The Inside Out Blog

Muscular Function

2011-05-25T19:53:00.000-07:00

One of the prime aims of the manual therapist is to improve circulation- circulation of fluids; this fluid is mainly water, but it contains, among other substances, red blood cells, so it's fairly common to refer to this vital fluid as blood. To get a clear picture of your role as a manual therapist, promoting circulation, I encourage students to visualise this watery substance moving through the veins, arteries, and lymphatic vessels.

Remember, also, that this water moves through the body in much the same way as a river moves through many parts of the country; it is a vital conveyor system, in some places moving ships with their cargo, in our body, it carries whatever is provided by our digestive system, or whatever it is that we consume - if a painkiller that we swallow has to get to the intended site, its only avenue is the circulatory system.

The heart has a major task of a circulatory pump, but it is aided - or it should be - by our muscular system. If you are sensibly active, then the muscles you use will also pump fluids. If you are idle, for whatever reason, then pumping is left to the heart.

So, in simple terms, muscles aid the heart, by:

contracting, moving the adjacent joint, compressing the joint, squeezing fluids out of the joint components,

expanding the muscle bundle, compressing its own blood vessels,

encouraging all opposing muscle groups to be stretched, which influences fluid movement in these zones as well.

This is the ideal situation; contraction of one group, and stretching of another group, followed by the reverse movement - maybe extension, followed by contraction. But, what we are often confronted with, or what we often experience ourselves, is:

(a) an over-strenuous series of flexions/extensions such as participation in a challenging athletic event, or

(b) a sustained contraction of one muscle group, perhaps promoted by stressful circumstances.

An over-strenuous exercise programme can strain the tissues, and interfere with the normal movement of fluids - just as surely as the involuntary contraction of muscles prompted by the demands of living.

Your work as a manual therapist really doesn't need too much modification in this regard; the person trying desperately to stay afloat emotionally in these challenging times will experience almost the same circulatory disruption as the athlete, the truck driver, the school teacher or the parent.

Think about it possums, there isn't a lot of difference between corrective massage and remedial massage when you think about it..

Muscular Balance

2011-02-01T14:23:00.000-08:00

I was prompted to put down my thoughts on this topic, after a visit from a client yesterday, who had had a fall the previous night while walking up stairs at his home; this was not his first event, and it reminded me of a few others , (including myself), with similar experiences - let me explain my version of the fall.

The ankle joint - if we compare it to the flagpole we discussed recently, has two particular cables that control its function; sure, there are many others in this region, but let's just consider today the movements of plantar flexion, and dorsiflection - standing on your toes, with your heels in the air, or rocking back on your heels so that your toes are elevated.

The muscles engaged here are :

the calf muscles, (gastrocnemius and soleus, and

tibialis anterior.

If you are a student, don't pressure yourself to memorise the names of muscles - study function, and performance, and the names will eventually plant themselves in your mind; for the present, if you look at an ankle joint from one side, a lateral view, the are a set of calf muscles at the rear of the ankle joint , and a single muscle at the front.

When the front muscle contracts, our toes are elevated, and we rock back on our heels; when the rear muscle(s) contract, our heel is elevated, and we are up on our toes.

Now, it is my opinion that we are more likely, in our day-to-day activities, to use calf muscles much more than we do our tibialis; as a result, an imbalance develops, and although tibialis doesn't suffer the same loss in tone, as say, triceps (as mentioned earlier this month), my point is, many people have a tendency to experience a loss of plantar flexion.

That is, when we walk, we become a little lazy about raising the toes, making us susceptible to tripping on small steps, or changes in the terrain, ( as my client did.)

If you occasionally want to walk with haste, and this is something I deliberately do, as a form of exercise, you occasionally meet uneven ground, or a set of steps. Age, and lack of deliberate tibialis exercises, put me in this category, and I experienced a few minor falls before I put some thought into the cause.

If you see me on the street, and I stumble, you will know that I once again, have neglected my Tibialis Anterior exercises !!!

