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Relief for Neck Tension and Headaches: A Guide to Suboccipital Muscle Care

1. Rectus capitis posterior major: Connects the spinous process of C2 to the occiput (back of the skull).
2. Rectus capitis posterior minor: Connects C1 to the occiput.
3. Obliquus capitis superior: Extends from C1 to the occiput.
4. Obliquus capitis inferior: Connects C1 to C2.

• Head Movement: Facilitate extension, rotation, and slight lateral flexion of the head.
• Postural Control: Provide fine adjustments to stabilise the head and maintain proper alignment.
• Proprioception: Rich in sensory receptors, these muscles play a role in detecting head position and movement, aiding in balance and coordination.

• Within the rectus capitis posterior major and minor, often near their attachments to the occiput.
• Obliquus capitis muscles can develop tension that radiates pain around the base of the skull.

• Pain often radiates to the top of the head, mimicking tension-type headaches.
• Tenderness around the base of the skull and behind the eyes is also common.

1. Office Workers and Students
   • Prolonged sitting with forward head posture (e.g., looking at a screen or reading).
   • Poor ergonomic setups that strain the neck.
2. Technology Users
   • Frequent use of smartphones and tablets, leading to “tech neck.”
3. Athletes
   • Activities requiring repetitive or sustained neck movements, such as cycling, swimming, or weightlifting.
4. Chronic Stress Sufferers
   • Emotional stress often results in tension in the neck and upper back, affecting the suboccipitals.
5. Migraine and Headache Sufferers
   • Those prone to headaches often experience tightness and trigger points in the suboccipitals as a secondary issue.

1. Trigger Point Therapy
   • Direct pressure is applied to deactivate trigger points, reducing referred pain and muscle tightness.
2. Dry Needling
   • Thin needles are inserted into the suboccipital muscles to release deep-seated tension and improve blood flow, offering significant relief for chronic pain.
3. Myofascial Release
   • Gentle techniques target the fascia surrounding the muscles, helping to restore mobility and reduce tightness.
4. Massage Therapy
   • Light to moderate massage reduces tension in the suboccipitals and promotes relaxation.
5. Stretching and Mobility Exercises
   • Myotherapists often recommend specific stretches to lengthen the suboccipital muscles and improve flexibility.
   • Example: Chin tucks and gentle neck stretches can relieve tension in this area.
6. Postural Education and Ergonomic Advice
   • Therapists assess posture and provide guidance on maintaining proper alignment during daily activities to reduce strain on the suboccipitals.
7. Heat and Cold Therapy
   • Heat increases blood flow and relaxes the muscles, while cold reduces inflammation and acute pain.
8. Breathing Techniques
   • Proper diaphragmatic breathing can reduce neck tension by alleviating stress-related clenching of the suboccipitals.

• Maintain Proper Posture: Keep your head aligned over your shoulders and avoid prolonged forward head posture.
• Take Breaks: Stand and stretch every 30-60 minutes if working at a desk or using screens.
• Use Ergonomic Tools: Adjust chairs, desks, and screens to encourage a neutral neck position.
• Stretch Regularly: Perform neck stretches daily to maintain flexibility.
• Manage Stress: Practice relaxation techniques to prevent muscle tension caused by emotional stress.

Relieve Tight Shoulders: A Myotherapist’s Guide to Trapezius Health

1. Upper trapezius: Originates at the base of the skull and runs down to the shoulders.
2. Middle trapezius: Spans from the upper thoracic spine to the shoulder blades.
3. Lower trapezius: Extends from the mid-thoracic spine to the lower shoulder blades.

• Upper trapezius: Elevates the shoulders (e.g., shrugging) and assists in neck movement.
• Middle trapezius: Retracts the scapula (pulls shoulder blades together).
• Lower trapezius: Depresses and stabilises the scapula.

1. Upper trapezius: Often found near the base of the skull or at the midpoint between the neck and shoulder.
2. Middle trapezius: Near the spine, along the shoulder blades.
3. Lower trapezius: Along the lower edge of the shoulder blade and thoracic spine.

• Pain may radiate to the neck, head (often mistaken for tension headaches), shoulders, or upper back.
• Upper trapezius trigger points frequently cause pain at the base of the skull or in the temples, mimicking a migraine.

1. Office Workers and Students
   • Long hours of sitting with poor posture or forward head position.
   • Stress and tension, leading to elevated shoulders and clenched muscles.
2. Athletes
   • Sports involving repetitive shoulder movements, such as swimming, tennis, or weightlifting, can overwork the trapezius.
3. Manual Labourers
   • Lifting heavy objects or prolonged physical strain can cause overuse of the trapezius.
4. Chronic Stress Sufferers
   • Emotional stress often manifests physically, with the trapezius holding tension as a protective response.
5. Older Adults
   • Age-related changes, like reduced muscle elasticity and weakened posture, increase susceptibility.

1. Trigger Point Therapy
   • Direct pressure is applied to trigger points to deactivate them and relieve pain.
2. Dry Needling
   • Thin needles are inserted into trigger points to release muscle tension and improve circulation, reducing pain and promoting healing.
3. Myofascial Release
   • Gentle, sustained pressure is used to stretch the fascia (connective tissue) around the trapezius, reducing tightness and restoring mobility.
4. Massage Therapy
   • Techniques like effleurage, petrissage, and deep tissue massage help relax the muscle, reduce inflammation, and improve blood flow.
5. Stretching and Mobility Exercises
   • Myotherapists provide tailored stretches to lengthen the trapezius and improve its flexibility.
   • Example: Neck tilts or shoulder shrugs can help relieve tightness in the upper trapezius.
6. Postural Assessment and Correction
   • A myotherapist evaluates posture to identify contributing factors, such as forward head posture or rounded shoulders, and recommends ergonomic adjustments.
7. Heat and Cold Therapy
   • Heat application increases blood flow and relaxes the muscle, while cold therapy reduces inflammation and acute pain.
8. Strengthening Exercises
   • Weakness in the trapezius can cause overcompensation by other muscles, leading to tension. Strengthening the lower and middle trapezius can help rebalance the area.

