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The Physical Determinants of Pain

24/4/2025

 
By Duke Autret, Myotherapist
When it comes to understanding and addressing pain, as well as the psychological and social factors it's important to also consider the physical determinants that can contribute to discomfort. In this blog post, we will explore the key physical determinants of pain and how they can impact our well-being. By recognizing and addressing these factors, we can work towards reducing pain and improving our overall physical health.
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Let’s start with the fundamental root cause of all structural problems from the physical standpoint, which is to say Overload. From here we'll look at the myriad of ways this comes into play.
When we break it down further, there can be two distinct categories of overload.

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Acute Injury vs Chronic Overuse
The obvious one is of course an injury, an acute trauma to some part of the body and the details of that event will determine what structure/s may have been damaged. 
Then there is the Overuse side of things. The main difference between acute injuries and chronic overuse is the timing and underlying causes of the pain. Again, Acute injuries often occur suddenly as a result of a traumatic event, such as a fall, an impact, a sudden or over-reactive movement, or sports-related incident, causing immediate pain, swelling, and limited mobility. On the other hand, chronic overuse injuries develop gradually over time due to repetitive movements or prolonged stress, resulting in persistent pain, localised tenderness, and perhaps stiffness. First course of  management for acute injuries will usually involve rest, ice, compression, and elevation, while chronic overuse injuries require a multifaceted approach addressing underlying causes, modifying activities, and implementing rehabilitation strategies to restore function and reduce pain.
So to sum up, while they are both still forms of Overload, one is from a sudden or Acute load, and the other from repetitive and/or prolonged Chronic loads.

Furthermore there are two main divisions when it comes to the tissues or structures of the body that may be overloaded. 1) Passive structures such as ligaments, cartilage, joint capsules, discs, bones etc. And 2) Active structures which are the muscles.   
And how does overload of the active and passive structures/tissues of the body occur?
Here are the main reasons. 

Weakness 
Weak muscles are themselves more easy to overload, and more quick to fatigue which not only can lead to muscle stress and resulting tightness, soreness and referral pain (pain which travels/radiates out to other places), but therefore can also can put additional stress on our joints and lead to pain and discomfort. Another phenomenon that can happen due to muscle weakness somewhere is that other muscles may have to work harder to compensate for it and thus then those muscles will be overworked/used/loaded.
Whether it's due to a sedentary lifestyle, lack of exercise, or specific muscle imbalances, weakness can contribute to musculoskeletal issues. Strengthening exercises targeted at the weak muscles can improve their capacity for load tolerance, overall function, resilience, and can help alleviate pain.

Mobility (hypo or hyper)
Restricted joint mobility and limited muscle flexibility can contribute to pain and discomfort. When adjacent regions to an area of complaint lack mobility, it can result in overloading that specific area. For example, a sore knee with normal range of motion may experience overload due to limited mobility in the joints above and/or below, such as the hip or ankle. On the other hand, excessive joint mobility, known as hypermobility, caused by weak muscles, stretched ligaments, or a fairly common genetic conditions (known as generalised hypermobility and/or Ehlers Danlos syndrome) can all lead to joint instability (and are susceptible to poor positioning and frequent subluxation or even dislocation when severe), muscle tightness, and subsequent pain or discomfort. Balancing joint mobility and stability is crucial in maintaining optimal musculoskeletal health. 
Other factors such as poor posture, prolonged sitting, and lack of stretching or movement can lead to stiffness and reduced flexibility and/or pulling an overstretching of passive structures. 
Incorporating regular mobility exercises, and mindful movement can enhance joint mobility, and alleviate pain. As can stability, strength, muscle endurance programs.

Movement patterns 
The way we move and perform daily activities can have a significant impact on our physical well-being. Dysfunctional movement patterns are ones that once again load up our structures more than necessary. Things such as poor technique when lifting, twisting, or repetitive motions. All of which can strain our muscles and joints and lead to pain. 
Different from strength, Movement patterns are more to do with muscle control, or how you use and regulate any muscle power, and can also be thought of as a repertoire of skills, many ways and techniques or patterns you could move to achieve an action or task. If your repertoire becomes limited then you end up having to use the same few patterns over and over again, leading once again to overload.
Mindful movement practices like pilates, taichi, feldenkrais and yoga, functional training, and ergonomic adjustments can help optimise motor control and movement patterns and reduce the risk of pain and injury.

