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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

Delayed Onset Muscle Soreness and Lactic Acid

Delayed Onset Muscle Soreness (DOMS) can happen at any time. However it usually occurs when people are just beginning an exercise program or when they are increasing their exercise workload/changing from one activity to another.

You’ve just begun a new exercise program in the gym or have taken up running. The following day the muscles you have been exercising are sore, achy and tired. This is Delayed Onset Muscle Soreness. The muscle discomfort and fatigue is commonly blamed on lactic acid build up by many athletes.

However this is a fallacy. Lactic acid is not the culprit for this muscle soreness.

Lactic Acid and ExerciseLactic acid is produced during high levels of activity when the oxygen requirements of the muscles are greater than can be supplied by the blood circulation system. In order for the body to produce the required energy, then the body begins another process, anaerobic metabolism, which does not require oxygen.

During the breakdown of glucose and carbohydrates, the cells of the body make ATP (adenosine triphosphate) which provides energy for most chemical reactions in the body. Lactic acid is a by-product of this reaction. Production of lactic acid is proportional to the amount of carbohydrates broken down to supply energy to the tissues.

Lactic acid has a bad reputation. When the body makes lactic acid, it splits into lactate ion (lactate) and hydrogen ion. The hydrogen ion (H+ acid) can interfere with electrical signals in the muscles and nerves, slows energy reactions and impairs muscle contractions. The burn felt during intense exercise is considered to be caused by hydrogen ion build-up. Lactate on the other hand is an extremely fast fuel. Whenever carbohydrates are used, a significant proportion is converted to lactate. This lactate is then used in the tissues as fuel or it is transported via the blood stream to other parts of the body that require energy.

Rapid use of carbohydrates for energy production during intense exercise accelerates lactic acid production. Temporarily lactic acid builds up in the muscles and blood, causing the familiar muscle burning sensations. If the intensity of the exercise is reduced then the rate of lactate used for energy soon catches up with the rate of lactate production.

Delayed Onset Muscle Soreness (DOMS)
Lactic acid is responsible for the burning muscles during exercise and this is why many suspect it to be responsible for soreness 24-36 hours after intense exercise. However, lactic acid is completely flushed out of muscles within 30-60 minutes of finishing intense exercise. Getting rid of lactic acid is not an issue.
There are no abnormal levels of lactic acid in the tissues or blood when the dreaded DOMS strikes.

Research indicates that DOMS is more likely caused by localised damage to the muscle fibres membranes, the connective tissue and the contractile elements – namely micro trauma to the muscle fibres.

Over the 24 hours post intense exercise, the damaged muscles become sore and inflamed. Chemical irritants are released from damaged tissue, triggering pain receptors. In addition to the injured muscle fibres, there is an increase in blood flow causing a swelling of the muscle tissues which again may stimulate pain receptors. In the morning following the exercise, the muscle fibres are fatigued, have microscopic tears and are inflamed.

The muscle nerve supply perceives this as an abnormal state and sends pain messages to the pain.

Ibuprofen Gels
Some people resort to using topical ibuprofen gels to deal with the muscle soreness post exercise. However, a 2010 research study (1) has determined that these offer no benefits in the form of pain relief.

  
In the study over 100 participants completed reps of elbow and knee flexion exercises designed to eccentrically contract the relevant muscles. 36 hours after the exercise then the participants were asked to apply either a topical ibuprofen gel or a placebo to the affected muscles. Evaluations of soreness were taken at various times after the application of the gel. The researchers found no differences between the placebo or the active ibuprofen gel in the treatment of soreness after an unaccustomed gym exercise.

Typical recommendations for dealing with DOMS include gentle stretching and exercise, massage (of course!), submersion in a hot bath, etc. All these are aimed at lightly increasing blood flow to the muscles and damaged tissues to faciliate repair (and not flushing out non-existing lactic acid buildup).

(1) Robert D Hyldahl, Justin Keadle, Pierre A Rouzier, Dennis Pearl, and Priscilla M Clarkson. “Effects of ibuprofen topical gel on muscle soreness”. Med Sci Sports Exerc. 2010 Mar;42(3):614-21.

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

Sciatica and Massage

Many people claim to suffer from sciatica but what is sciatica?

Put simply, sciatica is a pain, usually in the back of the leg caused by compression, irritation, or inflammation of the sciatic nerve. The sciatic nerves are the longest and largest nerves in the body, running down the back of each leg and are about the diameter of your thumb.