Muscular Balance

2011-01-30T15:15:00.000-08:00

I wanted to add a photo, to further illustrate this muscle balance/imbalance theme, so that I can be sure we are all on the one plane, before I proceed further with the discussion.

Here is an illustration of the elbow joint in action; there is a small amount of flexion, and one rope, (marked "B"), which represents the Biceps Brachii, displays some tension. This is a "drawbridge" situation, an analogy that I often use in anatomy workshops, where the biceps behaves like the rope or cable that raises the drawbridge that you might see at an ancient castle.

One point I am trying to make here is, the same cable that raises the bridge, lowers the bridge. At all times, the muscle marked "T", representimg the Triceps Brachii, is idle.

So, if you or I regularly use the biceps in elbow flexion, such as the person at the gymnasium that might be performing the exercise commonly known as "curls", the triceps will be on holidays; even if you're not a fitness person, many of your day-to-day activities will involve elbow flexion, and the triceps muscle is often under-used, and develops flaccidity, or looseness.

Consider what impact, small or great, this has on the elbow joints - remember, there are three of them, and, scapula position and performance.

More next week, possums.

Muscular Balance

2011-01-29T15:26:00.000-08:00

A lot of interest has been shown in the topic of muscular balance - we could pursue the topic from various directions, let me try one - joint weakness, perhaps due to muscular imbalance.

Many of you are manual therapists, massage therapists, or physical therapists; your hands are regularly used, the fingers, and the wrist muscles are flexed, not continuously, but often, as you grip, squeeze, manipulate, and mobilize. We would all agree, then, that finger, palm, and wrist muscles would enjoy advanced strength, and fairly healthy tone - compared, perhaps, to others whose work does not include such activities.

All of the joints in these areas, finger joints. palm joints, and wrist joints, are reinforced, (we're getting back to the flagpole idea again, ) by strong muscles on one side, and relatively weak muscles on the other - I ask you to consider, how does this imbalance affect the joint(s)?

Consider this experiment; many of my students have tried this, and I urge them to attempt it again.

Make a fist of your hand; have your friend clasp your closed fist, with both of their own hands. Now, your job is to try to open your clenched fist, against the resistance of your friend's hands - this is merely a test of the strength of your extensor muscles, hand, finger, palm, all of them together - you will, at least many of you, find a surprising weakness is present.

Now grasp your friend's hand as though in a handshake greeting - and slowly squeeze - don't try to crush the hand bones, this is a friend, after all!!!!

Compare the strength of your flexor muscles, against the strength of the extensors - there is almost always, a significant difference; the same disparity is evident between hip flexors and extensors, lumbar flexors and extensors, and even the elbow displays similar characteristics.

At this stage of my speculation about the relevance of muscular or kinetic balance, all I can say is, if someone consults me about a joint disfunction, ( and all muscular complaints become a joint complaint eventually,) then this in one angle I investigate.

Lumbar Pain

2011-01-23T16:47:00.000-08:00

Recently, I had visit from a man who is employed as a handyman/laborer/cleaner, at the local high school. This is a 45 year-old, of slender but muscular build. Typical of his duties was the occasional movement of furniture and other items considered to be too heavy or too awkward for class-room staff.

During one of these events, (moving a heavy waste-bin) he experienced pain in his right hip, in the vicinity of the SIJ. This was followed soon after by referred pain in parts of the lower limb, portions of the ITB, lateral condyle of the femur, and the right heel. Other zones of the R. leg had become numb, in his own words:you could stick a pin in here, and here, and I would feel nothing.

As this was classified as a work-related injury, for which the employer - the state Education Department - could be considered liable for the any costs, he was sent to the local medical practitioner for assessment.

The source of pain was initially diagnosed as linked to possible lumbar spinal disc damage, the extent of which could only be determined by radiological examination. As the local MRI facility was not available for at least a week due to demand, he was advised to take a week off work, while awaiting his turn in the queue.

