We get asked quite a lot if a scan like an X-ray, ultrasound or MRI is needed first before a Myotherapy or Remedial Massage appointment.

Generally, the answer is no, you won't need to go for a scan first. Myotherapy and Remedial Massage are very low risk treatments that can help with your pain without needing imaging first.

What can scans show you?
X-rays will show you bony changes. This can include obvious bone injuries like breaks and fractures, as well as things like arthritis and bone spurs.
Ultrasound can pick up changes in soft tissues like muscles, tendons and bursa. There are limits on how much detail an ultrasound can pick up especially if the tissue is deep inside the body, and it can sometimes be unpleasant because the scanning device needs to be pressed against the affected area to complete the image.
MRIs provide a more in depth look at injured tissue. They can be used to observe bone, muscle and nerve changes, as well as identifying other non-musculoskeletal conditions like cancer or abnormal growths.
CT scans are a series of images of the affected area to create a cross section view of bone and soft tissue.

When might you need a scan before an appointment?
There are certainly times that it can be useful to get your GP to refer you for a scan, like:

• If you've recently been in a high impact accident, like a car accident, falling from a height or being thrown from a horse
  
• If you've had a recent crushing injury, like having a car drive over your foot or having your hand crushed under a heavy pallet
  
• If your pain is extremely sensitive to even the lightest touch
  
• If your pain feels less like a muscular pain and more like a deep organ pain
  
• You felt a "pop" or "rip" sensation that started your pain, like footballers feeling a rip in their hamstring when kicking, or runners feeling a pop in the achilles while sprinting
  
• The area is hugely swollen, red and hot
  

Do you already have a scan or imaging report?
Great! Bring along the copy of your report to your appointment. Our practitioners can have a read of the findings and make sure that you understand what it means, and this can help inform our treatment approach to your pain.

Lets get started!
Book your appointment with us and we'll complete an assessment and treatment. If we think you may need some imaging we can write a referral to your GP explaining our assessment and asking them to complete further investigations so that as your health team we get you back to feeling and moving better!

Thats right! We have a new face in the clinic!
Meet Duke Autret, our new Remedial Massage Therapist!

Duke got his Remedial Massage qualifications in 2019 from Australian College of Fitness & Bodywork, which is the same college that Mel studied her Myotherapy qualifications.
He is also close to completing his certification as a Pilates instructor, and interested in leveling up to become a Myotherapist!

He's a body and movement nerd - and you know how much we love nerds here at Simple Wellness Myotherapy! In addition to a feel good remedial massage, he will be able to give you some great take home movements that help which you can use between your treatments to boost your recovery!

Our long term plan is that once Duke has finished his Pilates instructor training, we want to offer combination treatments where you can experience half the appointment as manual therapy, and the other half as a tailored pilates program.

You can book with Duke for remedial massage on Thursdays 3pm-7pm and Sundays 12pm-6pm.

After the nearly 3 month COVID lockdown, we're very happy to say that Myotherapy and Remedial Massage are back from Wednesday 28th October!

We've moved a few things around in the clinic, and we can't wait to welcome you back and resume your treatment plan.

We've given the first choice of appointments to those of you we know have been waiting patiently for this day, but we'll have our full online booking system up and running again very soon.

Thanks for your support throughout this year!

In short: Yes, we will be closing our doors again for a short 6 week period.

The new restrictions coming into place today have big consequences for almost all Melbourne residents, but lets talk the specifics of what this means in relation to your Myotherapy or Remedial Massage treatment plan.

We've been advised that Myotherapy and Remedial Massage can't continue.  Yes, we do screen every person we see, we clean thoroughly between every single appointment, and therapists and patients are both wearing masks. We've done everything we can to mitigate risks, and follow the ever-changing rules so we can keep you safe. But the DHHS have asked us to help by taking a temporary break.

There are significant fines for businesses and individuals who don't adhere to the new restrictions. The fines for a business staying open when they are not permitted is up to $10,000, and the fine for an individual is $1652. Thats a very expensive Myotherapy treatment!