Alignment & Posture 
Poor posture is basically a repeated and prolonged overuse of body parts and positions and can place excessive loads at certain areas and therefore stress on our joints, muscles, and connective tissues, leading to pain and dysfunction. Factors such as prolonged sitting, improper lifting techniques, and repetitive movements can contribute to postural imbalances.
Joint mechanics also requires good alignment when moving through ranges of motion, when a well centred joint has to move it can glide without any friction at its pivot point, and so whether in static positions or dynamic movement practising good posture and incorporating exercises that promote good alignment can help alleviate pain and improve overall function by better distributing the loads across the body rather than having it overly concentrated in certain places.

Muscle imbalances
Muscle imbalance refers mainly to relationships of length and stiffness between muscles and can occur for example when certain muscles become overactive or tight, while others become weak or underactive. It’s a kind of shorthand way of conceptualising the result of any of the above combinations, and then feeds back onto itself. So for example, poor movement patterns or long standing postural patterns can turn into muscle imbalances, which then in turn becomes more likely to reinforce poor movement and posture as well as joint positioning (joint centration), new compensations etc., and thus increased stress on areas of the body. Corrective exercises with an aim of restoring balance to opposing muscle groups via targeted stretching and strengthening to help rebalance muscles and joints and offload the irritated tissues.

Sedentarism 
Sedentarism, or a sedentary lifestyle (characterised by a lack of physical activity), is (perhaps the) one factor that contributes to all the ones above simultaneously. It leads to atrophy (reduced muscle size/fibres) of muscles within just days, which in turn means that weaker muscles are more prone to fatigue and overload, which can result in muscle stress, tightness, and referral pain. Additionally, weak muscles may cause joints to become hypermobile, and/or other muscles to compensate, and all to become overworked. A loss of mobility can often be caused by prolonged sitting and lack of movement, can lead to restricted joint mobility, reduced muscle flexibility, and limited range of motion through adaptive tissue length and pliability loss. This can contribute to pain and discomfort, especially in adjacent regions of the body or vice-versa. Dysfunctional movement patterns, such as poor lifting techniques and repetitive motions, can strain muscles and joints, while limited movement repertoires can lead to overload and pain. Additionally, muscle imbalances, characterised by overactive or tight muscles and weak or underactive muscles, along with malpositioning of joints, can alter joint mechanics and movement patterns, resulting in increased stress on specific areas. Poor alignment and posture, often influenced by factors like prolonged sitting and improper lifting, can further exacerbate tissue stress. To address these issues comprehensively and reduce pain while improving overall physical well-being, including metabolic and mental health, it is crucial to incorporate regular strength and mobility exercises, mindful movement practices, and promote good posture.


To recap and distil all of this, one final important distinction commonly made is simply whether a condition is a Movement issue or a Workload Management issue. After considering all the information we have looked at, it becomes evident that both of these are essentially 'load' issues, but with different underlying causes. 
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The first, a Workload Management issue, arises from overloading tissues beyond their normal capacity, either through excessive force/weight or prolonged duration/volume. On the other hand, a Movement issue stems from a lack of control and alignment in muscles and joint structures, reducing their capacity and tolerance to handle usually acceptable loads.

Although when simplified, load is at the base of all the physical determinants, it’s important to recognise also that there can be combinations of each and any of these various factors mentioned where the effects of overload can be compounded. For example a suboptimal movement pattern which has become repetitive, and then might be performed with extra load than usual (say a heavier item this time), and maybe even working harder to compensate for a currently stiff neighbouring joint, possibly throw in some muscle imbalances and/or joint instability and voila.. All these can obviously add up to a bit of a sore spot! Recognising these differences means we can tweak the way we might approach remedying the situation.

By addressing the physical determinants of pain, including weakness, insufficient mobility, muscle imbalances, alignment and posture, and movement patterns, we can take proactive steps towards reducing pain and improving our physical health. It's essential to work with healthcare professionals, such as physical therapists or exercise specialists, who can provide guidance and develop tailored strategies to address these factors. Embracing regular exercise, maintaining proper posture, incorporating mobility work, and adopting mindful movement practices can contribute to a pain-free and active lifestyle. Remember, each person's experience with pain is unique, so it's important to consult with a healthcare professional for a comprehensive assessment and personalised recommendations.