• Practice Good Posture: Keep your shoulders relaxed, neck neutral, and head aligned with your spine.
• Take Frequent Breaks: If you work at a desk, stand up and stretch every 30-60 minutes.
• Manage Stress: Regular relaxation techniques, such as deep breathing or meditation, can prevent tension buildup.
• Stay Active: Engage in exercises that strengthen your back, shoulders, and core to support your posture.
• Stretch Regularly: Incorporate neck and shoulder stretches into your routine to maintain flexibility.

Maximize Your Private Health Insurance: Claim Rebates on Myotherapy and Remedial Massage in Melbourne Today!

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• Claiming Rebate: Our clinic is equipped with HICAPS, and our Myotherapists are accredited and registered with most private health insurance providers, which allows for on-the-spot claiming, meaning you only pay the gap fee on the day of your appointment.
• Annual Allowance: Each calendar year, you’re given a specific allowance for services like Myotherapy and Remedial Massage. This allowance does not carry over to the next year, so any unused amount will expire on December 31st.
• Variety of Providers: Coverage for Myotherapy and Remedial Massage is offered by major private health funds, including Bupa, Medibank, HCF, NIB, and more. It’s advisable to check with your provider to confirm the rebate amount per session and your remaining annual balance.

1. Maximise Your Annual Allowance: If you haven’t yet used your annual rebate, booking a few sessions before the end of the year lets you take full advantage of your extras cover. This could mean hundreds of dollars in savings on treatments that support your health and well-being.
2. Ease Year-End Stress and Physical Tension: The holiday season brings extra stress, physical strain, and long hours sitting or standing. Myotherapy and Remedial Massage can relieve muscle tension, support relaxation, and boost your resilience through the busiest time of the year.
3. Prepare for the New Year: Start the new year with a fresh, pain-free body by addressing any lingering tension or discomfort. Using your benefits before December 31st means you’ll have a clean slate for additional sessions next year, maximising your health and insurance value.

1. Contact Your Insurance Provider: Many health insurers offer online member portals where you can check your remaining benefits for the year. Alternatively, you can call your provider directly to inquire about your current balance.
2. Choose an Accredited Clinic: Ensure that the Myotherapist or Remedial Massage therapist you choose is accredited with your health fund. Most reputable clinics in Melbourne are registered with major health funds and can process claims instantly with HICAPS.
3. Book Your Appointment: With many people realising the benefits of booking before year-end, clinic availability can fill up quickly. Book now to secure a convenient appointment slot and avoid the rush.

• Discuss Your Needs: Talk to your therapist about any specific areas of tension, pain, or discomfort. A personalised treatment approach will provide the best results.
• Stay Hydrated: Myotherapy and Remedial Massage can aid in releasing muscle tension and toxins from the body. Drinking water before and after your session helps with recovery and keeps your muscles hydrated.
• Follow Up with Home Care: Many therapists offer advice on stretches, strengthening exercises, or posture corrections that can help you maintain the benefits of your session. Consistent home care can make a big difference in managing musculoskeletal issues over the long term.

1. Can I claim for both Myotherapy and Remedial Massage?
   • Yes, most health funds allow claims for both treatments, as long as they are covered under your extras policy. However, each service may have a separate or shared annual limit, so it’s best to verify with your provider.
2. What if I’ve already reached my annual limit?
   • Unfortunately, once your annual limit is reached, further claims won’t receive a rebate until the allowance resets in the new year. However, you may wish to book ahead for January to ensure your first appointments of the year are covered.
3. How much can I expect to get back?
   • The rebate amount varies depending on your health fund and cover level. Rebates can range from around 50% to 85% of the service cost, so checking with your provider gives a clearer idea of your specific benefits.

Differences between -itis vs -otis in musculoskeletal conditions

1. “-itis” refers to inflammation, which is the body’s natural immune response to injury, infection, or irritation. Inflammation is typically characterised by the classic signs of pain, heat, redness, swelling, and loss of function. The inflammatory process is a protective mechanism intended to remove harmful stimuli and initiate the healing process.
2. “-osis” refers to degeneration or chronic, non-inflammatory changes in tissue, often associated with wear-and-tear, ageing, or prolonged overuse. Unlike “-itis,” “-osis” does not involve the acute inflammatory markers but is instead characterised by tissue degeneration, thickening, or structural alteration. This degeneration leads to a gradual decline in function and strength over time.

• Injury or trauma: Acute injuries like strains, sprains, or fractures may cause localised inflammation.
• Infection: Bacterial, viral, or fungal infections can result in inflammatory responses, as seen in conditions such as pneumonia or cellulitis.
• Autoimmune diseases: Conditions like rheumatoid arthritis are marked by inappropriate immune responses that attack the body’s own tissues, resulting in inflammation.
• Allergic reactions or irritants: Exposure to allergens or irritants can cause an inflammatory response, as seen in allergic rhinitis or contact dermatitis.

