When you have chronic pain, you get very familiar with pain that makes itself known every day. You may have some good days and some bad days, but either way its good to have a toolkit of things you can do at home to help reduce, manage or avoid pain flare ups.
This is even more important now, while Melbourne is under Stage 4 Restrictions in response to COVID19 and seeing your Myotherapist is no longer an option.
Your toolkit will likely be different to someone elses, but these are some of the things that you can incorporate at home to help keep pain as low as possible.
Gentle movement - Walking, yoga, pilates, dancing, cycling, and other low impact exercises to keep your joints and muscles mobile. What you can achieve may change day by day, work within your own limits. There are plenty of free or affordable online options, my favourite that I'm personally using throughout lockdown is Erica Webb Yoga & Pilates virtual studio ($37 a month for unlimited classes)
Stretching - Make time to stretch each day, especially the muscles that feel tightest. If you're working from home, its really easy to get stuck sitting for hours at your desk - or couch, coffee table, hammock, whatever your work from home set up looks like.
Self care tools - Foam rollers, tennis balls and spiky balls, acupressure mats, TENS machines: these can all help reduce muscle pain and tension. Don't have one? You can pick these up cheap online on eBay or through sports stores.
Hot or cold therapy - Heat packs, hot water bottles, electric blankets to keep you warm and take away some of the ache. Ice packs or cool compresses can work better for acute inflammation areas or for numbing persistent pain.
Nutrition and hydration - Eat well, drink water, and avoid foods that tend to flare up your pain. Pre-plan meals and snacks so you can have some easy to grab options on bad pain days where you don't have the energy to cook (or clean!)
Stress management - Easier said than done during a pandemic, right? Find things that bring down your stress levels, that will be different for each person, but some classics include reading, listening to music, taking a nap, having a warm soak in epsom salts, booking a telehealth appointment with a counsellor, writing in a journal.
Seek support - Don't suffer alone! Reach out for a conversation with your friends, family, coworkers, neighbours. Don't forget there are plenty of services to support you, including talking with your GP, a counsellor, and support groups online.
Pain relief - I know a lot of our patients choose not to use pain relievers, but in these times where its hard to get access to hands on treatments that help, you may find that taking pain relief is helpful. This may include prescribed medications from your GP or over the counter recommendations from your pharmacist.
Gels and creams - There are a heap of options for topical pain creams, the most commonly used ones include Deep Heat, Fisiocrem, and Voltaren. My personal favourite is a non-pharmaceutical blend by Doterra called Ice Blue Rub, its got a cooling menthol effect that is fairly long lasting, but it is on the pricey side for a cream. A little goes a long way!
Sleep - What can you do to optimise your sleep cycle? A well rested body has the best opportunities to repair and recover. Some things to experiment with are an earlier bed time, switching off screens well before bed, changing your pillow, listening to relaxing music.
We hope it won't be long now until we're able to offer hands on treatments again. As soon as we know more, we'll make an announcement and get our online booking page active again.
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:
Who should you see for urgent care?
We know and trust these local Allied Health practitioners:
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!
Dry Needling is a manual therapy technique used by Myotherapists to help reduce pain and tension in muscles.
We've previously discussed the similarities and differences between Dry Needling and Acupuncture, but you may still be wondering - how does Dry Needling actually work?
The "Dry" Needle
The reason they are called "dry" needles is to differentiate them from hollow needles like the ones used for blood tests or vaccinations. A dry needle can't inject or withdraw fluids from your body.
The needles themselves are ultra thin and flexible. They come with a guide tube to allow us to place them with care and precision.
All needles used for dry needling are single use only.
Where We Apply It
Myotherapists use dry needling in painful, tight or restricted muscle groups. You may have heard about Trigger Points - those painful, tight bands that can form within a muscle over time, with repeated use or from injury. Dry needling is a technique that helps address these trigger point areas in a very specific and precise way.
We assess the areas through watching you move and through palpating the muscles to find the best spots within the muscle to position the needle to relieve the trigger point. We also assess the surrounding joints and muscles, for example for hip pain we may find that dry needling in your lower back or in your thigh can help relieve pain and strain from your hip.
What Happens When We Needle A Trigger Point?
When we first insert the needle to the muscle, it can be felt as a little pinprick sensation on the skin. We then guide the tip of the needle into the right angle and depth of the muscle to directly stimulate the trigger point. This takes some skill and the ability to visualise in 3D the target muscle and the surrounding tissue like nerves, veins, arteries, bones and ligaments.
By applying the needle into that trigger point, it causes a combination of chemical and electrical responses by the muscle. The micro damage causes by inserting the needle sends chemical messengers to the brain to get a healing response to occur. It can also cause a nerve impulse to occur, making the muscle twitch and release.