Time off work, for many unskilled workers, represents a monetary loss, as well as an entry on his work record - not good for his reputation if he should attempt to gain employment elsewhere sometime in the future; he elected , therefore, to remain at work, on so-called light duties.

Impatient with the waiting, and the discomfort, he came to see me for advice; On examining him, I found muscular contractions in his RS lateral rotator muscles. Two treatments reduced these contractions, sufficient to lower the pain, and the numbness. he returned to work, no time was lost, and no compensation claim was pursued.

The moral of the story ?

Not that I achieved a miracle, many of today's properly trained manual therapists would have made the same examination, come to the same conclusion, and achieved the same result as I did.

My point is, that an MRI would probably not have revealed the presence of muscular contractions in the hip area, and, furthermore, the possibility that such muscular contractions, ( in the vicinity of gluteus medius), was not even considered as a likely culprit.

The medical practitioner was not at fault here, this is not a feeble attempt to score points at his expense - such a source of sciatica was, I suggest, probably not even taught at his college.

For about $100, the problem was quickly solved; an MRI would have cost thousands. The $100 might even have achieved a nil result- surely this is a reasonable wager ?

Muscular Balance

2011-01-22T14:57:00.000-08:00

One of my many interests in anatomy education is muscular balance; this is not a term I have invented - it is also known as, or referred to as kinetic balance. I usually explain my concept of muscular balance in the following way:

Consider a wooden post - perhaps a tent-post, or a flagpole. The stability of these columns depends on the positioning and strength of, supporting ropes.

Each of our skeletal joints has a similar reliance on supporting structures - the tent-post has ropes, our skeletal joint has muscle tissue.

The vertebral column is a great example - a long, slender column, supporting the cranium at the top, assisted by supporting cables; but as we understand, this vertebral column is made up of more than 30 individual joints. Nevertheless, we could view each joint separately, each pair requiring cables to control steadiness, or movement, whatever is required.

Let's consider a small section of the vertebral column, the cervical region; for many of us, our daily occupation requires us to be positioned over a :

treatment table,

a food preparation bench,

a computer desk,or

a computer.

There are many other occupations, I understand, but, unless you are, for instance, leaning back, painting the ceiling of your home, your vertebral column, including the cervical section, is usually in flexion, chin towards your chest. This suggests that the flexor muscles, at the front of your throat, are in some degree of tension, pulling your head forward. This is an incorrect assumption.

The head can sit in this forward position, under its own weight, without any assistance from the anterior muscles; only the extensor muscles at the rear, are active, as they pull back on the cranium, controlling its flexed position. This means that for much of the time spent at a desk, reading, or whatever, the flexor muscles are almost completely idle, while the extensor muscles are active.

One of the results of this overactivity of one set, and underactivity of an opposing set, is muscular imbalance; the extensor muscles maintain their strength, and their tone, while the flexors become flaccid by comparison. Our imaginary flagpole is now supported by a set of ropes on one side that have strength and tension, and an opposing set of ropes that are relatively weak, and slack. This means the complete assembly is adversely affected.

If we imagine the experience of a rear-end collision involving a couple of motor vehicles, the driver of the forward car, hit from behind, is forced into cervical extension; his head thrusts towards the head-rest, if there is one. There is insufficient time for the flexor muscles to contract in an attempt to limit this rearward movement - perhaps their flaccidity adds to this delay.

The head bounces off the support, possibly at the same time that the flexors respond, and there could be a series of this shuttling back and forth, all in a few seconds, until coming to rest.

This is a theoretical script of the scenes in such an accident - investigators more knowledgeable than I would be able to describe the details more accurately; I want you to consider the structure, and contemplate, in your own mind, the effect of muscular imbalance on the cervical spine, in even less dramatic circumstances.

Acute back pain (lumbar).

2011-01-18T14:54:00.000-08:00

When a client presents at your clinic, reporting sudden onset (acute) pain, there is, very often in their own mind, no valid reason or cause. If they were attempting to move heavy furniture, or an automobile, then they could easily identify the event.