Myotherapy for Hypermobility Spectrum Disorders & Ehlers danlos syndrome (EDS)

29/4/2024

 
By Duke Autret, Myotherapist

Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos Syndrome (EDS) present unique challenges for individuals due to their impact on connective tissues, resulting in increased flexibility and susceptibility to joint pain and instability. While HSD is considered less severe than EDS, it still significantly affects the quality of life for those affected. Myotherapy emerges as a valuable approach to managing the symptoms of both conditions, offering relief and improved functionality.
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Understanding the Connections between HSD and EDS
The broad umbrella encompassing both of these conditions is called Hereditary Connective Tissue Disorders (HCTD). Both HSD and EDS share numerous symptoms, but they also exhibit critical distinctions. HSD encompasses individuals with hypermobility who don't meet the criteria for an EDS diagnosis. EDS, on the other hand, is a genetic connective tissue disorder with the possibility of also affecting the skin, joints, and blood vessels and even heart.
Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos Syndrome (EDS) present unique challenges for individuals due to their impact on connective tissues, resulting in increased flexibility and susceptibility to joint pain and instability.
The exact causation of these conditions remains elusive, though it's believed to stem from a blend of genetic predisposition and environmental factors. While some may inherit a susceptibility from genetics, others may develop it due to joint injury or overuse. HCTD manifests primarily with joint pain, stiffness, and instability. Additional symptoms include fatigue, digestive issues, headaches, and challenges with balance and coordination.

Myotherapy Interventions for Managing HSD
Myotherapy serves as an effective approach in alleviating the symptoms of HSD, offering tailored techniques to address joint pain, muscle stiffness, and fatigue while promoting overall well-being.
  • Massage Therapy: Massage therapy, a cornerstone of myotherapy, aids in muscle relaxation, improved circulation, and pain reduction. It effectively eases joint stiffness and enhances mobility, crucial for individuals with HSD.
  • Myofascial Release: Myofascial release techniques involve applying sustained pressure to the connective tissue surrounding muscles, facilitating tension release and enhancing flexibility in joints and muscles. Usually this sort of intervention is avoided however in these conditions since joint flexibility is already excessive. 
  • Trigger Point Therapy: By targeting specific muscle points, trigger point therapy releases tension and alleviates pain, particularly beneficial for those experiencing muscle stiffness and tension associated with HSD.
  • Dry Needling: Dry needling, through the insertion of thin needles into muscles, effectively releases tension and promotes circulation. This technique proves invaluable for individuals with HSD experiencing muscle spasms and tension since it also has minimal lengthening effects on the supporting tissues and therefore avoids detracting from joint stability.
  • Exercise Therapy: This is one of the more necessary and effective interventions for Hypermobile conditions in the long term. Promoting both targeted and global joint stability and control via the coordinated and intrinsic muscular systems is paramount for the overall resilience of the joint, connective and also muscular tissues, which otherwise are over stressed from uncontrolled compensation strategies.

Embracing Relief through Myotherapy
Hypermobility Spectrum Disorder poses a myriad of musculoskeletal challenges, impacting joint stability, and inducing pain and discomfort. Myotherapy can be a helpful treatment avenue, offering a range of techniques tailored to manage symptoms effectively and support long term stability through exercise.

If you're grappling with HSD, consider integrating myotherapy into your treatment regimen to embark on a journey toward an improved quality of life. All of our therapists can help you with hypermobility related symptoms, and booking online is quick and easy to begin your treatment.

Simple Wellness Myotherapy is located at Shop 12B/150 Kelletts Rd, Rowville VIC 3178. Additionally, you can contact us on (03) 8204 0970 to arrange an appointment today. ​

The stiff joint: why are mobile joints necessary for musculoskeletal health.

3/3/2023

 
By Peter Pascalis, Clinical Myotherapist
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When joints become stiff and sore we can be very aware of them. Standing from a chair can make us feel like we've aged 30 years. It can feel hard to do the most basic of things, like just straightening or bending your knee or elbow. We can feel a sharp jabbing sensation somewhere in our neck, our back, or any other affected joint. 
Joint dysfunction can alter muscle patterns, often creating compensations which cause further stress on neighbouring tissues, and changes to our ability to sense our body in space.

​So what can we do about it?
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In order for joints to move nicely on each other a certain degree of motion must be available or we end up with faulty motion and the potential for pain, inflammation, scar tissue, and overly worked soft tissue. The assessment of these joint movements requires the clinician to observe active and passive range of motion (termed as physiological and accessory motion) which are the small movements we cannot consciously control but which must exist to ensure the congruency and optimal function of joint surfaces. 

A reduction in joint glide or slide can cause dysfunction of the musculoskeletal system often leading to pain and stiffness, not to mention more serious pathology like a disc herniation and chronic pain may be a result of ongoing joint issues.

In our clinical experience it is common to find these faulty joints often termed as hypomobile, meaning that they move less than other joints above or below them. 

