Year: 2024

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common peripheral nerve disorder resulting from compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist formed by the carpal bones and transverse carpal ligament. The compression of the median nerve leads to a constellation of symptoms, including pain, numbness, tingling, and weakness in the thumb, index, middle, and radial half of the ring finger. While CTS can have multifactorial etiology, manual therapy has emerged as a promising adjunctive treatment modality to alleviate symptoms and improve hand function.

The pathophysiology of CTS is complex and involves mechanical compression, ischemia, and inflammation of the median nerve within the carpal tunnel. Predisposing factors such as wrist anatomy, repetitive hand movements, trauma, hormonal changes, and systemic diseases contribute to the development of CTS. Compression of the median nerve leads to impaired nerve conduction, demyelination, and axonal degeneration, resulting in sensory and motor deficits in the affected hand.

CTS predominantly affects individuals engaged in repetitive hand and wrist movements, as well as those exposed to occupational or recreational activities that involve prolonged wrist flexion or extension. Thus, certain demographic groups are more susceptible to developing CTS, including:• Working Professionals: Occupations that involve repetitive or forceful hand movements, prolonged computer use, or vibrating tools predispose individuals to CTS. Office workers, assembly line workers, musicians, and those in the construction industry are at increased risk.
• Women: Studies have shown that women are more likely to develop CTS compared to men, possibly due to hormonal factors, smaller carpal tunnel dimensions, and increased susceptibility to soft tissue swelling during pregnancy.
• Aging Population: Older adults are at higher risk of developing CTS due to age-related changes in soft tissues, decreased nerve elasticity, and underlying degenerative conditions such as arthritis and ligamentous laxity.
• Individuals with Comorbidities: Systemic conditions such as diabetes, obesity, thyroid disorders, and rheumatoid arthritis are associated with an increased risk of developing CTS due to their effects on nerve health, tissue inflammation, and fluid retention.

Manual therapy encompasses a variety of hands-on techniques aimed at addressing musculoskeletal dysfunctions, improving joint mobility, and reducing soft tissue restrictions. In the context of CTS, manual therapy interventions target the underlying anatomical and biomechanical factors contributing to median nerve compression. Common manual techniques employed in the treatment of CTS include:
• Soft Tissue Mobilisation: Manual manipulation of the muscles, tendons, and fascia surrounding the carpal tunnel aims to reduce adhesions, improve tissue extensibility, and alleviate pressure on the median nerve.
• Nerve Gliding Exercises: Specific exercises designed to mobilise and stretch the median nerve can help reduce neural tension, improve nerve conduction, and alleviate symptoms of CTS.
• Joint Mobilisation: Gentle mobilisation of the wrist, hand, and adjacent joints aims to improve joint mobility, reduce stiffness, and optimise the biomechanics of the upper extremity.
• Therapeutic Exercises: Strengthening and stretching exercises targeting the muscles of the forearm, hand, and wrist can help improve grip strength, enhance proprioception, and promote functional recovery in individuals with CTS.

If you or someone you know are dealing with CTS, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see us 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.

Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) encompasses a group of disorders caused by compression of the neurovascular structures, including the brachial plexus, subclavian artery, and vein, as they pass through the thoracic outlet. The thoracic outlet is anatomically defined as the passageway between the clavicle and first rib, bounded by the scalene muscles anteriorly, the first rib inferiorly, and the posterior cervical muscles posteriorly. TOS can be classified into neurogenic, vascular, or nonspecific types, each presenting with distinct clinical features.

TOS can arise from various anatomical anomalies or acquired conditions that result in compression of the thoracic outlet structures. Common etiological factors include congenital anomalies such as cervical ribs, abnormal scalene muscle anatomy, muscular hypertrophy, trauma, poor posture, repetitive overhead activities, and anatomical variations in the bony and soft tissue structures. The compression leads to ischemia, nerve irritation, and mechanical distortion, giving rise to the characteristic symptoms of TOS.

Patients with TOS typically present with a constellation of symptoms, including pain, numbness, tingling, and weakness in the upper extremities. Neurogenic TOS primarily manifests with neurological symptoms, such as paresthesia along the ulnar aspect of the forearm and hand, while vascular TOS presents with symptoms related to arterial or venous compromise, such as cold intolerance, pallor, and swelling. Nonspecific TOS may exhibit a combination of neurogenic and vascular symptoms, making diagnosis challenging and often necessitating a multidisciplinary approach.