Myotherapists and Remedial Massage Therapists are not alone in this restriction though. In fact, it will effect all Allied Health practitioners in some ways. Over the last few days the advice has changed, depending who you ask, but in general it appears that urgent care can still be accessed from Allied Health providers like Physiotherapists, Osteopaths and Chiropractors. The initial advice was that all patients would need a referral in the form of an Enhanced Primary Care (EPC) or Chronic Disease Management Plan, but I have now seen the Chiropractic Association indicating that referrals may not be needed.

If you're in doubt over whether you can be seen by someone for urgent care, your GP is always a safe bet. They will be able to clarify which Allied Health practitioners you are able to see, and may also be able to give you additional guidance or prescribe you medication if its needed. Dr Wajib Dib at Together Medical Family Practice is a fantastic bulk billing GP, and is still taking new patients for phone consultations.

What does "urgent care" mean?
Urgent care may include things like:

• New or serious injuries from an accident, fall, or impact
• Post surgical pain and rehabilitation
• Severe, debilitating pain
• Change in sensations, especially numbness, loss of feeling or significant loss of muscle strength

Who should you see for urgent care?
We know and trust these local Allied Health practitioners:

• Physiotherapy - Travis and the team at Pathways Physiotherapy in Ferntree Gully
• Osteopathy - Robin and the team at Hosford Health in Upwey
• Chiropractic - Clare and Lachlan at Upwey Chiropractic in Upwey, or Nadine at Resonate Wellbeing in Ringwood
• Acupuncture - Amanda at Upwey Acupuncture in Upwey

I'm very sad to be closing my doors again, for the third time this year. One of the hardest parts for you, my local Knox and outer Eastern burbs patients, is that our local government area is actually one of the lowest in all of Melbourne for total and active cases. While other areas have huge rising numbers of cases, our area stays fairly low risk. I'm sorry I can't be here for you for face to face support for these next 6 weeks, but my phone and email are always here to offer advice, send you links to exercises and self care, or to answer questions.

As we've all seen over these last few weeks, there are a small number of people doing the wrong things, and unfortunately its come to that time where its now impacting everyone with a blanket restriction across the whole Melbourne Metro area.

Thank you for doing the right thing so we all get through this quicker. Thanks for getting tested if you show symptoms. Thanks for staying home til you get those test results.

Can't wait to see you again soon!

We took the last 10 days to take a slow and cautious approach to completing our risk assessment with the rolled back Stage 3 Restrictions here in Victoria.

I've just listened to Dan Andrews' update for Sunday 19/07/20, and after reviewing all the data of the last 10 days since the Stage 3 Restrictions were re-announced, I have some updates on our risk assessment.

And its good news!
Our local council area, Knox Council, has stayed a relatively low risk zone. Knox has remained one of the least effected regions of Metro Melbourne throughout the pandemic. As of 19/07/20, there are only 9 active cases of COVID19 in the Knox region, and the data shows good statistics on very low new cases occurring in our area, and good rates of recovery.

The Department of Health has advised that Myotherapy and Remedial Massage appointments are still allowed under the current Stage 3 Restrictions.


This means that you are currently allowed to continue getting treatment for chronic pain conditions, injuries, or pain from your new work from home set up!
We can help you with headaches, back pain, sciatica, shoulder pain, fibromyalgia pain, RSI, nerve symptoms like pins & needles and shooting pains, and these sorts of specific pains or injuries.

From Monday 20th July, we will be open these hours:
        Monday, Tuesday & Friday 9am-7pm
        Wednesday & Thursday 9am-4pm
        Saturday 9am-6pm


Dan Andrews has announced today that from midnight on Wednesday this week, it is mandatory to wear protective face masks outside of your home. This is to protect you, your family and your community. We know this may not feel comfortable during your treatment, but we will ask that you keep your mask on during your appointment.


Help us to keep COVID19 out of our clinic:

• Don't book an appointment if you have any cold or flu type symptoms like fever, cough, sore throat or if you have been in contact with someone with COVID19
• If you develop symptoms after making a booking, please do not attend your appointment and let us know with as much notice as possible
• Wear a mask
• If you or anyone in your household have been in contact with someone with confirmed or suspected COVID19, please inform us so we can reschedule your appointment if needed (including situations like if anyone in your household works in a business that has reported positive cases on the job site)

Please understand, if you arrive to an appointment and you have symptoms of illness, we will ask you to reschedule, and we may suggest that you go for COVID19 testing.