Hypomobility will increase the tension on adjacent joints making the inert tissues such as ligaments prone to stretch. This micro trauma can initiate an inflammatory response with scarring of tissue and further reduction of movement and pain. Due to the close proximity of spinal nerves, muscles and body systems can be affected often with increases in painful areas. 


Mobilisations are graded in 4 stages which correspond to the amount of movement and force applied by the treating practitioner. The assessment of movement and pain precedes an informed decision to mobilise joints and this must be agreed to by the client. Grades 1 & 2 are used to reduce pain and grades 3 & 4 to increase mobility.

Is a mobilisation the same as when a Chiropractor cracks your joints?
What sets mobilisations apart from high velocity thrust manipulations (the 'cracking" of the joints) is that manipulations are produced by progressing beyond the physiological limit of a joint range whereas all 4 grades of mobilisation are within the range of the joint. This is why a pop is heard during a Chiropractic manipulation, which is the release of gases from the joint surface. Both mobilisation and manipulation have similar physiological effects on joint movement and soft tissue responses and are carried out by professionally trained clinicians.


As Myotherapists we are trained and insured to perform all 4 grades of mobilisations. 
Joint mobilisation can reduce sensitivity to painful stimuli and changes to the sympathetic nervous system. For a more in depth understanding of the physiological and neurological effects of joint mobilisations please refer to the blog titled I’m In Pain: How Can Myotherapy Help?

When pain reduction and improvements of movement have been achieved another technique called Mobilisation With Movement (MWM) developed by Physiotherapist Brian Mulligan can further create pain free movement in the most restricted movement, meaning that the movement which causes restriction can be directly targeted with accessory glides whilst the patient performs the action. These are generally pain free and improvements can be seen instantaneously. The benefits of such a treatment is that patients can see and feel the immediate improvements in range and further progress can be achieved with sports taping to support the new range. Although mobilisations and mobilisations with movement are preferably performed on skin these techniques can certainly be effective for patients that prefer to be fully clothed for their treatment. The treatment belt is used for stabilisation during treatment and to mobilise the patient while movement occurs. 
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As mentioned earlier a thorough assessment is performed to identify the hypomobile joints however sometimes we can also find joints that are moving more than would be ideal - these are termed hypermobile joints.
Hypermobile joints have the opposite problem, they have too much freedom to move and this can cause muscular pain as your muscles work overtime to stabilise the joint. For this type of joint problem we would prescribe exercises rather than increasing mobility at an already hypermobile joint. 


Mobilisations and MWM’s are a couple of wonderful treatment techniques underpinned by extensive research and clinical efficacy which are used to improve pain and function.

Book with me for a thorough assessment and treatment plan for your joint pain, whether its stiff achy hypomobile joints or sore fatigued and over worked muscles stabilising a hypermobile joint. I'm available Mondays, Wednesdays, Thursdays and Saturdays, and you can make an appointment with me online or phone the clinic on 03 8204 0970 to book in.

now we have 5 therapists to choose from!

24/7/2022

 
Getting a Remedial Massage or Myotherapy appointment is becoming even easier now that we have two new therapists joining our Rowville team! Join us in welcoming our two great new practitioners to the Simple Wellness clinic!

Kel Levi will be joining us from Wednesday July 27th. Kel is an experienced Myotherapist who is currently working alongside AFL Premiers Melbourne Football Club helping their players during and after their matches. She's also a qualified personal trainer, and has a wealth of knowledge in the health and fitness realm. She has a great firm massage style, loves to use dry needling to help reduce pain and improve movement, and can use her extensive background in fitness and exercise to help you find ways to stretch and strengthen your trouble areas with ease. Myotherapy and Remedial Massage with Kel can be claimed through our HICAPS machine with private health insurers like BUPA, Medibank, HCF and all other health insurers.

Kel will be available: Mondays and Wednesdays 9-12, and occasional Fridays (when Melbourne Footy Club don't need her expertise in the club rooms!)
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Colette Corr is our new student Myotherapist, who is starting with us on Tuesday August 2nd. Colette is a final year Bachelor of Health Science Myotherapy student, which means she's completed the vast majority of the 3 year Bachelor degree program and is down to the last few subjects, including student clinical hours. We'll be offering discounted treatments with Colette while she's finishing up her degree. In addition to Myotherapy, Colette is also a yoga instructor with over 5 years experience, and loves to work with people with chronic pain and hypermobility/Ehlers Danlos Syndrome. As Colette is a student, private health claims can't be made for treatments with her.