The sciatic nerve is actually composed of four or five smaller nerves that leave the spinal cord from the lower spinal column, join together and then travel down each leg. It then divides into numerous smaller nerves that travel to the thigh, knee, calf, ankle, foot and toes. When these nerves are irritated or affected by the inflammation of nearby soft tissues, then this is referred to as sciatica.

There are several reasons why the sciatic nerve could become compressed, entrapped, or irritated. In “true” sciatica, the nerve roots can be compressed by herniated, degenerated or displaced lumbar spinal disc(s). This can be exacerbated by tight muscles and soft tissues in the lower back, buttocks or leg.

sciaticaThere are also other conditions which can mimic sciatic symptoms such as Piriformis Syndrome where the sciatic nerve is entrapped by the piriformis muscle in the buttocks. Piriformis Syndrome is sometime referred to as “back pocket sciatica” as pressure on the piriformis muscle and sciatic nerve can be caused by sitting on a wallet in the back pocket of a person’s pants. Another problem that can imitate sciatic pain is trigger points in the Gluteus Minimus muscle. The trigger points in this muscle can refer pain sensations down the back of the leg along the path of the sciatic nerve and also on the outside of the leg.

People with sciatica suffer from a wide range of symptoms. The pain may come and go at different times, it may be a constant problem and then it may subside for hours or days for no apparent reason. Some people may feel only a dull ache travelling down the back into the upper leg. For others, it may be intense sharp shooting pains all the way down the leg into the foot and toes.

Many factors can influence the pain of sciatica. If the sufferer sits in one position for long periods of time then the pain can increase. Long distance drivers and computer operators are particularly susceptible. Exercising, or even simple things like walking, bending, twisting or standing up may be difficult and painful. For some, the pain may change from side to side or be present in both legs. For others, back pain may appear before the sciatica emerges. In some severe cases, sciatica can impair reflexes, or result in the wasting of the calf muscles.

Treatments for Sciatica
The medical approach to dealing with sciatica is to treat the symptoms. This may include using painkillers, muscle relaxers or anti-inflammatory drugs such as NSAIDs . Traction, physical therapy or injections directly into the nerve roots may also be used. In severe cases, Surgery (such as microdiscectomy or lumbar laminectomy) is used to help relieve both pressure and inflammation.

  
Massage Therapy
Massage Therapy and Bodywork can help Sciatica, Sciatic Nerve Pain, in particular the conditions which mimic sciatica such as Piriformis Sydrome. Massage therapy can relaxes muscles, releases trigger points and abnormal tissue adhesions, and improve posture to relieve the pressure on nerve roots and other sensitive structures.

Other Manual treatments (including physical therapy, osteopathic, or chiropractic treatments) can help relieve the pressure. Chiropractic and Osteopathic techniques are often used in conjunction with treatment by a Massage Therapist.

Use a Tennis Ball
The knots in the muscles of the hip and buttock can be effectively treated with a tennis ball. Simply lie on a tennis ball such that it presses on deep, sore points and just wait for the feeling to fade. However please be aware that the piriformis muscle is so unusually reactive and the use of a tennis ball to massage the piriformis needs to be gentle and conservative.

Jump in the Spa to Relax the Area with Heat
Whether the pain is caused by the crushed sciatic nerve itself, or just by tight muscles, the muscles need to relax. Hot tubs, with jets, are ideal for sciatica.

Check Your Posture
The types of sciatica that are related by excessive sitting may be influenced by the ergonomic design of work station and/or chair. It may be worth experimenting with your chair and the layout of your work station. A simple option is to use a timer to remind yourself to get our of your chair at regular intervals such as every fifteen-twenty minutes.

By Richard Lane

Cellulite Massage

Cellulite – the mere mention of the word can bring about a highly negative reaction in some women. There are many creams, body wraps and treatments that are claimed to bring about reduction in or an elimination of cellulite, yet much of the money that is spent on cellulite is simply wasted as there is little evidence that they work. Some people claim that most of the research that is reported is paid for by companies with an interest in promoting favourable aspects of results and is not truly scientifically independent.

Abdominal massageThere are also many massage therapists who promote that their massage techniques can bring about a reduction in cellulite and they claim that there are studies that support that cellulite can be smoothed and reduced by a cellulite massage.