When the cause is not known, an analysis of the source and the severity of the damage is not simple and the therapist needs to proceed with caution, using logical steps to to determine:

(a) is this a task for a manual therapist - or should it be delegated to another, more expert clinician ?, or

(b) if you deem it prudent to proceed, try to identify which sections of the supporting structure are excessively contracted, and initiate corrective procedures.

Now and then, we see instances of acute lumbar pain, arising from the simple procedure of getting up from the seated position -perhaps after reading, or viewing TV, or working at a computer; no strenuous effort has been involved, and maybe the injured person even offers the defence " I don't understand how this could happen, I walk every day, to keep fit."

There are many possible causes of this sudden discomfort - let's discuss just one of them; many of you readers will already be familiar with this topic, and may wish to tune out at this point, but for you others :

Firstly, in the seated position, as the model is demonstrating, the ilio-femoral joint is to some degree, flexed - the lower the seat, the greater the amount of flexion.

If the ilio-femoral joint is flexed, the flexor muscles are shortened, and the extensors, ( on the opposite side of the same joint) are stretched.

If you stand up from this seated position, and you will probably do so with some haste - certainly not in "slow motion" - flexor muscles are suddenly transformed from the shortened state to the stretched; like any other tissues in the body, muscles have an admirable ability to protect themselves from perceived harm.

If, for example, your finger comes into contact with a hot surface, the reaction will be swift; if a small insect collides with your eye, again the protective measures will flash into gear. In the case of the finger, it is not just the hand that responds - often the whole arm, and even the torso, will become involved.

Any threat to your eye isn't just limited to a closing eyelid - often the head will be drawn back, as the cervical segments are rapidly extended. What determines the need for, and the speed of, and the extent of, this response ? This is not a conscious thought process - there's no time for thinking and consideration here - such luxuries are by-passed.

The automatic, (or autonomic) system - ANS- arranges all this - the selection of the appropriate muscles, and the speed of, and the extent of, the protective contractions.

So, returning to the person who has simply decided to stand upright after a period of sitting - flexor muscles are stretched - if such a stretch is interpreted by the ANS as a possible source of damage - a strain, or a tear - it may well initiate a series of contractions, all in the good cause of self protection.

As an experienced manual therapist, you can identify and examine the ilio-femoral flexors - don't overlook the psoas, (or ilio-psoas) in this task. Oh, and when the clients say that they are regular walkers, or diligent exercisers, remember that although walking is a fine way to achieve a certain amount of mobility, and see the country at the same time, give some thought to just how much the ilio-femoral flexors are really stretched during a normal, or even vigorous, walking programme - not very much, I hear some of you reply.

Bernard Scully

www.theinsideout.com.au

The business of manual therapy.

2011-01-17T17:25:00.000-08:00

General medical practitioners, and now registered nurses, ( who have been granted greater authority to perform certain tasks that were once the sole domain of medical practitioners,) very often decide, that in the event of a percieved acute musculo-skeletal discomfort in their client, the next port of call should be a physiotherapist.

I don't believe there is a statute or regulation somewhere that says this is what must happen - but it is generally the case in Australia. Now, you, as a manual therapist, might complain about this bias among yourselves, but change will not come about, at least for the present, for some very obvious reasons.

Let me list some of these reasons for you to consider, and discuss.

I keep a close watch on all of the major business directories in my part of the country, pertaining to manual therapy, and massage therapy. Under these two headings, I can see several sub-groups:

hot-stone therapy,

reorganization of the myofascial system,

reflexology,

aromatherapy,

trigger point massage,

reiki,

myotherapy,

onsen,

holistic,

dry needling,

chinese cupping,

dorn spinal massage ,

deep tissue massage ,

scenar pain relief,

shiatsu,

vibrational massage,

hawaiian massage or lomi-lomi,

cranio-sacral , and rolfing.