Colette will be available: Tuesdays 2-7 and Saturdays (alternating between morning and afternoon shifts)
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As always, bookings with our team of fantastic therapists can be made instantly online or by phoning us on 03 8204 0970.

Why Do My Joints Click, Crack and Crunch?

6/4/2020

 
We've all experienced a joint making a click, crack or crunch noise at some point. Some people much more than others.

But what is it that causes a joint to become noisy like this? And does it spell bad news for your joints down the track?
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Cavitation - The Gas Bubble
Cavitation is normal and not dangerous. Most popping and cracking joint noises are likely to be caused by cavitation - that is, the formation of a gas bubble within the joint.
Now you may have heard that joint noises are the popping of an existing gas bubble within the joint, however an interesting study published in PLoS One (Public Library of Science) in 2015 used real time visualisation of a joint under MRI to see exactly what occurs in the joint space when you crack a knuckle.
What they found was that when the joint separated, it formed a bubble, rather than popping an existing bubble.

Its called tribonucleation - this complicated sounding word describes the process of creating gas bubbles between two objects. It involves two solid surfaces that are covered in a liquid that contains dissolved gas. The surfaces resist being pulled apart because the liquid creates a suction effect, until enough force is generated to suddenly break the contact with each other, resulting in creating a gas bubble.

In a joint, the solid surfaces are the two bones and articular cartilage surfaces that form the joint. The liquid containing dissolved gas is the joint fluid, called synovial fluid, that lubricates the joint surfaces to make it easy and smooth for the cartilage-covered bony ends to slide over each other. When a joint is put under enough force, the bony ends can be moved far enough from each other to break their contact momentarily, and cause that familiar pop noise.

This can happen from purposefully trying to crack a joint, like cracking your knuckles, or from movements like squatting which can make your knees crack, or doing a spinal twist stretch which might crack your back either intentionally or unintentionally.

People with hypermobility in their joints can experience a lot more popping and cracking noises than other people. This is because their joints tend to have more freedom of movement due to having stretchy ligaments so its easier for cavitation to occur. The role of ligaments is to connect the two bones of a joint together and keep it stable and stop the bony ends from separating.

Will it cause arthritis? Its unlikely that cracking your knuckles and achieving that satisfying cavitation "pop" will cause you to develop arthritis in the long term, there are many more factors involved in developing arthritis.


Movement of Tendons over Joints
These sounds tend to be more of a snapping type of sound, because its the sound of the tendon moving over a bony area of the joint.
Tendons are the strong connective tissue bands that connect muscles to bones, and for muscles to move a joint they need to cross over it. This means that sometimes the tendon will have to slide over a bony point where it will have to stretch like a rubber band to maneuver it, and will "snap" back due to elasticity of the tissue.
Common snapping sounds from tendon movement can be heard in the knees, hips and shoulders.

These movements shouldn't be painful, but if you do start to feel pain when you're hearing or feeling the movement of the tendon over your joint, get it checked out. Your myotherapist may be able to make a big change to the discomfort through simple muscle relieving techniques.


Changes in Articular Cartilage
Sounds from changes in articular cartilage tend to sound crunchy, crispy or "like gravel". Its called crepitus, but the sound is often worse than the sensation, and many people don't feel any pain at all.

The term "bone on bone" gets thrown around, and this scares a lot of people because they visualise the bones literally grinding away at each other. The reality is that the ends of our bones are covered in articular cartilage, which is a smooth, squishy padding on the ends of bones that makes movement easy, fluid and painless and which prevents any direct "bone on bone" contact. Over a lifetime there will be normal changes to your cartilage, just like there is to a car, or a pair of shoes, or a well used garden pathway.

Sometimes the changes in the cartilage can be that it becomes torn or damaged, for example if you have an accident, take a big impact to the joint, or get an infection. It can also build up over time from things like high intensity sports, repetitive use of the joint, or increased load on the joints from growing quickly or rapid weight gain such as pregnancy.

Damaged cartilage can break down and remain in the joint space, which means the once-smooth surfaces become a bit rough, and there may be particles in the joint fluid. This can cause noisy movement of the joints, but its often painfree. Sometimes this can cause the joint to become irritated, which may cause it to swell up or become hot and inflamed, and then it can be temporarily painful.

Do you need surgery? Many kinds of surgeries are used for joint problems, but not every person needs to go down the surgery avenue. Surgeries range from very short day procedures like arthroscopes which clean out cartilage debris in the joint space, to full joint reconstruction or replacement surgeries. Many people find they can prevent surgery for a long time with a tailored exercise program to strengthen the joint and reduce load on it, and using supports like braces or taping. Surgery is not guaranteed to fix the problem.