Manual therapy encompasses a variety of hands-on techniques aimed at restoring mobility, reducing pain, and improving function in musculoskeletal disorders. In the context of TOS, manual therapy interventions target the underlying musculoskeletal and soft tissue dysfunctions contributing to thoracic outlet compression. Techniques commonly employed include:

• Soft Tissue Mobilisation: Manual manipulation of soft tissues, such as massage, myofascial release, and trigger point therapy, aims to alleviate muscular tension, reduce adhesions, and improve blood flow to the affected area.
• Joint Mobilisation: Gentle mobilisation of the thoracic spine, cervical spine, and ribs can help restore normal joint mechanics, alleviate restrictions, and reduce nerve impingement.
• Stretching and Strengthening Exercises: Specific exercises targeting the muscles of the neck, shoulder girdle, and upper extremities can improve flexibility, strength, and postural alignment, thereby reducing compression on the thoracic outlet structures.

• Postural Correction: Education and training in proper posture and ergonomics are essential components of manual therapy for TOS, as poor posture contributes to thoracic outlet compression and exacerbates symptoms.

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

Age: 40+

Gender: M

Symptoms: Nerve pain in elbow down to index finger on R hand

Medical history: No known injuries of relevance.

Lifestyle: Travels abroad frequently for work, while finishing a PhD at the same time.

The client has received 5x treatments here at HBM over 5 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 even with such a busy 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 TOS, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see us 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.

Lower Cross Syndrome

Lower Cross Syndrome

Lower crossed syndrome (LCS) is a musculoskeletal imbalance condition characterised by specific patterns of muscle dysfunction, primarily involving the lumbar spine, pelvis, and lower extremities. Tightness in the hip flexors (iliopsoas, rectus femoris) and lumbar extensors (erector spinae) is coupled with weakness in the gluteal muscles and abdominal stabilisers (transversus abdominis, internal obliques). The imbalanced muscle activity results in an anterior pelvic tilt, increased lumbar lordosis, and a protruding abdomen, leading to a characteristic swayback posture.

Individuals with LCS often experience chronic low back pain, hip pain, and tightness in the hip flexors. Dysfunction in the lumbar-pelvic region may contribute to secondary symptoms such as sacroiliac joint dysfunction and hip joint impingement. Additionally, LCS can impair functional movement patterns, affecting activities such as walking, standing, and squatting. Reduced hip mobility and stability may also predispose individuals to compensatory movements and increased risk of injury during physical activities.

One method myotherapists may use to address LCS is by manual therapy such as soft tissue mobilisation techniques, which include myofascial release and trigger point therapy, that target tight muscles (e.g., hip flexors, lumbar extensors) to alleviate tension and improve flexibility. Joint mobilisation and manipulation may also be employed to restore normal joint mechanics and address segmental dysfunctions, particularly in the lumbar spine and pelvis.

In addition to manual therapy techniques, exercise therapy is very beneficial and complements the above techniques in addressing LCS more comprehensively. Strengthening exercises focusing on the gluteal muscles and abdominal stabilisers are essential components of LCS rehabilitation. Hip extension exercises, core stabilisation exercises, and postural retraining aim to correct muscle imbalances and promote optimal alignment of the lumbar-pelvic region.

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

Age: 40+

Gender: F

Symptoms: Immense pain around lower back suddenly after going down the stairs one day, could barely walk after it happened.

Medical history: No significant injuries shown on MRI/X-Ray

Lifestyle: Works as a music teacher, and is seated for that mostly, also does Pilates to strengthen her muscles

The client has received 3x treatments here at HBM over 1.5 months to manage her symptoms, and even after the first treatment has had great improvement in mobilityand pain. Educating her on the importance of compliance to treatment has made a big difference on her quality of life, and after educating her on the possible cause (after numerous questioning and orthopaedic testing) and with some take home exercises and stretches, she’s been able to get back to her daily activities relatively pain-free.

If you or someone you know are dealing with LCS, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see us 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.

The Overlooked Facts of Fascia

Fascia is a complex, three-dimensional network of connective tissue that pervades the entire human body, surrounding and interpenetrating muscles, bones, nerves, and organs. Fascia consists of collagen fibers, elastin, ground substance, and cells such as fibroblasts. The arrangement of these components contributes to the diverse mechanical properties of fascial tissues. Fascia serves as a dynamic system with several key functions, including providing structural support, facilitating movement and flexibility, and participating in proprioception. Moreover, it acts as a conduit for neurovascular structures and plays a vital role in intercellular communication.