• Ageing: Degenerative changes are common as the body ages, with tissues losing their ability to repair themselves as effectively. Osteoarthritis and tendinosis are classic examples of age-related degeneration.
• Overuse or repetitive strain: Repeated microtrauma to a particular tissue without adequate recovery time can lead to degeneration. Tendinosis is often seen in athletes or workers performing repetitive motions.
• Genetic predisposition: Some degenerative conditions, such as osteoarthritis, may have a genetic component that accelerates the degradation of tissues like cartilage.
• Metabolic or systemic disorders: Conditions like diabetes can affect tissue health and lead to degeneration, as impaired circulation or inflammation may exacerbate structural breakdown.

1. Treating degenerative conditions with anti-inflammatories: In cases of “-osis,” where there is minimal or no active inflammation, prescribing anti-inflammatory medications like NSAIDs or corticosteroids may not address the underlying degeneration. For example, tendinosis, a degenerative condition of the tendons, may be mistakenly treated as tendinitis (inflammation of the tendons), delaying appropriate therapy like loading exercises and rehabilitation.
2. Confusing acute inflammation with chronic degeneration: The signs of acute inflammation (pain, swelling, heat) may sometimes mask the underlying degenerative changes. For instance, a patient with osteoarthritis (a degenerative joint condition) may experience occasional inflammatory flare-ups, leading clinicians to focus solely on inflammation while neglecting long-term management of degeneration.
3. Misidentifying pain patterns: Pain from degenerative conditions like “-osis” tends to be more gradual and dull, often increasing with activity. In contrast, inflammatory pain associated with “-itis” is usually more acute and intense. Failure to correctly identify the type of pain can lead to incorrect diagnoses and treatment approaches.

1. Tendinitis: Tendinitis is the acute inflammation of a tendon, often caused by sudden injury or repetitive strain. The inflammation is typically localised, and symptoms include pain, swelling, and tenderness over the tendon. Common forms include Achilles tendinitis (affecting the Achilles tendon) and rotator cuff tendinitis (inflammation of the tendons in the shoulder).
2. Bursitis: Bursitis is the inflammation of the bursa, a small fluid-filled sac that cushions bones and tendons. Overuse, injury, or infection can cause bursitis. Commonly affected areas include the shoulder, elbow (olecranon bursitis), and hip.
3. Appendicitis: This is the inflammation of the appendix, often caused by obstruction or infection. It is an acute medical condition that requires prompt surgical intervention.

1. Tendinosis: Tendinosis is a chronic degenerative condition of the tendon that occurs due to overuse or ageing. It involves the breakdown of collagen in the tendon without significant inflammation. Unlike tendinitis, tendinosis is a long-term problem characterised by a dull ache, stiffness, and reduced strength. Achilles tendinosis is a common example.
2. Osteoarthritis: Osteoarthritis (OA) is a degenerative joint disease characterised by the gradual breakdown of cartilage, leading to joint pain, stiffness, and reduced mobility. OA is commonly seen in older adults and is considered a classic degenerative condition rather than an inflammatory one.
3. Spondylosis: Spondylosis refers to degenerative changes in the spine, particularly the intervertebral discs and facet joints. It is a common cause of back pain in older adults and is associated with stiffness, reduced flexibility, and changes in the spinal structure.

Post Melbourne Marathon recovery aid

• Muscle fatigue: Prolonged running leads to muscle fatigue, particularly in the legs, hips, and core. The repetitive impact can cause microtears in muscle fibers, leading to post-race soreness, commonly known as delayed onset muscle soreness (DOMS).
• Joint stress: The knee, hip, and ankle joints endure repeated pounding over the course of the marathon, which can cause inflammation, stiffness, and pain.
• Tightness and muscle imbalances: After a long-distance race, muscles such as the hamstrings, quadriceps, and calves may become tight, leading to imbalances that can cause discomfort or increase the risk of injury.
• Reduced flexibility and mobility: Long runs can lead to stiffness, affecting range of motion in key areas like the hips, knees, and ankles.

• Deep Tissue Massage: Focuses on releasing deep muscle tension and breaking down adhesions, allowing for better muscle function and mobility.
• Trigger Point Therapy: Targets specific points of tension in the muscles that can cause referred pain and tightness, releasing them to restore muscle balance.
• Dry Needling: A technique used in myotherapy to release tight muscle bands and reduce pain by inserting fine needles into specific trigger points. This helps reduce inflammation and promote muscle relaxation.
• Myofascial cupping: Myofascial cupping involves the use of suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. Loosening tight fascia and muscle adhesions can restore normal tissue mobility and reduce pain.
• Myofascial Release: Helps to release tension in the connective tissue (fascia) surrounding the muscles, reducing stiffness and improving mobility.
• Joint Mobilisation: Gently moves joints through their natural range of motion to restore mobility, especially in the hips, knees,
  and ankles.

De Quervain’s Tenosynovitis

Author: Jerry Song

De Quervain’s tenosynovitis, also known as “washerwoman’s sprain” or “gamer’s thumb,” is an inflammatory condition involving the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons. These tendons run along the thumb side of the wrist and are responsible for thumb extension and abduction. Inflammation of the synovial sheath that surrounds these tendons leads to pain, swelling, and restricted movement. As a result, patients often experience difficulty with activities that involve grasping, pinching, or thumb movements.

The hallmark symptom of De Quervain’s tenosynovitis is pain and tenderness over the radial side of the wrist, which can radiate up the forearm or down into the thumb. The Finkelstein test is a common diagnostic manoeuver in which the patient bends their thumb into their palm and wraps their fingers over it, followed by ulnar deviation (moving the wrist toward the pinky side). A positive test, characterised by sharp pain, is indicative of De Quervain’s tenosynovitis.