Try your first treatment for $97 (normally $115)
If you're having significant pain with your noisy joints, let us help - book an appointment with us today!

Joint Subluxations: Like Dislocations (But Not Quite)

27/2/2019

 
​Most people understand joint dislocations. But subluxations, or partial dislocations, are a bit different. As a myotherapist, I see plenty of subluxations and related injuries every week. So let’s look at why subluxations aren’t quite dislocations, and what you can do about them!

​​What is a subluxation?
Unlike a dislocation, a subluxation is a partial displacement of the joint. With a dislocation, the bone is completely out of the joint it belongs to. But with a subluxation, the bone is only partly out.
 
Just because it is not a full dislocation doesn’t mean that it won’t hurt! Subluxation can still be painful, as the joint is being wrenched out of its usual spot. It can also leave you at higher risk of chronic pain if the joint isn’t rehabilitated after the injury.
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In the image above, we're looking at the ball and socket joint of the hip. The Normal hip joint shows the ball of the femur (thigh bone) sitting neatly inside the socket joint of the pelvis. In Dysplasia, the shape of the socket is not correctly formed so the socket doesn't snugly hold the ball of the femur. In Subluxation, the ball of the femur has partially slid out from the socket, and while its still almost in the right spot, it likely won't move smooth and painfree like the normal hip. And in the Dislocation, the ball of the femur has entirely moved out of the socket.

Why do joints sublux?

It is easier for a joint to sublux than it is to dislocate. That being said, if you have full strength and integrity in your joints, it will take a high-impact injury to sublux a joint. This is usually something like a fall, car accident or a sports injury.
 
However, some people are at a higher risk due to weak, unstable or unusually shaped joints. A previous history of dislocation or subluxation can weaken the joint and make it more prone to a sublux.
 
People with hypermobile joints can sublux joints with minimal force, because the ligaments (connective tissue that holds the joint together) are more elastic than they should be. This can lead to the person being very flexible but also more prone to subluxations – some of my more hypermobile clients can sublux joints while walking, sitting, or even sleeping!
 
You can also have variations in the shape of your hip or shoulder joints that make it easier to sublux. Hip dysplasia is one common variation that increases the risk of subluxing a hip joint, like in the image above.
 
Joints at risk of subluxation
In the clinic, I’ve seen almost every subluxation possible, thanks to my hypermobile clients! But there are several joints that are easier to sublux due to their location and structure:
  • Shoulders
  • Elbows
  • Hips
  • Knees
  • Fingers
  • Toes
 
If you have hypermobile joints, you may be at risk of subluxing other joints like ribs, jaw and collarbone.
 
How is a subluxed joint rehabilitated?
It can depend on the type of subluxation, and how it occurred. If it was due to high-impact trauma, there’s likely to be a decent amount of joint damage that needs attention. It could take weeks before the pain subsides enough to focus on rehabilitation.
 
But if the sublux occurred due to hypermobility or dysplasia, it might just need a little TLC for a week or two. After that, the focus will be on building up the muscles that support the joint to reduce the risk of recurrence.
 
Either way, the focus for rehabilitating the joint will include stabilising it, minimising any symptoms, and rebuilding the strength and integrity.
 
What can a myotherapist do for subluxations?
If you’re dealing with a subluxed joint (or multiple!), I’m here to help. Let’s look at how myotherapy can help with subluxations:

  • Assessing tight or weak muscles that are affecting the injury
  • Relieving muscle tension using remedial massage techniques
  • Mobilisation of the joint to help correct joint position, as well as increase movement and reduce sensitivity
  • Taping the joint using rigid or kinesiotape to boost stability and minimise pain
  • Prescribing exercises to rehab and strengthen the joint
 
So don’t sit at home and feel sore after a joint has subluxed. Come see your favourite myotherapist. We’ll have you feeling better in no time! Click here to book an appointment.