Some of the common fascial conditions include Myofascial Pain Syndrome (MPS), which is a pathology characterised by the development of trigger points within fascial tissues. These trigger points can lead to localised or referred pain, muscle stiffness, and reduced range of motion. Another fascial condition that may arise is fascial adhesions, which occur when collagen fibers in the fascial matrix become distorted or adhered, resulting in restricted movement and impaired tissue glide. This can contribute to chronic pain and dysfunction.

The Role of Manual Therapy in Fascial Treatment:

1. Soft Tissue Mobilisation:

Manual therapy techniques, such as soft tissue mobilisation, aim to address fascial restrictions by applying controlled pressure and movement to specific areas. This helps to break down adhesions, improve tissue flexibility, and restore normal function.

2. Myofascial Release:

Myofascial release involves sustained pressure and stretching of fascial tissues to release tension and promote optimal tissue mobility. Therapists use various hands-on techniques to target specific areas of fascial restriction.

3. Instrument-Assisted Soft Tissue Mobilisation (IASTM):

IASTM employs specialised tools to detect and treat fascial dysfunction. By applying controlled pressure through these instruments, therapists can break down adhesions and enhance the healing response.

Aside from the above, myofascial cupping and dry needling are two therapeutic modalities that can be effective in addressing fascial conditions, contributing to improved tissue mobility, pain relief, and overall well-being.

Cupping involves placing suction cups on the skin, creating a negative pressure environment. This negative pressure lifts the fascial layers, increasing blood flow and promoting the release of fascial restrictions. The suction effect can also create a separation between the layers of fascia, reducing adhesions and facilitating better tissue glide. Cupping is believed to also stimulate the lymphatic system, aiding in the removal of toxins and metabolic waste from the fascial tissues.

Dry needling involves the insertion of thin, solid needles into trigger points or tight bands of fascial tissue. These trigger points are areas of hyperirritability within the fascia. The needling creates a microtrauma, prompting a local twitch response in the muscle fibers. This response helps release tension and reset the neuromuscular system.

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

Age: 40+

Gender: M

Symptoms: Sensation of tightness in the lower back and forearms

Medical history: Disc bulge injury in L4-S1 in the past, Tennis elbow

Lifestyle: Works at a desk and sits in front of a screen for long periods. Did a lot of boxing until recently, when he increased his weightlifting sessions.

The client has received 3x treatments here at HBM over 1.5 months to manage his symptoms, and even after the first treatment has had great improvement in mobility. Educating him on the importance of compliance to treatment has made a big difference on his quality of life.

If you or someone you know are dealing with lower back pain, tennis elbow, headaches/migraines, and think it may be due to a fascial condition, book in an appointment to see us 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 therapists.

Knee Osteoarthritis (KOA)

Osteoarthritis (OA) stands as one of the prevailing chronic and degenerative maladies affecting cartilage, particularly prevalent among the elderly populace, with a notable predilection towards women. It is a common condition of the musculoskeletal system that can occur in any joint such as the upper limbs or spine, but it is mainly observed in large joints of the lower extremities, such as the hip and knee. These weight-bearing joints bear the brunt of loading activities, which require smooth, successful completion and absorption of loads or vibrations. Moreover, the progression of OA involves the gradual deterioration and depletion of articular cartilage concurrent with osteophyte development, synovial membrane inflammation, and hypochondriac bone destruction. Clinical manifestations include pain, stiffness, swelling, joint deformities, and functional impairment, with advanced stages potentially leading to muscular atrophy, further compromising the quality of life for afflicted individuals. OA is also among the diseases with the highest rate of comorbidity, which include: cardiovascular diseases, diabetes, obesity, chronic obstructive pulmonary disease (COPD), chronic pain and even depression (de Rooij et al., 2014).

Research by Tsokanos et al. (2021) has indicated that therapeutic treatments such as manual therapy (MT) and exercise contributes positively toward the treatment of patients suffering from KOA by reducing pain and increasing functionality. In addition, Nejati et al. (2015) had previously shown that performing exercise while also receiving MT for the knee showed significant positive effects that lasted up to a year.