What is Cellulite?
Cellulite is not an actual disease but a condition of bulging fat cells that lead to an appearance of bumpy looking fat on the skin. In some circumstances the fat cells expand to the point that they result in the bending of collagen fibres surrounding them which gives rise to a puckered skin appearance. There are still some arguments about how the fat cells originate; some say that it is the result of a build up of metabolic waste due to ineffective lymphatic drainage and/or poor circulation, others claim that it is more environmental (tight clothing for example) or diet related. However, aspects that are generally agreed upon are that the incidence of cellulite is hereditary and the thickness/configuration of the dermis plays a significant role. For example, men who typically have a cross-hatch type pattern of connective tissue beneath the dermis, are much less likely to be affected with cellulite.

Treatments for Cellulite
Exercise and Diet
Although there are so many health reasons for having a good diet with lots of fresh and natural foods along with regular exercise, unfortunately these will not “cure” cellulite. If you lose weight, then there may be a reduction in the levels of fat that occurs as cellulite but for most women, genetics are the overriding factor and the cellulite appearance can be considered as being predetermined by her genes.

Creams
Probably as much money is spent on creams as any other treatments but there is little evidence that they offer long term benefits. The proposition that a topically applied cream will penetrate the skin and act on the fat deposits, is hard to contemplate particularly as the skin is normally considered as a great barrier.

Some people do feel that regular application of creams does reduce the appearance of cellulite although it is probably the case that the cheaper creams are as good as the expensive creams that contain wild and exotic ingredients. This is particularly relevant if it is possibly the mere act of massaging the cellulite that may be responsible for the transient improvement in appearance.

Endermologie
For women who have spent time and money on cellulite cures, then the phrase Endermologie will be familiar to them. There are many clinics offering Sydney Endermologie or Lipomassage or the like. Endermologie is claimed to work by suctioning the skin with a vacuum and then applying a type of deep tissue massage using a set of rollers.

This type of process which can break up adhesions and fibrous bands, can improve the appearance of the skin for some women. However, the effects are not permanent and the cost of regular sessions can mount up very quickly.

Cellulite Massage
Whilst massage therapy has numerous benefits for the body and the mind, there are some therapists who claim that their massage will bring about improvements with respect to cellulite. For example, they wildly claim that deep tissue massage can break up the fat deposits and eliminate toxins. Lymphatic drainage may assist in removing oedema and accumulated fluid in cellulite affected areas but the relationship between fluid elimination and reduction in cellulite has never been proven.

  
Other Treatments
There are many other devices that are available with differing degrees of success and if you are interested in any of these, then it is a good idea to spend a little time doing research before you spend your money. And it is always good to be sceptical about suppliers’ claims.

One treatment that has been approved by the FDA that may offer some benefits is Vela Smooth which combines Bi-Polar Radio Frequency, infrared light energies, plus negative pressure and tissue manipulation to smooth the skin. Again though if you read independent online reviews then some women have claimed success whereas others have felt that they have wasted money and had their raised expectations dashed.

If you are thinking of trying a treatment, be it a cream, a machine or for sessions of lymphatic drainage massage for reducing your cellulite then it is advisable to shop around and do your research beforehand and always be wary of pre-paying large sums of money for treatments without guarantees of success.

By Richard Lane

Should Massage Hurt?

Ask 10 therapists this question and you are likely to get 10 very different answers. Some therapists do not believe that massage should be painful, ever, and if you are in any sort of discomfort then you are being massaged too hard. Other are at the opposite end of the spectrum and if you are not squirming, squealing and wriggling as they beat the knots out of you then they are not going hard enough.

My answer….it depends.

If you are purely after relaxation massage at a day spa or for stress relief then you would be looking for a massage that is be blissful and pain free. If you have never had a massage before then this is probably the end of the pain spectrum that you can reasonably expect to receive.

You should not feel sore or uncomfortable that day (or the next morning) and any pain is an indication that the therapist wasn’t listening to you or your body.

However, I’m sure I gave one of those massage in 2004.

Deep Tissue massage of a woman's thighPeople who book in to see me are generally after remedial, deep tissue or sports massage and for this group of massage recipients then some degree of discomfort both during and after the massage should be anticipated. Sometimes you have to take one step back to move two forwards.

If you are suffering from a sore back or a stiff neck then myofascial restrictions and adhesive scar tissues need to be worked. Polishing the skin just isn’t going to cut the mustard even if it does calm the nervous system and relax the sympathetic nervous system. You need to get into the muscles (and other soft tissues such as ligaments and fascia) and disrupt their current condition in order to obtain the response that you are looking for.

Now although a deep tissue massage sounds as though it should be excessively painful, this is not necessarily the case. Deep tissue merely means working the deeper levels of tissue, working through superficial layers of fascia and muscle to achieve a change in the structure of the deeper tissues.