What about Stage 4 Restrictions?

Theres a lot of talk going around about Stage 4 Restrictions, but Dan Andrews has not announced any plans to move to this level of restriction at this time.

If any further tightening of restrictions is announced, we will keep you informed with how that impacts your treatment plan.

To make a booking, go to our online booking page to see our current availabilities.

Our Myotherapists help a lot of people with scoliosis of varying degrees, from very mild curves to more exaggerated curves that permanently alter posture.

Myotherapy is not a cure for scoliosis, but ask any of our patients and they'll agree that managing the pain and muscle fatigue is much easier with a regular treatment to help manually decrease the load and pressure on their spine.

What is Scoliosis?
Scoliosis is a curvature of the spine to the right or left, creating a C or S shaped spine. It usually begins at puberty during growth spurts. Most people with scoliosis will have mild symptoms that can be managed by staying active and using therapies and tools that manage muscle tension and discomfort.

What do Myotherapists do to help someone with scoliosis?
As always, we start with an assessment. We'll look at your back, and how you move and check where you feel pain during your movement. You'll probably notice you have regular patterns that your scoliosis follows - like one hip or shoulder sitting higher than the other, one shoulder that rolls forward or backward more, or a particular painful spot that gets really tight or feels like it builds up pressure.

Hands on massage treatment is always a favourite with our patients. Why? It feels good! And it helps to stimulate the over-tired muscles supporting the spine. This can help reduce the muscle tension and fatigue, and let those high-pressure areas feel some relief.

Cupping is a technique that works particularly well for a lot of our scoliosis patients. We use cupping to help get a quick change in muscle tightness and reduce trigger point areas, while also bringing lots of new, fresh blood to the muscles to help them heal and release. The cups have a pressure valve and a pump that we use to create the gentle suction effect, which stretches the muscles and connective tissue under and around each cup, and stimulates increased bloodflow to that area. They can feel a little pinchy at first especially over tight areas, but after a few minutes that feeling usually goes away, and when the suction is broken the pressure releases and leaves the muscles feeling warm, stretched and more mobile.

The relief that comes after a treatment can be extended by using taping to help support your spine, hips and shoulders. Did you know you can keep the tape on for up to a week?

How often do I need to see a Myotherapist?
When you first come in, we like to see you again within 1-2 weeks to see how your first treatment settles in. From there we can work out the best schedule for you to keep painful flare ups at bay. This is really different person to person, but the average is about every 2-4 weeks - for some people we spend a little longer doing weekly treatments until it starts lasting longer, and for some people we can move to a 6-8 week schedule.

If you experience a pain flare up, come in for an appointment so we can settle the flare as quickly as possible and get you back to your normal maintenance routine.

How do I get an appointment?
Appointments can be made online or you can phone Mel on 0401212934.

Does this sound familiar?

• Aching hip pain when you wake up
• Hard to stand up if you've been sitting down for a while
• Hurts to walk up or down stairs
• Painful to sleep on your side
• Night time pain that can wake you up

These can be signs of hip bursitis, which is an inflammatory condition that can be a very common cause of hip pain.

What is Bursitis?
Bursitis is the name of a condition where the bursa in your joints become inflamed. Bursa are the fluid-filled sacs that help cushion joints and reduce friction as the joint moves. Healthy bursa are important in pain free movement.

When the bursa becomes inflamed it swells and becomes highly sensitive. The joint doesn't move easily, and the muscles surrounding it can become painful and tight trying to protect the joint.

Bursitis can cause acute pain that increases with physical activity. If the inflammation remains active for a long time, the pain can progress to a chronic state.

What causes hip bursitis?
The most common causes of bursitis are things like overuse or strain on the hip joint. This can happen through a high level of exercise or activity, or through repetitive unbalanced activities like holding a baby on one hip, or leaning your weight to one side to avoid pain in other areas like your lower back, knee or ankle.

Other causes can be less common things like infection or gout within the joint. People with autoimmune conditions like rheumatoid arthritis can be more vulnerable to developing this inflammatory condition.