Manual therapy encompasses a variety of hands-on techniques performed by trained healthcare practitioners to diagnose, treat, and manage musculoskeletal and neuromuscular conditions. Some common manual therapy techniques include:

• Joint Mobilization: This technique involves the passive movement of a joint within its natural range of motion. It aims to improve joint mobility, reduce pain, and restore function. Joint mobilization is often applied to the spine or extremity joints.
• Soft Tissue Massage: Massage therapy involves the manipulation of soft tissues, including muscles, tendons, and ligaments. Various techniques such as effleurage, petrissage, and deep tissue massage are employed to enhance blood circulation, reduce muscle tension, and promote relaxation.
• Myofascial Release: This technique focuses on the fascia, a connective tissue that surrounds muscles, bones, and organs. Practitioners use sustained pressure to release tension and tightness in the fascial system, promoting improved mobility and reducing pain.
• Trigger Point Therapy: Trigger points are localized areas of muscle tightness and tenderness. Therapists apply pressure to these points to release tension and alleviate pain. This technique is often incorporated into massage or manual therapy sessions.
• Strain-Counterstrain: Also known as positional release, this technique involves placing the body or a specific joint in a position of minimal strain, allowing muscles to relax and pain to diminish. It is particularly useful for treating muscle spasms and acute pain.
• Stretching Techniques: Manual therapists use various stretching methods to improve flexibility, enhance range of motion, and alleviate muscle tightness. This may include static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation (PNF) stretching.
• Neural Tissue Mobilization: This technique focuses on mobilizing and releasing tension in the neural structures, such as nerves and nerve roots. It aims to address conditions involving nerve compression or irritation, such as sciatica.

As part of a comprehensive approach to managing musculoskeletal disorders and promoting overall well-being, myotherapists here at HBM may employ these techniques, among others, to treat KOA.

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

Age: 70+

Gender: F

Symptoms: Pain and swelling in both knees (particularly in right), with apprehension and restriction fully bending and straightening knees out.

Medical history: Recent scans showing severe OA of R knee, no previous surgery to lower limbs.

Lifestyle: Retired but still active. Walks at least 10k steps/day, and goes for aquarobics class daily.

The client has to date received 2x treatments here at HBM in the span of a month and noted an improvement in pain and functionality. After the second treatment she mentions how the treatment has given her hope for managing her knee pain again.

If you or someone you know are dealing with KOA, book in an appointment to see us 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 myotherapist Jerry Song.

The Role of Myotherapy in Treating Headaches and Migraines

Headaches and migraines represent some of the most prevalent and burdensome neurological disorders worldwide, impacting individuals across diverse demographics and age groups. Understanding the scientific differences between these two entities is crucial for accurate diagnosis and appropriate management. Below, we outline the key differentiators between the two:

• Neurovascular Mechanisms:
  • Headaches: The term “headache” is a broad descriptor for pain or discomfort in the head or neck region. It can result from various causes, including tension, sinus congestion, or other non-specific factors. While the exact mechanisms of tension-type headaches, for example, are not fully understood, they are generally considered to involve muscular tension and contraction.
  • Migraines: Migraines, on the other hand, are a type of primary headache with specific neurovascular involvement. The prevailing theory is that migraines involve abnormal brain activity and interactions with the trigeminal nerve, leading to the release of neuropeptides and vasodilation of cerebral blood vessels. This process is believed to contribute to the characteristic throbbing pain associated with migraines.
• Aura:
  • Headaches: Most headaches, particularly tension-type headaches, do not typically present with auras. Auras are transient neurological symptoms that precede or accompany certain types of migraines.
  • Migraines: Migraines with aura are a subtype characterized by the presence of specific neurological symptoms, such as visual disturbances or sensory changes, preceding or during the headache phase. These auras are thought to be related to cortical spreading depression, a wave of altered neuronal activity in the brain.
• Duration and Intensity:
  • Headaches: Headaches can vary widely in duration and intensity. Tension-type headaches, for instance, are often described as a mild to moderate, non-pulsating pressure or tightness.
  • Migraines: Migraines typically last longer than common headaches, often between 4 to 72 hours if untreated. They are characterized by moderate to severe pulsating pain, often unilateral, and are associated with other symptoms such as nausea, vomiting, and sensitivity to light and sound.
• Triggers and Contributing Factors:
  • Headaches: Triggers for common headaches can be diverse and may include stress, lack of sleep, postural issues or environmental factors. Secondary headaches may have specific underlying causes, such as infections or other medical conditions.
  • Migraines: Migraines often have identifiable triggers, including hormonal changes, certain foods, sensory stimuli, and stress. Genetics also play a role, as migraines tend to run in families.