But while it needn’t be excessively painful, in reality it is almost always the case that it can be uncomfortable. Personally I do take issue with therapists who say that deep tissue massage should never hurt and feel that either they have never experienced genuine deep tissue massage or they are doing it wrong.

By the same token, though there are therapists who work at such a pressure and intensity that a client is literally bruised and in more discomfort than when they started the massage. “No pain – no gain” may the mantra of the therapist. This doesn’t sit comfortably with me but if it works for them and their clients then so be it. So long as they are genuine with their intentions, explain how they will work and warn their clients how they will feel after the massage then that’s ok with me.

It’s just not the way I work.

  
I like to work within the clients pain threshold so that whilst it may be uncomfortable and bordering on painful (when I consider it to be appropriate), it should never be so heavy that they are wincing and flinching on the table. By the way, the level of pain threshold does tend to increase the more massage you receive and arguments have been made that this isn’t necessarily a good thing (eg needing more and more pressure to achieve the same response is almost an addiction).

Ultimately it is up to you to find a massage style and therapist that suits you. If you have never had a massage before and you are in pain during the massage, then speak up. Similarly if you know what you want and the therapist is one of those who insists on not hurting you at all then maybe you need to find someone else who can give you the type of bodywork you are after.

By Richard Lane

Massage Swaps

There are very few people who do not benefit from massages and massage therapists are no exception. In fact, given the physical nature of the work often with suboptimal postural position, massage therapists probably need more massage than some other professions.

There are often debates on social networks about the merits of fellow massage therapists trading massages.

Massage exchangeIt can be a great way for students to practise their strokes and receive constructive criticisms about their bodyworking style in a non-threatening environment. They can learn and discuss new techniques. They can ‘talk shop’ about the massage industry, their ideas and their business plans.

However, professional therapists who trade massages in Sydney tend to be the exception rather than the rule.

In theory it should seem logical that therapists work on each other. However, in practice, even though most therapists try it at some stage in their career, most end up deciding that paying for massages works better for them.

There are a number of reasons for why professional do not tend to swap massages.

– They struggle to find someone that they want to receive regular bodywork from who also wishes to trade.
– They struggle to find suitable times that work for both parties.
– Very few therapists like to do a mutual swap within the same session. It is always very hard to get up from a massage table and then have to give your trade partner a massage straightaway.
– If they do find a massage swap partner who they do like, it is very rare that the bartering relationship is completely reciprocal. As often occurs in any relationship, one party tends to feel that they are investing more than the other. Eg one therapist may cancel or put paying clients ahead of their trade partner.

  
Most therapists tend to find swap partners when they are studying and it may well be that they only swap whilst they are learning new modalities or techniques. There are massage exchange websites where therapists can check out other massage practitioners who they may wish to consider swapping with. However, as a word of caution, many those with register with these sites may be after a sensual massage swap.

Even therapists who find that they are compatible with respect to swapping massages often drift away over time and what might start out as a weekly or fortnightly swap, ends up being just an occasional massage. In the end most experienced therapists end up preferring to become just another paying customer with therapists they enjoy receiving bodywork from.

By Richard Lane

Massage and Physiotherapy

Often when people ring to enquire about the nature of the Sydney remedial massage services that we offer there is some confusion and misunderstanding about what the differences between physiotherapists and remedial massage therapists. Some people believe that we offer similar services but this is not the case. Whilst there is a degree of overlap between the two professions, there is significantly more that is different.

Historically there are suggestions that the first chartered society of physiotherapists formed from remedial massages so there is a degree of commonality between them. However, since that time physiotherapists and physical therapists have moved away from this background and offer distinctly different treatments and therapies from remedial massage therapists who have largely stayed constant with their approach. Remedial massage therapists still rely on the same touch and palpation skills to provide the same benefits for their clients and there is no reason why the effectiveness of the application of these skills will have changed over the years.

Massage Therapy
physiotherapy and massageMassage therapists rely on touch to deliver remedial bodywork to their clients. There are many different massage modalities available such as deep tissue, sports, Swedish, Thai, trigger point therapy etc and they all work on the soft tissues of the body (mainly muscles but also tendons, ligaments and connective tissue/fascia). Massage therapists do not do any manipulation and, most importantly as a means of distinction from physiotherapists, they do not have sufficient training to be considered as diagnostic practitioners. If you are after a firm diagnosis of any condition you are faced with then you will need to see someone other than a massage therapist (although your masseur should be able to advise who to see for diagnosis).

