Monthly Archives: November 2011


Regardless of whether your pain is acute or chronic, there are general treatment principles that you can apply to help ease the pain and swelling related to an injury or illness.  These approaches are commonly referred to as RICHES – rest, ice, compression, heat, elevation, support.  Severe sprains or other injuries should be evaluated by a physician, especially if symptoms worsen.
REST is a period of time in which little to no movement is allowed.  This allows your body to heal and repair the injured tissues.  During this time, you should also assess pain levels and even take notes to monitor your progress.  Once you feel improvement, slowly resume activity.  Most minor injuries heal in 1-2 weeks.
ICE is particularly recommended for injuries to the musculoskeletal system.  It is a tried and true anti-inflammatory!  Typically, a cold treatment should last 10-20 minutes and repeated every hour.  Keep in mind that prolonged use of ice treatments may cause damage.
COMPRESSION to an injured area can help prevent swelling.  One common form of compression is an ACE bandage applied to the injured area.  Make sure it is not too tight, and seek approval from a medical professional.
HEAT may be used for an injury and can help relieve tightness and spasm.  Make sure that at least 72 hours as passed post-injury before beginning heat treatments.  Applying heat too early in the recovery phase may actually make an injury worse.
DO NOT use heat in the following cases:
-during acute phase of healing.
-if swelling/discoloration is present
-if there are any signs of infection (i.e. redness, heat, swelling).
-if you are prone to blood clots or have high blood pressure.
-against the advice of a physician.
ELEVATION of the injured body part above the heart can help decrease swelling, and allows gravity to assist moving fluids back towards the heart.
SUPPORT and protection of the area is critical.  It may be necessary to wear protective splints or braces if injury requires.
A good rule of thumb to follow is “When in doubt, use ICE.”  Within the first 72 hours of an injury, ice is the most effective in relieving pain and swelling.
Remember, always pay attention to your body and its pain signals!  If ice is not helping to relieve your painful muscle spasms, switch to heat, preferably a moist heat source.  One easy trick is to place moist washcloths in the microwave for a couple minutes and use as local spot treatments.  Careful, they may be very hot at first.  Moist heat penetrates the muscles easier without dehydrating them!  If you choose to utilize heating pads as your heat source, do not use more than 15- 20 minutes at a time, doing so will only cause a reverse reaction.  It is very easy to overdo this approach.  Monitor your time and try again every hour if needed.
Hope some of these tips help you decide on your next RICHES approach.



Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage “friction of kneading“, or from Arabicmassa meaning “to touch, feel or handle” or from Latin massa meaning “mass, dough”, cf.Greek verb μάσσω (massō) “to handle, touch, to work with the hands, to knead dough”. In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio.



Massage involves acting on and manipulating the body with pressure – structured, unstructured, stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids. Target tissues may include muscles, tendonsligamentsfasciaskin,joints, or other connective tissue, as well as lymphatic vessels, or organs of thegastrointestinal system. Massage can be applied with the hands, fingers, elbows, knees,forearm, and feet. There are over eighty different recognized massage modalities. The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.

Gastrocnemius: A Cramp in the Calf

At some point, patients with posterior leg cramping and pain will seek your services. A multitude of factors produce these symptoms, from dehydration, overuse, poor conditioning, muscle fatique, to low levels of potassium, sodium and or carbohydrates.

Let’s focus on the gastrocnemius muscle, reviewing key points, showing its four myofascial trigger point locations, pain referral patterns and treatment techniques. If the gastrocnemius muscle is the cause of the pain and not properly treated, the pain will become more persistent and intense.



Gastrocnemius is a two-headed muscle that crosses two joints, the knee and ankle. The medial head is slightly larger and longer than the lateral head. The two heads of the gastrocnemius merge to form the inferolateral and inferomedial boundaries of the popliteal fossa. The gastrocnemius, along with soleus, and plantaris comprise the superficial group of muscles in the posterior compartment of the leg. (Image 1) A three headed calf muscle formed by the two-headed gastrocnemius and soleus. This large muscle merges into the calcaneal tendon or achilles tendon. It plantar flexes the ankle joint, raising the heel off the ground against body weight, as when a person is walking or balancing on their toes.

posterior compartmentImage 1Symptoms

Complaints from myofascial trigger points in the gastrocnemius muscle include: night cramps and might be activated by climbing up steps, steep slopes, running uphill or riding a bicycle with the seat is adjusted too low. Patients with active trigger points may complain of pain while walking in the soft sand of a beach or on a slanted surface. Any of these activities coupled with cold air temperature, might contribute to the development of trigger points in the gastrocnemius. Other factors that might promote the development of trigger points include having the ankle in a cast, wearing clothing that restricts circulation or reclining chairs that reduce blood flow.