I haven't exhausted the offerings - these are but a few. If the medical practitioner, or the duty nurse, or a rehabilitation officer has an idea that simple, yet competent, manual therapy, would be of assistance to the injured client - what is he/she supposed to think when confronted with this amazing array of options ?

Get real about your profession, possums - these fringe elements are dragging your status down by confusing the injured client with this absurd labelling; we don't want to hurl accusations at the other groups, but, we really have to take steps to provide separation between the two distinctive camps.

Massage Associations

2011-01-09T15:07:00.000-08:00

So, you're in business as a massage therapist, (or are planning to,) and you have been advised to join a professional association of people with similar views to yours. If you are reading this is Australia or New Zealand, then you may have been convinced that such a membership is virtually compulsory.

Firstly, membership is just another form of advertising, which you can adopt as a part of your marketing strategy, or you can reject - there is still no law that says "thou must have membership of an approved society".

So, should I join, or should I not ?

As when faced with any cross-road, in life, or in business, I suggest you weigh up the advantages against the disadvantages.

Association membership costs money; not a lot for many therapists, but it's still an expense.

Membership gives you access to Health Benefits Funds, that you would find difficult to obtain as a non-member - it would also assist you with your insurance contract.

On the all-important issue of business revenue, or your reputation in the manual therapy business, I have some serious doubts; membership of an association does not guarantee you success, nor will it be very helpful in day-to-day running of your clinic - this is all up to you and your team, if you have one.

In order for an association to have influence, whether over the therapists, the government, the administrators of the various health insurance funds, the public liability insurers, or even the advertisers in their own magazines, they need high membership numbers.

I am quite familiar with this situation - I have a society of hand-picked therapists, numbering in the low hundreds - so small to be easily overlooked, but so special, that you could easily select any one of them from the directory, and know you would consult a true carer, with high capability.

So; in order to fill the ranks, I'm talking massage therapy here, or better still manual therapy, or massage science, any other association needs to expand their criteria for admission.

Other forms of massage, other treatment systems, other beliefs, even the most fanciful, have to be considered by the association managers - and, as long as there is evidence of training, this application is generally accepted, and, membership granted.

Think about this, possums - you could be a member of a group that numbers in the thousands!! Attend the seminars, and you could be quite impressed by the huge crowds - but, when you advertise to the world that you have these glossy credentials, don't be surprised if the client says - isn't the guy in the next street that uses chanting, and who beats a drum, and who uses hot rocks, in the same association as you - doesn't that make you the same ?

Massage Science - advertising

2011-01-05T17:50:00.000-08:00

Each year, when the latest version of the telephone directory arrives, I peruse it to see that the publishers have entered my details correctly; I have another motive for this perusal. There is a general section, listing my name,address, and phone numbers, and a second section, where, if you have paid the extra premium, your details are published in a trade directory - in Australia, this trade section is called the Yellow Pages.

So, you could open the general directory - The White Pages, and find the name Bernard Scully listed, with address and phone number; alternately, you could consult the trade directory - the Yellow Pages , search under "Massage Therapists", and find the same Bernard Scully listed, along with many others.

Ask any advertising or marketing advisor with local experience in Australia, and he/she will tell you " no business could expect to exceed or survive, without a noticeable entry in the Yellow Pages directory. (YP)

There are, of course, many other directories published who want to compete with the firmly established YP, another two were launched just this week, but for the present YP has the upper hand.

Wherever you are when you read this, you can probably nominate the directory of choice, and relate to what I'm talking about. Now, I can at last get to the point I want to discuss with you : why does a person consult you for manual therapy treatment, and not your competitor ?

I have kept statistics for over twenty years on this matter, and here are my findings;

60% say : I saw your ad in the YP,

15% say: I have seen your ad in the YP for many years, and figured you are here to stay,

10% say: a friend recommended you to me,

5% say: my medical practitioner recommended you, and

10% say: I've wanted to have a manual therapy treatment for some time now, but didn't know where to go, because I was uncertain, and suspicious of many of the therapists I heard about, and the advertisements they publish.