To Stimulate or Not To Stimulate
Because our aim in using dry needling is to get a change in the muscle tension, we often can stimulate the needle. This means we might gently move the needle in a pulsing in/out movement to repeatedly stimulate the trigger point, or we might twist the needle in a particular direction or in a series of back and forward movements.
Stimulation of the needle can lead to more twitching, what we call Local Twitch Response. Dry needling can be effective even without the involuntary muscle twitch response.
Some practitioners prefer a more intensive stimulation of the needles, however we prefer a gentle and slow approach.
Does Dry Needling Hurt?
In most cases, not really. Which is often surprising! The most common sensations you'll feel are the pinprick of the needle being positioned, a dull aching or tightening sensation around the needle, and the quick twitching response of the muscles releasing. The twitching can sometimes feel intense, but only lasts a very short time.
After needling, some people can experience a little localised soreness at the sites of the needles, but most people just feel relief from tension and pain in those areas.
Is Dry Needling Safe?
In the hands of a trained practitioner, dry needling is a safe and effective technique.
Myotherapists undergo many months of training and assessment in the skillful use of dry needling, however not all practitioners who offer dry needling are Myotherapists. Remedial Massage Therapists, Chiropractors, Physiotherapists, and other skilled practitioners can opt to undertake short courses in dry needling.
Here in the Simple Wellness Myotherapy clinic, we only allow our Myotherapists to use dry needling on our patients, and we strongly believe that a weekend short course is not enough time to develop the skills needed to use dry needling safely and effectively.
What Sort Of Pain Can Dry Needling Help Treat?
Dry needling is great for releasing tight trigger point areas all throughout the body. It can be effective in treating headaches, neck and shoulder pain, back pain, bursitis, pain from disc injuries, sports injuries, plantar fasciitis - so many things!
Want to try dry needling for your muscle pain? Book an appointment with one of our Myotherapists.
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
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:
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.
Here in Melbourne, we're back in Stage 3 Restrictions.
That means that most of our favourite ways to move, stretch and exercise may not be available to us right now, including gyms, yoga studios, pilates classes, martial arts, personal training, and lots more.
So what are your options from home to keep moving, stretching and feeling physically well? Here are some of our favourite at home, online accessible resources.
Erica Webb Yoga & Pilates Virtual Studio - Erica has an amazing and gentle approach to movement as medicine. Shes fun, insightful, and her classes are suitable for people of all ages and abilities. Erica is a local yoga teacher from Croydon. Her membership subscription costs less than a single traditional yoga class per month.
Nate Bower Fitness - you don't need a boxing bag to be able to follow along with these boxing drills. Guaranteed to get your heart rate up, and lots of beginner friendly classes. This YouTube channel provides free 20-30 minute boxing class videos.
Couch To 5K App - Want to start running? This app helps you go from dusting off your old runners, to running a full 5km. Starting with very small bursts of running with big walk intervals, and as your fitness improves the interval timing changes, until you can make it through your full 5km run. I've used this app myself in the past and found it really useful and encouraging. You can use the official C25K app on Apple or Android, or there are plenty of similar versions for free (maybe with a few ads!)
Mountain Pilates - Jeanette Tatton is a local pilates instructor in the Hills, and is running Zoom pilates classes each week. Pilates is a great full body workout that is gentle but effective at strengthening your body.
Alpha Health - Our good friend Ash and her partner Paul are amazing personal trainers offering online coaching to keep you fit and moving throughout isolation. When Anytime Fitness in Ferntree Gully is open, Ash offers training there, too.
What are your favourite online resources to stay inspired and healthy during lockdown? Let us know on our social media channels on Facebook and Instagram!
Unless you've been hiding under a rock, if you live in Melbourne then you'll be aware that our local new COVID19 cases have been dramatically increasing, and that in response to the rapid rise of infection numbers, Premier Dan Andrews has rolled Metro Melbourne back into Stage 3 Restrictions.
What does this mean for your treatment plan with your Myotherapist or Remedial Massage Therapist?
The good news is that Myotherapy and Remedial Massage have been given the OK by the Health Department, and getting a treatment is included in the four reasons to leave your home under the Seeking Medical Care category.
However, we're taking a cautious approach.
We are planning a short closure from Thursday 9th July to Sunday 19th July, and aim to reopen from Monday 20th July.
Why are we closing if the Health Department have not forced us to close?
In short, we want time to gather more data about these spikes in infection to inform our risk assessment.
We closed for 9 weeks when the pandemic was first announced. At that time, most infections in Melbourne were coming from international travelers and people returning home from overseas. Health experts were unsure how the numbers would play out, and we followed the advice from the Association of Massage Therapists to close our doors for safety. The strict stay at home orders during March through til June appeared to keep our infection numbers low in Victoria, and these numbers have started rising quickly in the weeks since restrictions have been eased.
The situation now feels closer to home and even more serious than back in March. The infections Melbourne is experiencing right now are a high number of community transmissions.