While you may know the location of trigger points and their specific pain referral patterns, your patients do not and they will respect the professional level of patient education you are providing. For example, in photo 2, “X” indicates the common location of trigger points within a muscle. When a trigger point is activated during treatment, it will produce referred phenomena (pain, tingling, pressure, etc) which is shown in red. (Image 2) Solid red areas indicate an essential pain zone or area of pain experienced by nearly every patient that had that trigger point activated. The red dots indicate spillover pain zones. These are areas of pain experienced by some, but not all, patients outside of the essential pain zones.

referred phenomenaImage 2Locations and Patterns

The most common trigger point (TrP ) in the gastrocnemius is TrP 1. It is located just distal to the posterior knee, near the medial border of the medial head. It has a strong referral pattern to the ipsilateral instep with a spillover pattern that extends from the distal posterior thigh, along the medial aspect of the calf to the medial maleolus. The next most common trigger point is TrP 2, which is located slightly more distally then TrP1, in the lateral head and refers mostly in a regional pattern near the trigger point. (Image 3) TrPs 3 and 4 are located just distal to the knee and also refer very regional patterns near the location of the trigger point.


There are numerous techniques for releasing myofascial trigger points. The patient must always be comfortable with your treatment pressure, so communicate before, during and after the session. If during a treatment session, your patient is reflexively contracting muscles, pulling away, holding their breath or cinching their teeth because the therapy hurts, then your pressure should be released immediately. Assume the treatment pressure was too much, discontinue treating the sensitive area and return a few minutes later with less pressure.



The gastrocnemius can be a “real” cramp in the calf. It can produce a great deal of pain and dysfunction for your patients. Educate your patients of the contributing causes and symptoms of gastrocnemius trigger points.

Conditioning for ultimate performance

Many people are unaware of the importance of stretching and conditioning the body before physical activity. We typically become so motivated to get up and go, our bodies are left to adjust without warming up.


When stretching is avoided, a critical opportunity for injury prevention is missed. Inactive bodies are more vulnerable to a muscle tear or a strain, as opposed to a body that is flexible and limber.


According to the Clinical Massage Therapist , “Flexibility not only reduces stiffness in the body, but it also helps your body to pump blood to your muscles and nerves, helps alleviate the possibility of aggravating or reinjuring yourself if you have any musculoskeletal problems and helps maintain good range of motion of your joints.


This is why many professional athletes will stretch thoroughly and receive clinical massage treatment before game time. Flexibility is a major catalyst in athletes seeking to prevent themselves from injury and perform at their best.


Active bodies

Our bodies are designed to be active – but we must be conditioned first. Prolonged sedentary behavior can disrupt the body’s equilibrium. Imagine getting up from the couch after 10 hours – the body feels stiff and mobility is weakened. This position has led the body’s natural biomechanics to tighten up, therefore limiting functionality.


Over time, this irregular position in which the body has been contorted can lead to imbalances throughout the body. As a result, the body struggles to perform at its greatest ability.


As stated in a Clinical Massage Institute article, “Any imbalance, can cause pain, weakness, lack of function and overall a decrease in your maximum output. If the imbalance isn’t corrected and you cover up the symptoms your body is sending you, over time, this will lead to degeneration and an early retirement from your sport.”


Clinical Massage can correct the body’s postural imbalances and realign components of the musculoskeletal system. By correcting these imbalances, limberness is restored, providing headway for an athlete’s overall performance when needed the most.


Cooling Down

Athletes in the final stretch of a run, or the expiring minutes of an intense sporting event find themselves in “the zone”. Their bodies have endured physical activity and are now running full bore on all cylinders. Pain, at this point, is no longer apparent. The body may be tired, but nothing beats the gratification of a thorough workout.


It is after exercise when athletes need to point their focus toward therapist care. Injuries can come abruptly. Whether it is from repetitive motion, collision with another athlete, or impact on hard surfaces – injuries typically show their true colors after the adrenaline of exercise has settled down.


When soreness and pain are experienced after exercise, relief typically comes in the form of aspirin, acetaminophen, and other NSAIDs. Painkillers only create temporary relief and prolong the extent of the injury – the keyword being relief. The body needs treatment when dealing with persistent pain.


For example, a twisted knee can cause the body to slump to one side, dropping the hip, which disturbs to the lower back. While NSAIDs may provide quick relief, the problem is not resolved. Most are unaware that their back pain is derived from an ailment in the knee. Athletes of all levels should seek clinical massage to correct the issue.


Clinical Massage therapist specialize in the biomechanics of the body; they pinpoint the origin of pain, to relieve other parts of the kinetic chain that can potentially be affected.


Having the ability to exercise and be active is a huge part of many of our lives. In order to carry on our passion for exercise and sports, we need to take care of our bodies.

Osteopathic Pain Relief Cetre Singapore 65.6327.8545


Between muscle and bone

Muscles, joints, and connective tissues are the body’s first line of natural shock absorption. Repetitive forces to this part of the musculoskeletal system can cause fatigue-failure and an aggravating source of pain.

When repetitive forces are combined with biomechanical faults, previous injury to a joint, or a rigid walking surface – degenerative changes progress rapidly and symptoms frequently develop.