This final 10% group intrigues me - you could be well-trained, and capable therapist, and an all-round model citizen, but if you are a member of a group therapists, or if you associate with therapists who continue to condone, and approve, wierd and unscientific methods, you run the risk of alienating yourself from a significant portion of the community.

Frozen Shoulder

2011-01-05T17:17:00.000-08:00

Frozen shoulder is a descriptive term often applied when someone has limited ability to abduct the humerus laterally; sometimes, this gleno-humeral abduction can be as small as 45 degrees. any attempt to travel beyond this point can produce pain near the top of the humeral shaft (near the tubercle,) and/or further down the shaft, towards the lateral deltoid insertion.

Quite often, this restricted abduction situation can persist for several months; a discussion of one of the possible causes of this situation is contained on my web-site www.theinsideout.com.au , but today I want to speculate about the possible ongoing symptoms. What is likely to occur, if the condition is not dealt with promptly ?

When abduction of the gleno-humeral joint is unhindered, and you can freely point your fingers towards the ceiling, without pain, and without distortion of the torso, muscles such as the serratus, teres, and pectoralis are enjoying a stretch; limit this abduction movement, and these muscles will become fibrotic.

When abduction of the gleno-humeral joint is freely, and regularly performed, muscles such as the lateral deltoid, levator scapula, upper trapezius, and supraspinatus, experience contractions; limit this contractile experience, and eventually these muscles will develop flaccidity, and a degree of weakening.

So, as a manual therapist who has the opportunity to correct the original fault, i.e., the limited abduction, you may, on occasion, be called upon to deal with, one group of muscles in need of stretching, and another in need of strengthening .

Massage Science, and Australia

2010-11-28T17:41:00.000-08:00

Many of the readers of this journal are from the northern hemisphere, and understanably, are fascinated by our kangaroo; we, on the other hand, or, the other paw, often see these creatures as a cute, cuddly nuisance.

However, I was quite surprised, and somewhat gratified, to come face-to-face with a host of these weird animals, no more than 20 minutes away from my own home, just a few weeks ago. Local readers will, perhaps, have heard of the location of an asylum for the insane, in the early days of the settlement of our island colony, at Morrisett.

A few friends dropped in to see this wonderful site, after many years absence, and as we stepped off the tourist coach, the herd slowly descended upon us, seeking easy food, no doubt.

Nuisance they might be, to many, but mesmerising to others - consider these amateur shots, possums.

Knee surgery

2010-11-28T16:51:00.000-08:00

I met an old friend today at the usual haunt, the coffee shop. He is my age, mid seventies, and has had left knee joint replacement, (tibio-femoral) three years ago. He was subdued about the success of the procedure - for those of us who have never had surgery of any kind, I believe we can never imagine the impact on our day-to activities that follows surgical intervention.

Many people feel a great relief from the cessation of pain - others, well, they often report a reduction in mobility, and a sense of frailty.

Let's discuss this latter group, including my friend at the coffee shop.

His concern was a reduction in mobility in the left knee joint - flexion was, immediately after the operation, limited to about 40 degrees; remember, this man and I were very active in our early years in mechanical and structural engineering, so our grasp of this aspect of his situation was quite clear. Medical scientists, who have a clear understanding of the methods, and the intricacies, of joint replacement, seem to have a poor view of the structural side-effects of their wonderful efforts.

Having adhered to the advice of the orthopaedic surgeon, which included the almost compulsory recommendation of physiotherapy, my friend returned to his daily walking and golf programme, and today, almost three years post-surgery, flexion is still limited to about 90 degrees, and when he walks, his paces are no more than one third of a metre.

After consulting the original surgeon three times, and another specialist in the next capital city for a second opinion - he was left with the forecast that: such poor results are not uncommon, you have an abnormally high degree of fibrosis. Either you learn to live with the situation, or, come back in year or so and we will slice through the tendon of the offending extensor muscle, to give some relief to your problem.

