).

Therapeutic relief through positional release techniquesPositional release is a gentle and relatively non-invasive technique that allows for pain relief effectively by the body healing itself. It relies on the use of placing the body or painful part of the body in a comfortable position so that myofascial trigger points can release.

Positional release can be incorporated into a remedial massage bodywork session to assist with reducing the pain for particularly stubborn area or it can be considered as a standalone session. In addition, once you have experienced pain relief from using positional release then it is possible to perform some level of self-positional release.
In order to perform positional release, then a therapist will locate the areas of dysfunction (most often affected by trigger points) and then they will manoeuvre the client’s body into such a position that the pain experienced from the trigger point is eliminated (or at least minimised). The client will stay in this position for up to 2-3 minutes (which may be assisted by the therapist supporting an arm, a leg or the head for example).

The philosophy behind of positional release is that painful muscles when put into such a position that they are shortened (without contraction) then the pain sensors within the muscle can in effect be “switched off”. The muscle may then be in a more relaxed state when the passive support is removed and the level of pain and discomfort can be decreased.

Self-Positional Release
If you are having problems with soreness in your neck then lie on your side on a pillow and using your fingers or thumb find a spot that is particularly tender. Often these points are just below the occiput (ie just under the bone of the skull at the back of the neck). Now very slowly and very easily move your head in different directions whilst monitoring the pain you are experiencing. You may need to tilt your head backwards, forwards or to the side or even rotate it in one direction. Hopefully you will move into such positions that the pain will be reducing – if you find that it is actually increasing then move in the opposite direction.

  
Once you have found a position such that the pain is minimised then support your head as much as possible in that position and just stay there for a couple of minutes (no need to keep monitoring the pain with your fingers at this time). Gradually ease yourself back into a normal position and hopefully your pain will be less. If you need to work on the opposite side then simply turn over and repeat.

Obviously never force your head into uncomfortable or strained positions whilst you are attempting to perform self-positional release and if you have any concerns regarding the pain and discomfort you are feeling, always consult a health care professional.

By Richard Lane

Dry Needling

If you have been a regular recipient of remedial massage over the years then there is a reasonable chance then at some stage you would have been offered the opportunity to try dry needling. More and more massage (and for that matter physiotherapists) in Sydney have been trained to provide dry needling. Some of the therapists who work with Inner West Mobile Massage are trained to provide dry needling treatments.

But what is dry needling, is it different to acupuncture and is it effective?
Deactivation of trigger points through use of dry needles in SydneyA technicial definition is that dry needling uses a variety of needling techniques to initiate change in soft tissue dysfunction which are the results of physiological loading causing inflammation or irritation of the soft tissue. A more normal description is that dry needling is used to de-activate trigger points in the muscles (for information regarding trigger points then there is more information here). The insertion of a needle is considered as being an effective way of relieving the pain and discomfort which may be attributable to the trigger point.

For a dry needling treatment, then a thin needle is inserted into the trigger point (which the therapist has identified through palpation). If the needle is positioned correctly then there will normally be a local twitch response, an involuntary reflex as the muscle fibres of the taut band of the trigger point contract.

As with any bodywork modality, the effectiveness of a dry needling treatment is directly related to the skill of the practitioner. Obviously just sticking needles into the muscles and hoping is not likely to provide good results. The therapists palpation skills and knowledge of anatomy are critical to the success of the therapy.

Dry Needling and Acupuncture
Although both modalities use needles to initiate healing for the body there is a distinct difference regarding the philosophy behind dry needling and acupuncture. Dry needling aims to reduce pain through the de-activation of trigger points. The needles are inserted into the trigger point but they are not left in the muscles for much more than a few seconds.
Acupuncture uses needles to enhance energy and chi flow through the meridians of the body. An acupunturist would normally leave the needles in the meridian points for an extended period of time.

Now whilst there is a huge underlying difference in the intent of the two modalities, there is also a significant area of commonality. It is often reported that there is an overlap of somewhere between 70-90% for trigger points and the meridian points used by acupunturists.

Effectiveness of Dry Needling
Research on the effectiveness and efficacy of dry needling is fairly limited. Some commentators will argue that many positive findings are based on small sample sized research studies which may or may not have flaws with respect to methodology. One of the major problems is similar to research studies into acupuncture: the skill, training and knowledge of the practitioner is a variable largely out of the control of researchers. Also most practitioners will vary their approach depending on issues that the client presents with and for them, there is no standard treatment.

  
Dry Needling – Inner West Mobile Massage
Whether or not dry needling can be clinically proven to provide pain relief through de-activation of trigger points may be considered as being a mute point anyway. The issue is whether it can work for you.

If you are interested in trying dry needling then a couple of the therapists who work with us are trained and qualified to offer this therapy. Give us a call on 0421 410 057 if you would like more information.

By Richard Lane


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