How can we help?
Remedial massage and myotherapy can help relieve painful symptoms of hip bursitis. We can reduce muscle tension around the hip joint, and assess the other areas above and below the painful hip so that we can address any issues that are contributing to your bursa becoming irritated. Taping for stability and support can be very useful, and can help relieve pain for longer. We can give you a program of exercises to gradually strengthen  your hip without increasing the irritation.
Book a time with us to get the ball rolling.

Should I see a doctor?
If your hip pain has been ongoing for quite some time, it can be a good idea to check in with your doctor.
Your GP can advise you if a course of anti inflammatory medication will be helpful for you, or you can ask your pharmacist for an over the counter recommendation for symptom relief.
We're lucky to be located inside Together Medical Family Practice in Knoxfield, where you can get access to a fully Bulk Billed GP in the clinic with us and an understanding pharmacy team downstairs.

Many people are familiar with the term "bulging disc" in regards to lower back pain. It can feel like an intense, sharp, stabbing sensation that can often travel down your leg through your hips and bum, sometimes as far as your feet.

This is a common diagnosis when you start to develop back pain. You get a scan which shows changes in the disc, and the pain matches the effected nerve area. It can be a scary diagnosis.

But you may be surprised to know that a lot of people who don't have pain have also been found to have changes in their discs. I find this study to be really encouraging, because it shows that people who have significant changes to their disc structure can still live a painfree life. It suggests that the disc changes may have already been there for some time before any painful symptoms even began, and gives hope that even if the structure doesn't change, that the pain can change.

Lets have a look at this interesting literature review, particularly in regards to the findings around disc degeneration, disc bulges and disc protrusions.

This is a literature review of 33 separate studies that investigated the imaging of spinal degeneration in painfree people ranging from their 20's to their 80's. It was published in the American Journal of Neuroradiology in 2014.

In total, the review takes into account MRI and CT scan imaging on 3110 individuals with no painful symptoms.

As you would likely predict, the number of findings increased with the participants age group, showing age-related degeneration occurs even in people who aren't experiencing pain.

Lets have a look at the imaging results for the disc degeneration, bulge and protrusion categories:

Disc degeneration - changes to the disc and surrounding vertebrae that result in loss of cushioning and support, may include signs of osteoarthritis at the joint.

The Results:
Disc degeneration in painfree participants was identified in:

• 37% of 20-29 year olds
• 52% of 30-39 year olds
• 68% of 40-49 year olds
• 80% of 50-59 year olds
• 88% of 60-69 year olds
• 93% of 70-79 year olds
• 96% of 80+ year olds

Disc bulge - changes that alter the shape of the disc and can make portions of it "bulge" out of place, which can apply pressure to nearby nerves.

The Results:
Disc bulge in painfree participants was identified in:

• 30% of 20-29 year olds
• 40% of 30-39 year olds
• 50% of 40-49 year olds
• 60% of 50-59 year olds
• 69% of 60-69 year olds
• 77% of 70-79 year olds
• 84% of 80+ year olds

Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves.

The Results:
Disc protrusion in painfree participants was identified in:

• 29% of 20-29 year olds
• 31% of 30-39 year olds
• 33% of 40-49 year olds
• 36% of 50-59 year olds
• 38% of 60-69 year olds
• 40% of 70-79 year olds
• 43% of 80+ year olds

What does this mean for your bulging disc?
It means that theres a good chance that your structural changes were already present before your back became painful. The area may be irritated or flared up right now, but these findings are a good indication that even if your scans don't change, your back pain still can settle down.
It means that a scan showing disc changes doesn't have to be a life sentence of pain.

Does this mean bulging discs DON'T cause pain, then?
Don't get me wrong, bulging discs can be painful, and for some people it can be severe. This study just helps to show us that theres more to back pain that what shows up on MRI or CT scans. Structural changes are just one layer in the complex onion that is back pain.

We can help!
There are lots of ways we can change your experience of back pain through massage and myotherapy techniques like dry needling, taping and support, strengthening the surrounding muscles with exercises that are appropriate for you, and supporting your understanding of how your back functions.
Book a time to come see us to talk about your back pain and creating a treatment plan to reduce it.