I propose to you possums reading this diary entry that some people just don't understand that fibrosis - excess scarring - is common; it is a natural adjunct to many forms of bodily invasion, such as surgery, radiology, and muscle tears. Such scarring limits movement of the joint(s) in the vicinity of the invasion, so that recovery can occur.

To propose surgery as a means of improving mobility is a contradictory thesis - surgery will only promote more scarring - this man needs a programme of stretch, either alone, or assisted, and much of the fibrotic tissue can be modified, and mobility enhanced.

I'm only an out-of-work engineer/lawyer kiddo's, but I know how this stuff works at a basic level - and that's manual therapy, massage science, my massage science, working at a basic,yet vital level.

Lymphoedema

2010-11-21T17:38:00.000-08:00

In our business as manual therapists, we are aware that there are, - broadly speaking, - two body systems that we can have a significant influence over; these are the circulatory and the nervous systems. Your influence in these areas can be positive, or damaging, depending on your intention, your training, or your current attitude.

I'm prompted to speak to you today about circulation - there are many people with sedentary jobs - maybe computer-stuck - others are elderly, or not energetic for whatever reason; their lower limbs will suffer from poor circulation, maybe leading to varicose veins.

Unfortunately, walking, as an exercise, has its upside and its downside, for all of us.

Walking, whether slow or brisk, means the leg muscles, (and many others) will call for additional fluid, to provide the fuel for the task. A lower limb that is already struggling to cope with normal, day-to-day functions, may not be able to deal with a surge in the fluid that walking invites.

A solution , you ask ?

You can answer this yourself - this is a column for thinkers, for massage scientists.

Ban walking ? Unless you have severe skeletal difficulties and ailments, this would be poor advice.

Apply a garment to the lower limb? If it is to be effective, any garment, whether surgical or bandage, must be firm-firm enough to influence the peripheral circulation -that's the whole point - so there will be negative outcomes.

There is oedema, that is our starting point. If you have read my other publications, you know that oedema is, in a way, self propagating; oedema is one of the side-effects of poor circulation, and oedema has a seriously negative effect on the circulatory system - the very system that was originally designed to deal with oedema.

I propose, that unless dealt with promptly, varicose veins, like other forms of oedema, will self propagate.

One of the solutions is inversion therapy - think about this, possums, and we will speak again.

Massage Science.

2010-11-15T15:24:00.000-08:00

Yesterday, I met an old friend, limping towards me at the local shopping village.

I am a manual therapist with an avid interest in anatomy, and anatomical irregularities; this girl, 45 years old, had an obvious injury to her left ankle, which she said was due to" a fracture of the ankle."

We moved away from the bustle into a coffee-shop, so she could rest her foot a little, and she revealed a few things to me:

1. While delivering product for her employer, she stepped out of her car, tripped on a loose piece of paving, and falling, fractured her fibula. This is a slender bone in the lower leg, that really, is an ankle bone, rather than a leg bone - but I digress...

2. She had the necessary examinations, and fibreglass cladding, and here we are, four weeks after. Her foot is swollen, and quite uncomfortable in the shoe; her calf is also enlarged, and she is beginning to experience hip pain.

3.She has been receiving physiotherapy treatment, for ankle rehabilitation, as well as the post-injury oedema - this involves the use of a surgical garment for the lower limb. I would point out here that outside the coffee shop it was approaching 35 degrees, so, any kind of bandage, any kind of excess clothing, was not a good option.

4. The employer is trying to avoid liability - and is making noises about stopping,or limiting, the insurance cover.

Another life, in another city; oedema can not always be helped with bandages, or garments - adding heat to an already stressed zone will only invite more fluid into the area.

Consider the extra effect of the emotional stess of a lone parent, desperately needing the job, on her feet much of the day, with the insurance company breathing down her neck.

A lot of the therapy we are asked to provide goes beyond structure, possums,

Massage Science-shoulder pain.