​All About Hypermobility – Supporting Your Loose Joints

10/9/2018

 
Many people know what it’s like to have a loose joint. Maybe you even considered yourself ‘double jointed’ when you were in primary school. But hypermobility is something that can be benign, or it can be a serious concern in some cases. So let’s look at hypermobility and how you can support a loose joint naturally.
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What is hypermobility?
Hypermobility is when a joint has a greater range of movement than usual. This can be caused by a handful of factors, including:
  • The range of movement of tendons and ligaments
  • The range of movement of muscles
  • Whether there has been any stretching or damage to any of these structures
The diagram above from the Hypermobility Syndromes Association shows some joint mobility tests that can help identify generalised hypermobility. Having any or all of these signs doesn't necessarily mean you have a hypermobility syndrome, but can be an indicator. As always, see your GP if you are concerned.
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Is hypermobility a bad thing?
Not always. Some people can actually train their joints to become hypermobile over time – think people who do gymnastics or calisthenics. This isn’t a problem, as long as the joint isn’t damaged and the muscles are strong enough to prevent the joint from slipping out.
There are also people that have one or more hypermobile joints, but don’t have any problems as a direct result. This is generally described as benign hypermobility.
But it can be problematic for some people. Sometimes, it’s a short-term problem – like if you dislocate a shoulder during football. This will mean you need to nurse the joint back to normal mobility to prevent further injury.
Sometimes, hypermobility is part of a bigger concern. There are conditions that present with hypermobile joints, including most forms of Ehlers-Danlos Syndrome and Marfan Syndrome. Sometimes, hypermobile joints that become problematic are the first clue that there is an underlying issue.

Tips to support a hypermobile body part
If you have some hypermobility and it’s not causing you any issues, you might be just fine. But if your joint is causing you pain, is unstable or affecting your life in any way, here are some tips to support it back to health.
Keep exercising within your limitations
The body thrives off movement, and it boosts blood flow throughout, which is needed for healing. If you have an injured body part, do any kind of exercise that doesn’t cause pain or discomfort. For example, if your shoulder is the issue, go for a daily walk still. If it’s an ankle, keep doing upper body work at the gym that doesn’t require standing.
Remember, if you’re not sure how to exercise safely due to injury, the best course of action is to consult a myotherapist who can assess the situation for you.
Use taping and other tools to increase proprioception
One issue that is common with hypermobile joints is a loss of proprioception. Proprioception is where your brain thinks your joint is. If you lose proprioception, your body can start to think that the correct position for your joint is partially dislocated, or subluxed.
A good tool to use to increase proprioception is taping. By taping a joint, you can stabilise the joint when it is very unstable. Once the joint improves, kinesiotape can help to increase your awareness, or proprioception, of the joint.
In the clinic, I offer both rigid and kinesio taping services. In fact, return clients can book in a follow-up taping session, so we can re-tape a loose joint until it regains stability. To book a taping session, contact me directly.
If your joint is particularly loose, you can also consider tools like splints, supports or orthotics to help with proprioception. These are most useful for highly unstable joints, or for times when you can’t focus solely on where a joint is. Not sure which tool is best for you? Ask your friendly myotherapist.
Be cautious with stretching and yoga
Stretching and yoga can have oodles of benefits. But if a joint is already stretched out of place, the wrong stretches or yoga poses can exacerbate the situation. Just because you can move into an extreme stretch doesn't always mean you should - often the safest option is to stop short of your absolute maximum stretch, because here you'll have the most control over your movement. Control at our very end range of movement can be difficult, and if your joints are prone to dislocation and instability due to loose or unreliable ligaments then ideally you should be aiming for a stretch where you can still keep excellent muscle control over the joint. If you’re not sure what is safe to do, have a chat to your practitioner or yoga teacher.
Work with a hypermobile-literate myotherapist
If your body is sore, a massage therapist can relieve some pain. But if you want to get the injury rehabilitated, you want to work with a myotherapist who is familiar with hypermobility.
With myotherapy, we can not only give immediate relief using massage and other treatment techniques, but also put together a personalised treatment plan. A hypermobility management plan will include targeted strength and proprioception exercises. By rebuilding the muscles and teaching your joint where it should sit, you can get back on track.
 
I’ve had the opportunity to work with many people who have hypermobility – both short-term and chronic. So whether you have a loose joint post-injury or a condition like Ehlers-Danlos Syndrome, I’m happy to help. Click here to book in an appointment.

Proprioception – Is This Why You’re Clumsy?

20/7/2018

 
Everyone knows someone who is a bit of a klutz. But often, there is a reason behind someone being naturally clumsy. It all comes down to what we call proprioception.
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What is proprioception?
To put it simply, proprioception is a fancy way of describing where your brain perceives your body to be in space. If you have good proprioception, your brain knows that your arms and legs are where they are.
 
But if you have issues with proprioception, your brain might think that you’re a little more to the left or right of where you actually are. This is where it’s common for people to do things like walk into doorframes, stub their toe or miss a step.
 
Some people can be born with a reduced sense of proprioception, particularly if they have neurological conditions such as autism. Others may have proprioceptive issues because of hypermobile joints. Sometimes, proprioception of a particular body part can be reduced through injury, such as a dislocation.
 