Causes of De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is primarily caused by overuse or repetitive strain of the tendons involved in thumb movement. Specific causes include:

1. Repetitive Hand and Wrist Movements:Activities that involve repetitive motions of the thumb and wrist, such as lifting, grasping, and pinching, are a leading cause of De Quervain’s tenosynovitis. These activities place strain on the APL and EPB tendons, leading to inflammation and irritation. Common repetitive tasks include typing, texting, gardening, and lifting infants.
2. Direct Trauma or Injury:Acute trauma to the wrist or thumb area, such as a direct blow or excessive strain, can trigger inflammation in the tendons and synovial sheath, leading to De Quervain’s tenosynovitis.
3. Chronic Overload:Repeated overloading of the tendons over time, even without obvious injury, can lead to microtrauma in the tendons, resulting in inflammation, swelling, and thickening of the tendon sheath.
4. Inflammatory Conditions:Systemic inflammatory diseases, such as rheumatoid arthritis, may contribute to the development of De Quervain’s tenosynovitis due to underlying chronic inflammation in the joints and tendons.

Demographics Most Likely to Suffer from De Quervain’s Tenosynovitis

While De Quervain’s tenosynovitis can affect individuals of all ages and backgrounds, certain demographics are at higher risk of developing the condition:

1. Women:De Quervain’s tenosynovitis is more common in women than men, with some studies suggesting a female-to-male ratio of 4:1. This may be due to anatomical differences in tendon and joint structures, as well as the increased likelihood of women engaging in repetitive tasks such as child-rearing, household chores, or manual labor that involves hand and wrist movements.
2. Postpartum Women:New mothers are particularly susceptible to De Quervain’s tenosynovitis due to the repetitive lifting and holding of infants. This condition is often referred to as “mommy’s thumb” because the motion of lifting a baby from a crib, car seat, or carrier places strain on the thumb and wrist tendons.
3. Manual Labourers and Office Workers:Individuals whose occupations involve repetitive wrist and thumb movements, such as typists, assembly line workers, carpenters, and hairdressers, are at a higher risk of developing De Quervain’s tenosynovitis due to repetitive strain and overuse.
4. Smartphone and Video Game Users:The rise of smartphone usage and video gaming has led to an increase in cases of De Quervain’s tenosynovitis, particularly among younger demographics. Prolonged texting, scrolling, and gaming require constant thumb movement, which can lead to inflammation of the thumb tendons over time.

How Manual Therapy Can Help Treat and Manage De Quervain’s Tenosynovitis

Manual therapy is a non-invasive approach to managing musculoskeletal conditions, including De Quervain’s tenosynovitis. It involves various hands-on techniques aimed at reducing pain, improving mobility, and addressing underlying muscular imbalances. Manual therapy has shown promise in reducing symptoms and facilitating recovery in patients with this condition.

1. Soft Tissue Mobilisation and Massage

Soft tissue mobilisation and massage techniques target the muscles, tendons, and fascia surrounding the wrist and thumb. This approach helps reduce tension, improve blood flow, and promote healing in the affected tendons. Soft tissue techniques can alleviate pain and prevent the progression of inflammation by addressing tightness in the muscles around the wrist and hand.

2. Joint Mobilisation

Joint mobilisation techniques can help improve the range of motion in the wrist and thumb joints by gently moving the joints through their natural range. This technique is particularly beneficial for individuals experiencing stiffness or restricted movement due to inflammation and swelling.

3. Dry Needling

Dry needling is a manual therapy technique in which fine needles are inserted into specific trigger points or tight bands of muscle to release tension and reduce pain. In the context of De Quervain’s tenosynovitis, dry needling can be used to target the muscles and tendons involved in thumb and wrist movement, particularly the APL and EPB tendons.

Dry needling works by stimulating blood flow to the area, promoting the release of tight muscle fibers, and reducing local inflammation. This helps alleviate pain and allows the affected tendons to heal more effectively. When combined with other manual therapy techniques, dry needling can help accelerate recovery and improve overall function in patients with De Quervain’s tenosynovitis.

4. Myofascial Cupping

Myofascial cupping is a technique in which suction cups are placed on the skin to create negative pressure, lifting the skin and underlying fascia. This technique improves blood circulation, reduces fascial adhesions, and promotes tissue healing. In cases of De Quervain’s tenosynovitis, myofascial cupping can be applied to the forearm, wrist, and thumb areas to relieve tension and reduce inflammation.

Cupping helps improve tissue mobility by releasing tight fascia and muscles, allowing for better tendon glide and reduced pain. It can also be used in conjunction with stretching and strengthening exercises to improve range of motion and restore function to the affected area.

5. Stretching and Strengthening Exercises

Manual therapy often includes the incorporation of therapeutic exercises designed to stretch tight muscles and strengthen weak ones. Specific exercises for De Quervain’s tenosynovitis may include wrist stretches, thumb abduction and extension exercises, and forearm strengthening movements. These exercises help improve flexibility, restore tendon function, and prevent recurrence of the condition.