People will most commonly see remedial massage therapists when they are suffering from muscular and soft tissue complaints. Sessions will typically last around an hour (or longer) and the therapist will use their hands, fingers, knuckles, elbows and forearms to provide the manipulation to the soft tissues. Although most remedial massage sessions have a direct therapeutic objective, for many people an added benefit is that, whilst the massage itself may be a little painful and intense, it will always provide a degree of relaxation for the massage recipient.

Physiotherapy
Physiotherapists will treat people who are suffering from injury or physical condition using a range of different techniques. Whilst hands on bodywork may be incorporated within this treatment, typically it is only a small component of any session. A typical physical therapy session will involve some assessment, some bodywork (if appropriate), application of ice, ultra-sound or tens machines and some corrective exercise therapy (which will normally involve exercises that the patient may do away from the clinic).

Typical injuries that may be treated by physiotherapists are both acute and chronic in nature. It is not uncommon for a physiotherapist to be seeing two or three patients simultaneously and so you may experience times during your session as the physiotherapists when you are not actually being formally treated by the therapist.

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If you are not sure who you should be seeing then it is always advisable to talk to any potential practitioner about your requirements prior to booking. You have the right to expect an honest answer regarding their suitability and appropriateness (although sometimes it can be a little tricky to make complete assessment over the phone). You should ask them about the nature of the treatment that you can expect.

As a rule of thumb, if you are suffering from an acute injury or require a firm diagnosis of your condition then it is probably preferable that your first port of call be a physiotherapist. It may be that after a few sessions then massage therapy may become more relevant for your treatment (generally in our view most people would sooner experience a massage assuming that their treatment goals are met).

  
If your condition is more general and chronic in nature, such as stiff neck or ongoing sore shoulder then massage therapy may be appropriate. This is particularly the case if you wish to have a more general approach with the therapist devoting their time solely to your body rather than a session that is totally dedicated to dealing with the soreness in your left forearm, for example.

Regardless of the therapy you receive, then it is suggested that you talk to your therapist about goals and milestones with the treatment program. If you do not feel you are progressing at the rate you would like then it may be an idea to consider alternative treatments (although it is also recommended that you give a therapist a fair opportunity to make progress and not just chop and change after one or two sessions).

The Benefits of Abdominal Massage

Many massage therapists will spend the vast majority of session working on the back of the client. They will give great bodywork to the back, shoulders, neck and the back of the legs but then only give cursory attention to the front of the body. Now it is true that most of us have significant issues with the back of our bodies but to neglect the muscles and soft tissues at the front of the body is to provide an incomplete session. Only a few therapists would routinely incorporate an abdominal massage within a full body massage, yet there is little doubt that bodywork through the stomach area can offer many health benefits.

Abdominal massageMost people who do request an abdominal massage would likely do so because of digestive issues although there is also significant musculature in the area that may require release to assist with physical problems. For example, a tight and contracted rectus abdominis muscle will impact on the stability and movement of the lower part of the body or lead to us slouching forward setting up postural imperfection through the lower back.

In total there are at least four layers of muscles in the abdomen and these can impact on your core strength (both your physical and emotional core). Trigger points are not uncommon in the abdominal muscles and the pain referral patterns can include the lower back. Simons and Travell (1) observed that

An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level … In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.

Regardless of the requirement for remedial massage and trigger point techniques for hypertonic muscles in the abdomen, the vast majority of abdominal massage will be for digestive issues. Most therapists consider that massage to the stomach areas will improve the capability of the digestive system and will potentially benefit some of the organs that are contained within the abdominal cavity (such as liver, pancreas, gall bladder, small intestine and colon). A recent review of research has confirmed that there are likely to be benefits for performing abdominal massage to treat chronic constipation. Sinclair (2) concluded “studies have demonstrated that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it. There is also good evidence that massage can stimulate peristalsis in patients with post-surgical ileus.”

Routine for Abdominal Massage
In order to give an abdominal massage then the stomach needs to be exposed and it is usually recommended that there be some bolstering under the knees to slightly relax the abdominal region. Normal massage lubricatants are fine to use.

– Place your hands gently on the stomach and palpate. The stomach should feel soft and relaxed

– Always be aware of the breathing of the client and work with the breathe, not against it.

– Sink in through the diaphragm region with the breathe of the client

– Lightly work along the lower border of the rib-cage with fingers and thumbs.