What are signs of proprioception issues?
There are some common signs of proprioception issues, including:
  • Being ‘clumsy’ in general
  • Running or bumping into things regularly
  • Tripping over things
  • Unconsciously holding joints or body parts in unusual ways, such as hunching
  • Reduced hand-eye coordination
  • Feeling of vague pain areas that can't be pinpointed to one spot
  • Being less able to tell the difference between subtle sensations, like a soft vs dull touch
 
It can also come with other signs, depending on the cause. Proprioceptive issues will come with sensory signs in people with autism. Hypermobile people will often experience more injuries such as rolled ankles because they have more flexible joints than most people.
Have you ever noticed that if you have an injury, you will be more likely to bump that injured limb or area? Thats because that area is where the misinformation is coming from - for example, I cut my finger a few weeks back, and managed to bump it on something on at least 3 different occasions that day! My general awareness of that finger was raised, but my ability to hone in on the location-specific proprioception was decreased due to injury.
 
How can I fix my proprioception?
The good news is, you can work on your proprioception and reduce the clumsiness. Proprioception is influenced by information from your nervous system and your balance. Here are some ways to retrain your brain and increase body awareness.
 
Move your body
A lot of people will avoid exercise because they think they are clumsy. But the more that you move your body, the more chances your brain gets to correct itself. So don’t avoid exercise – just stick to gentler options while you retrain your brain.
 
Retrain your balance
There are specific exercises that can challenge proprioception and retrain the brain. Stability and balance exercises are the most effective. These start with very simple and supported movements, then increase in difficulty as your proprioception adapts. For example, you might stand on one leg with your eyes open. Once you can do that easily, movements of your raised leg can be included which will challenge your balance. If that becomes easy, you can try it with your eyes closed, or add a wobble cushion or balance board. 
 
Exercises will need to be tailored to your specific proprioceptive needs. As you can see from the example above, there are many stages of these exercises that progress to harder and more challenging movements as your proprioception enhances.

Neurons that Fire Together, Wire Together
Have you heard this phrase before? The brain loves short cuts, so movements, actions, thoughts and sensations that are often felt together can become neurally linked. We can use this to our advantage by using exercises and movements in a way that can "rewire" the proprioception of a joint so it relearns its movement or activation patterns.
 
Taping
Using tape can help to retrain your proprioception in conjunction with stability exercises. It helps to indicate where the body part is because the tape is slightly stretched on your skin for a number of days - your brain gets a consistent signal from the sensation receptors on the skin saying "Hey! Here I am!".
Taping can also help with holding the joint or body part where it should be, preventing issues such as hunching or rolling of the shoulders. It’s best to get taping done by a qualified practitioner who can tape you correctly. This is why I offer taping sessions for my clients who need re-taping between appointments.
 
Do you want to work on retraining your brain and increasing your proprioception? We can put together a personalised management plan to help.

Try your first treatment for $97 (normally $115!)
Book in an appointment today to get started.

    Meet Our Team

    We have a team of great practitioners available 7 days a week at our Rowville clinic.

    Mel Simon
    Mel is our Senior Myotherapist.
    She's a nerdy, geeky bookworm who loves to help explain complex pain in an easy to understand way.
    ​She has a special interest in chronic pain conditions like fibromyalgia and Ehlers Danlos Syndrome, and more.

    Dr Sarah Varmalis
    Dr Sarah is an experienced Senior Osteopath. She works with multiple body systems, not just the musculoskeletal system.
    ​Her clinical techniques include addressing concerns with the vascular system, nervous system, and organ systems.​

    Duke Autret
    Duke is an outstanding Myotherapist and Remedial Massage Therapist.
    He has a deep interest in movement and alignment. He enjoys helping people regain strength and mobility to reduce their pain.

    Kel Levi
    Kel is an experienced Myotherapist and Remedial Massage Therapist, currently also working with AFL Premiers Melbourne Football Club.
    She has a great firm pressure and expertly uses Myotherapy tools like dry needling and cupping to ease pain.

    Peter Pascalis
    Peter has over 10 years experience as a Remedial Massage Therapist, and completed his Bachelor of Health Science in Myotherapy in 2022.
    He is known as our Dry Needling Wizard, and gets exceptional results for chronic pain and acute injuries using advanced needling techniques.

    Rachael Bird
    Rachael is a Myotherapist and Remedial Massage Therapist, with a background in beauty therapy. She is enthusiastic about helping people recover from pain and live well.

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