Benefits of Manual Therapy in Managing De Quervain’s Tenosynovitis

Manual therapy offers several benefits in the management of De Quervain’s tenosynovitis, including:

1. Pain Relief:Manual therapy techniques, including soft tissue mobilisation, dry needling, and myofascial cupping, help alleviate pain by reducing inflammation and releasing tight muscles.
2. Improved Mobility:By addressing joint stiffness and tendon adhesions, manual therapy helps improve range of motion in the wrist and thumb, allowing patients to perform daily activities with less discomfort.
3. Increased Blood Flow:Techniques such as massage, dry needling, and cupping promote circulation to the affected area, which enhances tissue healing and reduces recovery time.
4. Reduced Inflammation:Manual therapy helps reduce swelling and inflammation in the tendons and surrounding tissues, which is crucial for managing the symptoms of De Quervain’s tenosynovitis.
5. Prevention of Recurrence:By incorporating strengthening exercises and ergonomic advice, manual therapy can help prevent the recurrence of De Quervain’s tenosynovitis by addressing the root causes of tendon overuse and imbalance.

If you or someone you know are dealing with De Quervain’s tenosynovitis, musculoskeletal pain, or even myofascial trigger points, book an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.  Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Hazards and effects of working at a desk

Author: Jerry Song

In today’s digital world, many of us spend countless hours sitting at a desk, working on computers, or scrolling through our phones. While this sedentary lifestyle is a norm for many, the consequences of prolonged sitting and poor posture, particularly slouching, can have lasting effects on our health. One of the most significant issues resulting from poor sitting posture is forward head posture, a common condition that causes both discomfort and long-term anatomical changes. In this blog, we’ll explore how desk work affects your posture, the specific impact of forward head posture, and the long-term consequences of poor sitting habits.

The Immediate Effects of Sitting for Long Hours

Sitting for extended periods without proper ergonomic support can lead to several immediate issues, including:

• Muscular Tension:The muscles in the neck, shoulders, and lower back can become tight and stiff, particularly if you slouch or hunch over.
• Reduced Circulation:Prolonged sitting reduces blood flow, particularly to the lower extremities, leading to numbness and discomfort.
• Pressure on the Spine:Sitting places more pressure on the spine than standing or lying down, particularly when posture is poor. This extra pressure can lead to discomfort and increase the risk of spinal problems.

However, the most concerning impact of prolonged sitting is the long-term effect it has on posture, particularly in the development of forward head posture.

How Slouching and Forward Head Posture Affect Your Body

Slouching occurs when you round your shoulders forward, curve your upper back, and allow your chest to collapse. Over time, this leads to forward head posture (FHP), which occurs when the head juts forward in front of the shoulders rather than being aligned over the spine. This posture has become increasingly common due to the frequent use of computers, smartphones, and other digital devices.

Forward Head Posture (FHP): What Happens to Your Body?

Forward head posture may seem like a minor issue at first, but it causes significant anatomical changes that affect your entire body:

1. Cervical Spine Strain:In a neutral position, the head weighs about 10-12 pounds, and the cervical spine (neck) easily supports this weight. However, for every inch that the head moves forward, the strain on the cervical spine increases dramatically. This added pressure can lead to chronic neck pain and headaches as the muscles and joints are forced to compensate for the additional load.
2. Rounded Shoulders and Upper Back (Kyphosis):As your head moves forward, your shoulders naturally round, and your upper back starts to hunch, leading to a condition known as kyphosis. This further strains the muscles in the chest, shoulders, and upper back, weakening the stabilising muscles in the shoulder blades.
3. Compression of the Thoracic Spine:Forward head posture places stress not only on the neck but also on the mid-back, leading to compression of the thoracic spine. This can limit mobility in the upper back and restrict movement in the chest and rib cage, making breathing more shallow and laboured.
4. Tightening of Chest Muscles:The pectoral (chest) muscles become tight and shortened due to the forward position of the head and shoulders. Over time, this imbalance leads to further postural problems and reduced mobility in the upper body.
5. Weakening of Neck and Upper Back Muscles:The muscles that support the head and upper spine, including the deep neck flexors and upper back muscles, weaken due to prolonged forward head posture. This creates a vicious cycle where weak muscles further exacerbate poor posture, leading to increased strain and discomfort.
6. Jaw and Temporomandibular Joint (TMJ) Issues:Forward head posture can also affect the alignment of the jaw, leading to jaw pain, clicking, or temporomandibular joint dysfunction (TMJ). The forward positioning of the head alters the relationship between the jaw and the skull, placing undue stress on the joint.

Long-Term Effects of Poor Posture and Forward Head Posture

If poor posture and forward head posture are left unaddressed, they can lead to long-term consequences that affect your overall health and quality of life:

1. Chronic Pain:Forward head posture often leads to chronic neck, shoulder, and upper back pain due to the constant strain on muscles, ligaments, and joints. Over time, this pain can become debilitating and affect daily activities.
2. Degenerative Spinal Changes:Prolonged forward head posture increases the risk of degenerative conditions in the spine, such as herniated discs, osteoarthritis, and cervical spondylosis. The additional pressure on the cervical vertebrae accelerates wear and tear on the joints, leading to chronic pain and reduced mobility.
3. Breathing Difficulties:As the rib cage becomes compressed due to slouching and forward head posture, lung expansion becomes restricted. This can lead to shallow breathing, reduced oxygen intake, and even shortness of breath, particularly during physical activity.
4. Nerve Impingement:Poor posture can also lead to nerve impingement, where nerves in the neck and shoulders become compressed due to muscle tightness and spinal misalignment. This can result in tingling, numbness, or shooting pain in the arms and hands, known as cervical radiculopathy.
5. Impact on Mental Health:Chronic pain and discomfort caused by poor posture can take a toll on mental health, leading to increased stress, anxiety, and even depression. Poor posture can also affect confidence and self-esteem, as it often leads to a more closed and withdrawn body position.
6. Poor Postural Alignment:Long-term forward head posture alters your body’s overall postural alignment, making it harder to stand and sit upright. This misalignment can contribute to balance issues, reduced coordination, and an increased risk of falls, particularly in older adults.