– Gently effleurage the area with light circular strokes. Always work in the direction of the digestive system which means working clockwise around the stomach.

– Place your hands over the rectus abdominis and gently palpate for areas of tenderness and restriction. Work the edges of the muscles with static compression (asking the client to tense the muscle by have them start to sit up) with sufficient pressure to be therapeutic but not too much that it causes pain. Release attachments at the xyphoid process (obviously without ever putting direct pressure on the vulnerable process itself). Release the attachments at the upper border of the pubic bone (mindful of the sensitive nature of this area – if client has any concerns then you can get them to use their own hand to achieve this release or alternatively work through a drape).

– Work deeper under the ribcage on both sides of the body (be aware of working too deeply directly into the liver which is on the right side of the body). Cross friction at any tender points.

– Pull through the sides of the body with relaxed hands, reaching around the body as far as possible, working and stretching the fascia.

– Work the ascending colon (right side) and descending colon (left). Make sure you connect with sufficient pressure through colon although not too much so that it causes pain. Some therapists recommended clearing the descending colon first too “make room”.

– Finish with a calming connective touch to the abdomen.

  
Normal massage contraindications would apply for abdominal bodywork and if the massage is to be performed for a specific health objective then it is recommended that it be discussed with suitable doctor prior to treatment. Also be aware that many people may have emotional sensitivity and instinctively be highly protective of this so any bodywork needs to be mindful and respectful

1. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body, 2nd Edition. Lippincott, Williams and Wilkins, 1999:943.
2. Sinclair M. The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 2011; 15:436-445.

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Update – a 2011 review of the effect of abdominal massage in chronic constipation found that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it.

“The use of abdominal massage to treat chronic constipation.” Sinclair M.
J Bodyw Mov Ther. 2011 Oct;15(4):436-45. doi: 10.1016/j.jbmt.2010.07.007. Epub 2010 Aug 25.
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By Richard Lane

Therapeutic Breast Massage

Breast massage can be a contentious issue amongst therapists. Some promote that there potential health benefits through lymphatic drainage; others are less enthusiastic about any advantages of performing breast massage. Some are concerned about the personal nature of any Sydney massage that involves touching of breast tissue; others are more relaxed.

However, it must be mentioned that professional associations have policies regarding breast massage. For example, the Australian Association of Massage Therapists offers a policy development document on this issue at http://membership.aamt.com.au/lib/Journals/Summer06/AAMTbreast.pdf.
Within this document they state:

Massage therapists must recognise, accept and respect the right of every individual client to choose whether they wish to decline breast massage …..
Even when agreement with the client for the breasts to be included in a treatment is granted, it is entirely inappropriate and completely unnecessary to provide disproportionately prolonged massage to the area and that that the client is free to revoke that consent during the massage.

AAMT suggest that massage of the breast tissue is currently practiced in modalities of Manual Lymph Drainage, Lymphodema, Lomi Lomi and post surgical breast augmentation and when specifically prescribed by a Medical Practitioner. During a standard remedial or relaxation massage then there is no reason for the breasts to be massaged and the ATMS policy is that mammary glands should not be massaged and only professional techniques should be applied to surrounding tissues.

This last point can cause a little confusion from massage recipients though. For example, the pectoral muscle groups are often indicated when people have tension in their neck and shoulders. Tightness in the upper back muscles is often the result of excessively hypertonic pectoral muscles bringing the shoulders forward. Therapists may often feel that lengthening these muscles of the upper chest is important for improved posture yet to access these muscles then the therapist needs to work close to breast tissue.

Massage for the pectoral musclesThe picture to the right on this page of this page demonstrates a therapist performing a remedial massage technique on the pectoral region. It is easy to image that, on women with a larger bust, performing such a stroke for the pectoralis major and pectoralis minor muscles would be extremely difficult without touching breast tissue.

But this stroke would not be applying massage to the breast itself.

  
Therapists do need to be mindful of such strokes, explaining why they need to work in this area and soliciting permission from the client before commencing. The client also has the right to request the therapist stop should they ever become uncomfortable about the nature of the touch. Some therapists may ask the client to hold their breast to provide a physical barrier between the therapist’s hand and the breast.

As mentioned above breast massage in Sydney is not permitted within a remedial or relaxation massage. I have included the technique (with client permission) during Lomi Lomi massage. Within a traditional Lomi Lomi massage then including massage to the breasts is considered to be a normal part of the routine and whilst there is obviously no muscles within breast tissue, there are claims that it can reduce pain and stress in the chest.


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