Our choice to close for a short time is more of an ethical choice than a legal choice. Legally, we are allowed to remain open throughout the 6 week Stage 3 rollback. However, we always want to put patient health and safety first, and after a 9 week closure earlier this year we feel it would be irresponsible to ignore the very real risks that are present now.
Our current risk assessment
Thankfully, our clinic is in a location that has very few local cases. Knox has 2 active cases as of 9/7/2020, and has had less than 30 confirmed cases total throughout the pandemic, according to the Victorian Government website.
The majority of our patients live in Knox, Yarra Ranges, Casey, Maroondah and Monash council areas. Many of you are now working from home, but some are still traveling for work or have family living in other regions.
We know that some COVID19 test results are taking up to 5 days to process, which means the daily new case figures may be reflecting the test results of up to 5 days ago.
We have also seen many of our high risk patients choosing to stay home in isolation a little longer, including people with compromised immune systems, elderly or caring for elderly, or people with pre-existing respiratory conditions.
We currently expect that our risk level is relatively low due to our location, screening procedures, sanitisation and cleaning procedures.
However, we acknowledge that it would only take one infected person to potentially risk others.
What do we expect to learn by closing temporarily?
In the safety of closing for this short period, we expect to gain more insight on infection numbers close by to our clinic, and in Metro Melbourne as a whole.
We do expect numbers will continue to rise because of the delays between testing and results. We hope by taking an extra 10 days to wait on the numbers we will get a better understanding of the situation so we can modify our COVID19 Plan if we need to.
We hope to see the Knox and surrounding areas new case figures to stay low and stable.
Will we definitely reopen on Monday July 20th?
At this stage, that is our goal date. If our risk assessment findings start to indicate a higher level of risk, we will potentially extend the closure for safety of patients, our practitioners, and the doctor and staff of Together Medical Family Practice who we share facilities with.
What will happen when we reopen?
We'll continue to use our COVID19 Procedures that we created to maintain a clean and hygienic treatment environment. This includes continuing screening every person at every appointment they attend, and the longer periods between each appointment for ventilation and thorough sanitisation.
Our practitioners will be wearing masks, we'll be smiling underneath even though you can't see it!
The Together Medical Family Practice has also arranged a hygiene station at the front door for anyone who enters to use hand sanitiser and take a face mask.
Our waiting area has been rearranged to distance the chairs, and we are recommending that everyone waits in their car until we call you in to avoid the need to sit in the communal waiting room.
Who should you see if you urgently need an appointment while we are closed?
Our good friends at Tecoma Myotherapy are remaining open throughout the restrictions. Mat Richardson and his team are exceptionally caring and friendly therapists, offering Myotherapy and Remedial Massage. Let them know that we've asked them to take care of you while we are closed, we know you'll be in good hands.
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?
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.
Disc degeneration in painfree participants was identified in:
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.
Disc bulge in painfree participants was identified in:
Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves.
Disc protrusion in painfree participants was identified in:
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.
We're pleased to say that after weeks of being closed due to COVID19, we're very close to reopening! We're sure you're as excited as Emily and I both are to get back into our treatment room for the myotherapy and remedial massage therapy treatments you've been missing!
We've been given the OK to reopen 4 days a week by our medical professional landlords, Dr Wajib Dib the GP we share our clinic with at Together Medical, and Amer Dib the pharmacist who owns and runs Knoxfield Pharmacy downstairs from us. They've been happy with the policies and procedures we've put in place for sanitisation and screening, and are welcoming us back from the start of June.
Needless to say, due to COVID19 we’ve needed to optimise the cleanliness of our space and put in place procedures to maintain social distancing outside of your treatment.
These are the changes we’ve made to ensure your health and safety during your appointment:
What else is new?
We've broken up Myotherapy and Remedial Massage into 2 categories. We hope this will make it easier for you to know what type of treatment you want to book.
If you have an injury to be assessed, a chronic condition needing expert maintenance, or want more advanced treatment techniques like dry needling, cupping, mobilisation, taping, or a tailored exercise plan, you can book a Myotherapy appointment.
We've also removed the need to book an Initial or a Return session for Myotherapy treatments, you can now just choose the appointment length you need.
This means if you would prefer "just a massage" to address your aches and pains, you can book for a Remedial Massage and get what you're expecting - feel good, hands on massage! Perfect for muscle soreness and general preventative care!
Appointment Length and Fees
From June 1st, we'll be offering the following appointment types:
Myotherapy - 30 mins ($79), 50 mins ($99), 80 mins ($134)
Remedial Massage - 30 mins ($70), 60 mins ($100), 90 mins ($130)
Ready to book in? Pick a time from our online booking page for when we return in June!
Meet Our Team
We have a team of great practitioners available 7 days a week at our Knoxfield clinic.