How to Correct Forward Head Posture and Improve Overall Posture

Fortunately, with awareness and the right interventions, forward head posture and its long-term consequences can be corrected or significantly improved. Here are some strategies to address poor posture and reverse forward head posture:

1. Ergonomic Adjustments:Adjust your workspace to promote good posture. Ensure your computer screen is at eye level, and use a chair with proper lumbar support to maintain a neutral spine position. Your feet should be flat on the floor, with your knees at a 90-degree angle.
2. Posture Awareness:Regularly check your posture throughout the day. Focus on sitting and standing tall with your shoulders back and your head aligned over your spine. A good way to practice this is to imagine a string pulling you upward from the top of your head.
3. Strengthening Exercises:Incorporate exercises that strengthen the muscles of the upper back and neck, such as rows, chin tucks, and scapular retractions. These exercises target weak muscles and help restore proper postural alignment.
4. Stretching Tight Muscles:Stretch the chest, shoulders, and neck muscles to release tension and improve mobility. Doorway stretches, chest openers, and neck stretches can help counteract the effects of slouching and forward head posture.
5. Foam Rolling and Myofascial Release:Foam rolling can help release tension in the thoracic spine and upper back muscles. This improves flexibility and helps the body return to its natural alignment.
6. Movement Breaks:Take regular breaks from sitting throughout the day. Aim to stand, stretch, or walk for at least 5 minutes every hour. These movement breaks can help alleviate tension and prevent prolonged strain on your posture.

If you or someone you know are dealing with shoulder bursitis, musculoskeletal pain, or even myofascial trigger points, book an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.  Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Shoulder Bursitis

Author: Jerry Song

Shoulder bursitis is characterised by the inflammation of the bursae, small fluid-filled sacs that cushion and reduce friction between tissues in the shoulder joint. The condition commonly affects the subacromial bursa, which lies between the acromion and the rotator cuff tendons. Shoulder bursitis can cause significant discomfort and limit the range of motion, impacting daily activities and quality of life. While conservative treatments are often effective, manual therapy, including dry needling and myofascial cupping, can play a crucial role in symptom management and functional restoration.

Shoulder bursitis can arise from various factors, often classified into two main categories: acute and chronic causes.

1. Acute Causes:
   • Trauma: Direct impact or injury to the shoulder can cause inflammation of the bursae.
   • Overuse: Repetitive overhead movements or heavy lifting can irritate the bursae, leading to acute inflammation.
   • Infection: In rare cases, bacterial infections can cause septic bursitis, resulting in significant inflammation and pain.
2. Chronic Causes:
   • Degenerative Changes: Ageing and wear-and-tear can lead to degenerative changes in the shoulder, contributing to chronic bursitis.
   • Postural Imbalances: Poor posture, such as forward head posture or rounded shoulders, can increase the risk of bursitis by altering shoulder mechanics.
   • Systemic Conditions: Conditions such as rheumatoid arthritis and gout can cause recurrent bursitis due to systemic inflammation.

Shoulder bursitis affects a wide demographic, with certain groups being more susceptible:

1. Age: The risk of developing shoulder bursitis increases with age, particularly due to degenerative changes in the shoulder joint.
2. Occupation and Activities: Individuals engaged in occupations or activities involving repetitive shoulder movements, such as painters, athletes, and manual labourers, are at higher risk.
3. Gender: While both genders are affected, certain studies suggest a slightly higher prevalence in females, possibly due to differences in shoulder anatomy and biomechanics.
4. Posture and Biomechanics: Poor posture, muscle imbalances, and improper biomechanics can predispose individuals to shoulder bursitis by increasing stress on the shoulder joint and bursae.

Manual therapy offers a range of non-invasive techniques to manage shoulder bursitis, alleviating pain, improving mobility, and promoting healing. Key manual therapy interventions include:

1. Dry Needling

Dry needling involves the insertion of fine needles into specific trigger points or areas of muscle tightness to promote pain relief and muscle relaxation. Benefits of dry needling for shoulder bursitis include:

• Reduction of Muscle Tightness: Targeting trigger points in the shoulder and surrounding muscles can alleviate tightness, improving range of motion and reducing stress on the bursae.
• Pain Relief: By disrupting pain signals and promoting local blood flow, dry needling can effectively reduce pain and inflammation associated with bursitis.
• Improved Muscle Function: Enhancing muscle function around the shoulder joint can stabilise the area, reducing abnormal movement patterns that exacerbate bursitis.

2. Myofascial Cupping

Myofascial cupping involves the use of suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. This technique can:

• Enhance Blood Circulation: Increased blood flow aids in nutrient delivery and waste removal, promoting healing and reducing inflammation.
• Release Myofascial Restrictions: Loosening tight fascia and muscle adhesions can restore normal tissue mobility, reducing pressure on the bursae and alleviating pain.
• Reduce Muscle Spasms: The negative pressure from cupping can relax muscle spasms, improving muscle tone and function in the shoulder region.

3. Soft Tissue Mobilisation

Soft tissue mobilisation includes techniques such as massage and myofascial release to manipulate the soft tissues around the shoulder:

• Massage Therapy: Techniques like deep tissue massage can reduce muscle tension, improve circulation, and decrease pain, facilitating recovery of muscle function and flexibility.
• Myofascial Release: Applying sustained pressure to myofascial restrictions can eliminate pain and restore motion, addressing tightness in the shoulder muscles and fascia.