Manual therapy, encompassing various hands-on techniques, has emerged as a promising adjunct to conventional treatments and offers an alternative to drug consumption (Puledda et al., 2018).

• Manual Therapy for Headaches:

1. Peripheral Joint Mobilisation:

• Peripheral joint mobilisation focuses on articulating and mobilising joints outside the spinal region. This technique, often applied to the temporomandibular joint (TMJ) or other peripheral joints, can be effective in addressing musculoskeletal imbalances contributing to certain types of headaches. By improving joint mobility and reducing tension in peripheral structures, this approach may offer relief without direct manipulation of the spine.

1. Active Release Technique (ART):

• Active Release Technique involves combining precisely directed tension with specific patient movements to address soft tissue restrictions. This technique is particularly effective in targeting myofascial trigger points and releasing muscular tension, offering an alternative to myofascial release techniques for tension-type headaches.

1. Postural Correction Exercises:

• Emphasising corrective exercises for postural realignment can be an alternative approach to cervical mobilisation. Strengthening and stretching exercises targeting the neck and shoulder muscles may address postural imbalances, promoting long-term relief from tension headaches associated with poor posture.

1. Myofascial Release Techniques:

• Myofascial release, encompassing soft tissue manipulation and stretching, targets muscular trigger points and fascial restrictions contributing to tension headaches. By releasing myofascial restrictions, these techniques promote improved blood flow and muscle flexibility, potentially providing relief from chronic tension-type headaches.

1. Cervical Mobilisation:

• Cervical mobilisation techniques focus on restoring normal range of motion in the cervical spine. Through gentle and controlled movements, these interventions aim to reduce cervical joint dysfunction, addressing underlying mechanical factors associated with certain headache types.

• Manual Therapy for Migraines:

1. Connective Tissue Manipulation:

• Connective tissue manipulation involves gentle stretching and mobilisation of the fascial network throughout the body. This technique aims to improve the mobility and elasticity of connective tissues, potentially influencing the central nervous system and reducing migraine-related hypersensitivity.

1. Manual Lymphatic Drainage:

• Manual lymphatic drainage focuses on gentle rhythmic movements to stimulate the flow of lymphatic fluid. This technique may be beneficial in reducing congestion and promoting drainage, potentially addressing migraines associated with fluid retention or vascular factors.

1. Proprioceptive Neuromuscular Facilitation (PNF) Stretching:

• Proprioceptive Neuromuscular Facilitation involves a combination of stretching and contracting muscles to enhance flexibility and neuromuscular control. Applied to muscles associated with migraines, PNF stretching may contribute to the relaxation of hypertonic muscles and improve overall muscle function.

1. Soft Tissue Mobilisation:

• Soft tissue mobilisation techniques, including massage and trigger point therapy, target muscular tension and trigger points commonly associated with migraines. By promoting relaxation and reducing muscular hypertonicity, these interventions may contribute to a decrease in the frequency and severity of migraine attacks.

1. Neuromuscular Techniques:

• Neuromuscular techniques focus on addressing imbalances in the neuromuscular system. Practitioners apply targeted pressure to specific points, aiming to normalise neural function and alleviate trigger point-related pain. This approach may be particularly beneficial in managing migraines with associated myofascial pain.

Bevilaqua et al. (2016) reported a greater reduction in the frequency of the episodes after applying cervical mobilisations and massage and myofascial release twice a week over a 4-week period, and thus, a higher frequency of treatment may have yielded better results. As part of a comprehensive approach to managing headaches/migraines and promoting overall well-being, myotherapists here at HBM may employ these techniques, among others, as appropriate.

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

Age: 50+

Gender: F

Symptoms: Pain in suboccipital region causing referral symptoms in the head.

Medical history: No injury to head/neck region, frequent debilitating headaches. Takes Panadol/neurofen to help with pain but they don’t help much usually.

Lifestyle: Works at a desk and sits in front of a screen for long periods. Took up piano lessons recently which places her in a similar position postural-wise.

The client has received 5x treatments here at HBM over the past 2 months to manage her headaches, and even after the first treatment has had great improvement on her symptoms. Educating her on the importance of compliance to treatment has made a big difference on her quality of life.

If you or someone you know are dealing with headaches/migraines, book in an appointment to see us 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.