Multiple Sclerosis is a many, many layered condition that has a long list of symptoms, including pain, fatigue, and weakness. There is currently no cure for MS.

But just because there is no cure, does that mean there is nothing that can be done to help reduce these symptoms and maintain muscle health? From clinical experience, I've found massage and a variety of myotherapy techniques to be incredibly useful for patients living with MS. You can read more about my clinical experience with treating MS in this blog.

I've been running for The May 50K during COVID19 isolation to raise funds and awareness for MS, so I thought its only fitting that I write up a bit of a literature review on the research!

You can read the article here for the full study details, as published in the International Journal of Therapeutic Massage and Bodywork in December 2016.

What does the research say specifically about massage therapy and MS?
There are a few things to keep in mind when we read this study.

Firstly, manual therapies are hard to study, because the techniques used are almost always different every single treatment. As experienced therapists, we select techniques that are the most relevant to the patient each time they come for an appointment, and our selections are based off what we assess in the consultation, as well as what the patient agrees to on the day - for example, some days a deep pressure trigger point treatment can be tolerable and helpful, and other days it may feel too much.

Secondly, Multiple Sclerosis affects people in widely different ways. There is no one "best" treatment technique for MS, and the symptom types, areas and intensity are vastly different from person to person.

Keeping that in mind, lets have a look at how these researchers completed their study, and what they found.

How did they design a study for massage therapy for Multiple Sclerosis?
A specific massage sequence was designed for the study. This sequence was to be followed to the letter for every patient at every session, regardless of the symptoms on the day. This isn't an ideal way of providing a treatment in a clinical setting, however in a research setting its important to be able to make the tested treatment or therapy able to be reliably the same for every subject in the study. The sequence involved a full body massage therapy routine which included gliding strokes, kneading, cross fibre friction, and trigger point treatment.

The 24 participants were scheduled for a weekly one hour treatment using the specific massage routine for 6 weeks. If a participant missed a scheduled treatment, they aimed to reschedule it within a week, so that each participant received 6 identical treatments over the course of no longer than 8 weeks.

How did they measure and assess it?
Five measurement scales were used to assess the outcomes in a variety of symptoms. The participants recorded scores for

• fatigue on the Modified Fatigue Impact Scale (MFIS)
• spasticity on the Modified Ashworth Scale (MAS)
• pain on the MOS Pain Effects Scale (MOS)
• emotional and mental health on the Mental Health Inventory (MHI)
• quality of life using the Health Status Questionnaire (HSQ)

These were measured before and after treatments to analyse any changes to the symptoms.

What did they find out?
The results overall suggested that massage therapy was a safe and useful tool in providing relief from fatigue and pain, and improving mental health and general quality of life.

Fatigue - The MFIS indicated that 22 out of 24 participants reported decreased fatigue scores. There was a significant correlation between fatigue decreasing and pain decreasing.
Spasticity - 19 out of 24 participants completed the MAS spasticity evaluation, and of these, 16 reported experiencing spasticity symptoms ranging from slight to considerable increase in muscle tone. There were no significant changes in spasticity after the end of the 6 week treatment period.
Pain - On average, participants reported a significant 18% reduction in pain on the MOS Pain Effect Scale. The reduced pain scores correlated with improved mental health scores.
Mental Health - A significant increase in the total scores on the MHI indicates overall mental health improvement. A small number of participants did not improve on some subscales, such as anxiety (3 participants) and depression (1 participant)
Quality of Life - Overall, the quality of life scores on the HSQ showed improvement. Emotional and Social subscales showed more improvement than Health and Physical. The results indicated that as fatigue and pain decreased, measures of quality of life increased.

Can we help you?
Do you have MS and want to discuss treatment options? Our clinic is temporarily closed due to COVID19, but we expect to reopen by June. Check our availability on our  online bookings page for updates.

Are you receiving assistance from MS Employment Services?
You may be eligible for funded Myotherapy treatment through your Occupational Therapist. Contact your OT to see if you can apply, and they will forward us the documents to begin the process for you.
Do you have MS, you're currently working or seeking work, and you're not receiving assistance? Check the MS Employment Services website to see if you're able to receive support.