4. Joint Mobilisation

Joint mobilisation involves applying controlled forces to improve the range of motion and alleviate pain in the shoulder joint:

• Glenohumeral Joint Mobilisation: Techniques to mobilise the glenohumeral joint can enhance joint mobility, reduce stiffness, and correct abnormal mechanics contributing to bursitis.
• Scapulothoracic Mobilisation: Addressing scapular movement can improve overall shoulder mechanics, reducing compensatory stresses on the bursae.

5. Manual Stretching

Manual stretching techniques aim to improve flexibility and reduce tension in the muscles around the shoulder:

• Pectoral and Rotator Cuff Stretching: Stretching the pectoral and rotator cuff muscles can relieve tension and improve range of motion in the shoulder.
• Upper Back and Neck Stretching: Addressing tightness in the upper back and neck can reduce stress on the shoulder and improve posture.

Listed below are some details of a client dealing with shoulder bursitis who is seeking treatment here at HBM, which may also serve as a case study:

Age: 50+

Gender: M

Symptoms: Right shoulder pain

Medical history: Non pertinent

Lifestyle: Frequently goes cycling long distances, and seated for work mainly

The client has received fortnightly treatments here at HBM over the period of 3 months to manage his symptoms, and even after the first treatment has had great improvement in mobility and pain. Educating him on the importance of compliance to treatment due to his active schedule has made a big difference on his quality of life, and after educating him on the possible cause (after numerous questioning and orthopaedic testing) and with some take home exercises and stretches, he’s been able to get back to his daily activities with much improvements on symptoms.

If you or someone you know are dealing with shoulder bursitis, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.  Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Hallux Valgus Deformity (aka Bunions)

Author: Jerry Song

Hallux valgus is a structural deformity of the foot that involves the angling of the great toe (hallux) towards the second toe, accompanied by a bony prominence known as a bunion on the medial aspect of the first metatarsophalangeal joint (MTPJ). This deformity can lead to pain, discomfort, and functional limitations, significantly affecting an individual’s quality of life. While surgical intervention is often considered for severe cases, conservative treatments, including manual therapy, play a vital role in managing symptoms and slowing the progression of the deformity.

Hallux valgus develops due to a combination of intrinsic and extrinsic factors:

1. Genetic Predisposition: Family history of hallux valgus suggests a genetic component that affects foot biomechanics and structural alignment.
2. Footwear: Wearing narrow, high-heeled, or poorly fitting shoes can exacerbate or contribute to the development of hallux valgus by applying abnormal pressure on the toes and altering foot mechanics.
3. Biomechanical Factors: Abnormal foot mechanics, such as overpronation or excessive supination, can contribute to the development of hallux valgus. Muscle imbalances and weak intrinsic foot muscles may also play a role.
4. Arthritis: Conditions like rheumatoid arthritis can affect joint alignment and contribute to the development of hallux valgus.
5. Trauma: Previous injuries to the foot or toe can impact the alignment of the great toe and contribute to the deformity.
6. Muscle Imbalance: Weakness or imbalance in the muscles supporting the foot can affect the alignment of the toe and exacerbate the deformity.

Hallux valgus develops due to a combination of intrinsic and extrinsic factors:

1. Age: The condition is more common in older adults, with the prevalence increasing with age due to cumulative biomechanical stress and degenerative changes.
2. Gender: Women are significantly more likely to develop hallux valgus than men. This disparity is often attributed to footwear choices, such as high heels and narrow-toed shoes, which can exacerbate the deformity.
3. Family History: Individuals with a family history of hallux valgus are at a higher risk, indicating a genetic predisposition.
4. Footwear Choices: Wearing tight, narrow, or high-heeled shoes regularly increases the likelihood of developing hallux valgus, especially in women.

Manual therapy can play a supportive role in managing hallux valgus by alleviating symptoms, improving foot function, and addressing contributing factors. Key manual therapy interventions include:

1. Dry Needling

Dry needling involves the insertion of fine needles into specific trigger points or areas of muscle tightness to promote pain relief and muscle relaxation. Benefits of dry needling for hallux valgus include:

• Reduction of Muscle Tightness: Targeting trigger points in the foot and lower leg muscles, such as the flexors and extensors, can alleviate tightness and improve muscle balance.
• Pain Relief: By disrupting pain signals and promoting local blood flow, dry needling can effectively reduce foot pain and discomfort associated with hallux valgus.
• Improved Muscle Function: Enhancing muscle function around the foot can aid in improving foot mechanics and reducing abnormal stress on the MTPJ.

2. Myofascial Cupping

Myofascial cupping involves using suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. This technique can:

• Enhance Blood Circulation: Improved blood flow helps in nutrient delivery and waste removal, promoting tissue healing and reducing inflammation in the affected area.
• Release Myofascial Restrictions: Loosening tight fascia and muscle adhesions can restore normal tissue mobility and alleviate pain associated with hallux valgus.
• Reduce Muscle Spasms: The negative pressure can help relax muscle spasms, improving muscle tone and function in the foot.

3. Soft Tissue Mobilisation

Soft tissue mobilisation techniques include massage and myofascial release to manipulate the soft tissues around the foot and toe:

• Massage Therapy: Techniques like deep tissue massage can reduce muscle tension, improve circulation, and decrease pain, facilitating recovery and improving foot function.
• Myofascial Release: Applying sustained pressure to myofascial restrictions can eliminate pain and restore motion, addressing tightness in the foot and lower leg muscles.