2010-11-15T14:44:00.000-08:00

I am interested in science, and the methods of science; I understand that advancements in general knowledge, very often , need to rely heavily on data, tests, accumulation of results, and interpretation of these results, so that old assumptions can be supported, or that new assumptions can be made. This is OK, and it is fairly normal for today's scientists to suspect, or even reject, any thesis that lacks a scientific framework; but, I have this strong suspicion that (a) either some of the data is interpreted badly, and/or (b) all un-scientific offerings to the data pool are rejected out of hand. Let me give an example.

I am a massage therapist, with an engineering and legal studies background; anatomy has fascinated me since I had my first lesson in 1985. Because of its complexity, and because of the large number of complaints, the shoulder assembly captured the bulk of my attention, mentally and in the clinic.

I have developed a system of examination of shoulder malfunction that is brief, non-invasive, and quite simple; having applied this system over a 25 year period, I have no hesitation in carrying out this examination, and, applying the appropriate soft-tissue corrections, in order to prove my thesis. Clinical results stand at about 85% success.

Firstly, I am not a recognised scientist, so most professionals would ignore any of my publications; and, secondly, journals such as those issued by physical therapy associations would never be found guilty of allowing feral documents, regardless of the level of veracity within, to be considered for examination, or publication.

What are we left with ? A search of the internet by those who are affected by shoulder malfunction generally suggests radiological or ultrasound examinations, followed by the offer of three alternatives:

1. Adapt to the discomfort, or
2. Adopt a series of exercises to correct the so-called rotator-cuff injury, or,
3.Consider surgery to the damaged rotator cuff component.

I put this to you, possums; speaking broadly, there are only two main causes of shoulder malfunction - one of them might require surgery, and the other does not.

I, and those who I have trained, can easily carry out the examination, and subsequent treatment, to demonstrate the appropriateness of the thesis. If we fail to help ? You have spent a few dollars, and you can continue down the path to surgery.

Massage as a profession

2010-10-31T20:25:00.000-07:00

This has always been a sore point with me, as my colleagues will know; we are seen as three or four rungs below physical therapists, on a scale measuring professional worth. Yet, physical therapists, or as they are titled in Australia, physiotherapists, are not too involved with - perhaps not interested in - manual therapy. There is, as I see, a gap in the health care method - who wants to provide manual therapy ?

You and I can do this - we are already doing this - and we understand:

our ability, and,

our limitations.

Last month , I was appointed as one of the editors of a magazine issued by the American Medical Massage Association; I'm not blowing big trumpets here, possums - it's just that manual therapists in the USA are facing the same issues as we are here - hot rocks against logic.

Keep in touch, because I will not let you down......

Massage Education

2010-10-31T20:05:00.000-07:00

I have decided to take this business of blogging seriously; my attitude to massage education has always been serious, but my grasp on the technicalities of the internet is quite delicate, as Catherine and Johanna will testify.

I don't profess to know everything about massage and anatomy, and people, but I know a few things well, and I pride myself on being able to explain what I know, in a way that most others would absorb, and understand.

In my final few years, I would like to,by way of this extraordinary media,

add to what you already know,

discuss issues of concern ,

extend the influence of manual therapy in the health-care system, and

get to know you all .

2010-03-08T17:58:00.000-08:00

We are pleased to announce the release of 3 new Videos. These well presented videos are both instructional and educational and cover a large amount of information on exciting topics such as... Massage for Beginners, Lymphoedema Management, and Anatomy for Therapists.

The Inside Out Online Web Log

2009-10-13T21:24:00.000-07:00

www.theinsideout.com.au is the website for the Human Anatomy Revived Institute (H.A.R.) The HAR came about as a means of offering all interested parties a means of supplementing their anatomical understanding.

In training to be say, a medical practitioner, the amount of anatomical training is quite staggering; a manual therapist does not need this depth and width of training – to attempt such a programme would either deter the new student, or if he/she lasted the distance, would fill him/her with a false sense of capability. Yet, the text books available today, and the dissected specimens available at medical universities need a little supplementation on occasion.

The Inside Out will attempt to enhance and clarify your current knowledge.