4. Joint Mobilisation

Joint mobilisation involves applying controlled forces to the MTPJ and surrounding joints to improve range of motion and alleviate pain:

• MTPJ Mobilisation: Techniques to mobilise the MTPJ can enhance joint mobility, reduce stiffness, and correct abnormal mechanics contributing to hallux valgus.
• Manual Traction: Applying gentle traction to the MTPJ can reduce joint compression, alleviate pain, and improve alignment.

5. Manual Stretching

Manual stretching techniques aim to improve flexibility and reduce tension in the muscles and tissues around the foot:

• Toe and Foot Stretching: Stretching the intrinsic and extrinsic muscles of the foot can relieve tension and improve flexibility, aiding in better alignment and function.
• Calf Stretching: Addressing tightness in the calf muscles can improve overall foot mechanics and reduce stress on the MTPJ.

6. Proprioceptive Neuromuscular Facilitation (PNF)

PNF stretching combines stretching and contracting targeted muscle groups to enhance flexibility and strength:

• PNF Techniques: Effective for improving the flexibility and strength of the foot muscles, promoting better mechanics and reducing pain associated with hallux valgus.

If you or someone you know are dealing with bunions, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain. Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Headaches

Author: Jerry Song

Headaches are one of the most common neurological complaints encountered in clinical practice, affecting individuals across various demographic groups. They can be broadly categorised into primary and secondary headaches, with each category encompassing multiple subtypes. Understanding the etiology of these headaches and the demographics most likely to suffer from them is crucial for effective diagnosis and management.

1. Primary Headaches

Primary headaches are not caused by an underlying medical condition but are disorders themselves. The main types include migraines, tension-type headaches (TTH), and cluster headaches.

1. Migraine

Migraine is a recurrent headache disorder characterised by moderate to severe pain, typically unilateral and pulsating in nature. The pain is often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can be preceded by aura, which includes visual disturbances or other neurological symptoms.

Etiology: The exact cause of migraines is not fully understood, but it is believed to involve a combination of genetic, environmental, and neurological factors. There is evidence suggesting abnormal brain activity and blood flow changes, as well as dysfunction in the trigeminovascular system.

Demographics: Migraines affect approximately 12% of the global population, with a higher prevalence in women than men (about 3:1 ratio). They are most common in individuals aged 18 to 44, particularly among women of childbearing age due to hormonal fluctuations. There is also a genetic predisposition, as migraines tend to run in families.

1. Tension-Type Headache (TTH)

Tension-type headaches are the most common type of primary headache. They are characterised by bilateral, mild to moderate pain, often described as a tight band around the head. These headaches can last from 30 minutes to several days.

Etiology: The etiology of TTH is believed to involve muscle tension and stress. Psychological factors such as anxiety and depression are also associated with TTH. The pain is thought to result from peripheral activation or sensitisation of myofascial nociceptors.

Demographics: Tension-type headaches affect up to 80% of the population at some point in their lives. They are slightly more common in women than men and are most frequently reported by individuals in their 30s and 40s. Stressful life situations and poor posture are common triggers.

1. Cluster Headache

Cluster headaches are characterised by severe, unilateral pain, typically around the eye or temple, often accompanied by autonomic symptoms such as tearing, nasal congestion, or eyelid swelling. These headaches occur in clusters, with multiple attacks over weeks or months, followed by periods of remission.

Etiology: The exact cause of cluster headaches is unknown, but they are thought to involve abnormalities in the hypothalamus, leading to dysregulation of circadian rhythms. Genetic factors may also play a role, though they are less prominent than in migraines.

Demographics: Cluster headaches are rare, affecting about 0.1% of the population. They are more common in men than women (about 4:1 ratio) and typically begin between the ages of 20 and 40. Smoking and alcohol consumption are significant risk factors.

2. Secondary Headaches

Secondary headaches are symptomatic of an underlying medical condition. The pain is often due to infection, trauma, vascular disorders, or other systemic issues. Common types include:

1. Medication Overuse Headache (MOH)

Medication overuse headache, also known as rebound headache, occurs as a result of frequent use of headache medications. The headache is usually present upon waking and can resemble a tension-type headache or migraine.

Etiology: MOH is caused by the regular use of analgesics or triptans for headache relief, leading to a cycle of overuse and increased headache frequency.

Demographics: MOH is more prevalent in women, particularly those aged 30 to 50. It is also common among individuals with a history of chronic headaches, such as migraines or tension-type headaches.

1. Sinus Headache

Sinus headaches are caused by inflammation or infection of the sinuses, leading to pressure and pain in the forehead, cheeks, and eyes. These headaches are often associated with sinusitis and may be accompanied by nasal congestion, fever, and facial swelling.

Etiology: Sinus headaches occur due to inflammation of the sinus cavities, often secondary to infection (viral or bacterial) or allergic reactions. The pain results from increased pressure within the sinuses.

Demographics: Sinus headaches are more common in individuals with a history of allergies or chronic sinusitis. They are equally prevalent among men and women and can affect all age groups, though they are more common in adults.

1. Cervicogenic Headache

Cervicogenic headache is a secondary headache caused by disorders of the cervical spine and its components, such as intervertebral discs, facet joints, or cervical muscles. The pain is typically unilateral and may radiate from the neck to the front of the head.

Etiology: Cervicogenic headaches result from cervical spine disorders, such as osteoarthritis, herniated discs, or whiplash injuries. The pain is believed to originate from the convergence of nociceptive input from the cervical spine and trigeminal nerve.

Demographics: This type of headache is more common in individuals with neck trauma or chronic neck pain, particularly those aged 30 to 50. It is slightly more prevalent in women than men.

If you or someone you know are dealing with headaches, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain. Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.