Getting out of the bed or picking up the newspaper can become difficult tasks for many people, sending waves of pain through each extremity. Instead of your patients “living” with joint pain or using those weak knees as weather predictors, the problem needs to be controlled.

The severity of joint pain can make this sound nearly impossible for patients, but a few proactive steps can go a long way in joint rehabilitation. The best way to restore weakened, painful joints is to strengthen them. Weak joints that receive prolonged rest will simply remain weak.

Getting Active

Joint rehabilitation, in conjunction with chiropractic treatment, should consist of stretching and exercising. This will help patients build muscle mass, joints, and other parts of the musculoskeletal system.

Low-impact activities should be considered when patients begin an exercise routine. The body, and weak joints need time to adjust, so it is important to start each routine at a reasonable pace. Walking, stretching, and aerobics are all beneficial to building up weak bone structures.

Exercise can boost patients’ energy and ultimately help reduce weight, which is a major factor in chronic joint pain. According to CNN Health, “Maintain a healthy weight. It’s the best thing you can do to preserve your joints. Keeping your weight down will help reduce those small tears that break down cartilage.”

Setting aside 30 minutes each day for physical activity is a great way to reduce stress and relieve joint pain. Patients don’t have to be competitive triathletes in order to get the vitals flowing within the body.


Heel Strike

It is important for patients to protect their bodies when exercising. Even mild forms of exercise such as walking, can expose the spine and lower extremity joints to repetitive impulses that are created with each step. At heel strike – the moment of impact when the heel makes contact with the ground – a shock wave is propagated through the entire human musculoskeletal system. This shock wave force can be the cause of persistent painful and stiff joints.

In normal situations, the shock of heel strike is at least partially absorbed by a series of tissues and joints. However normal aging, vascular changes, injury, and chronic high pressure can break down the fat and connective tissue that naturally protect the feet.

This common problem can be dealt with simply and cost-effectively through the application of individually designed Stabilizing Orthotics.

By fitting patients with shock-absorbing Stabilizing Orthotics, a significant source of joint stress and excessive strain can be eliminated. Stabilizing Orthotics are designed to assist the body in dealing with the forces of walking and other forms of exercising.

Joint pain can happen to anyone at any age. There are hundreds of different ways to spark tension between muscles and bones. With the help of a chiropractor, daily exercise, and orthotics joint pain can be diminished. The choice should be simple, to no longer “live with it.”


Physiological Effects of Therapeutic Massage

The term therapeutic massage (TM) is a general, nonspecific term referring to any type of massage, from superficial to deep, that may have a healing effect. Most massage therapists “train in multiple programs and therapies and there is high variability in the training programs and in what therapies practitioners choose to learn.” Methods of massage include, among others, effleurage, petrissage, friction and tapotement. TM also can refer to most hands-on therapies including fascial manipulation, Graston, structural integration, active release, Swedish massage and others.

Claims regarding the effects of TM include changes in hormones, neurotransmitters, blood flow and cortisol, among others. However, as with most other mechanical pressure methods used on humans, there is a paucity of research supporting its efficacy, optimal treatment parameters and underlying physiologic responses.

Recent studies have added to the body of knowledge regarding the effects of mechanical load, showing definite physiological and clinical changes related to TM. An important effect of TM is thought to be its effect on peripheral blood flow. While skin temperature correlates with skin blood-flow studies, skin probes and their effect on the skin are questionable. A recent study using dynamic infrared thermography compared the effects of a 20-minute massage that included a deep muscle combination of friction, gliding (effleurage), kneading (petrissage), direct pressure and passive stretching to the neck and shoulders versus light touch (just the hands placed in contact with the skin) or a control scenario in which the patient rested quietly in the treatment position.

Light touch produced some changes in temperature, but the most significant changes occurred with the deeper massage treatment. What is most interesting is that the areas not massaged (posterior right arm, C6 to C8 dermatomes, and thoracic middle back T1 to T8 dermatomes) showed an increase in skin temperature and peripheral blood perfusion similar to the areas massaged, indicating a possible neural as well as a circulation component. The areas receiving a deeper massage showed increased temperature for 35 minutes and remained above baseline levels after 60 minutes.

One of the effects of deep massage is temperature elevation that changes hyaluronic acid molecules, which are responsible for the gel phase causing tissue restriction. The increase in temperature with associated pressure changes the gel to a fluid phase and creates the necessary tissue sliding. One study found that massage to a depth of between 1.5 cm and 2.5 cm caused changes in muscle temperature significantly greater than ultrasound.

Some of the same authors of the above study submitted another significant paper on deep massage that recently appeared in Manual Therapy. This study compared the same three groups as the previous study: deep massage and light touch over the neck and upper trapezius areas, along with a control group. This time, the authors measured flexor carpi radialis α-motor neuron pool excitability (Hoffmann’s reflex, otherwise known as the H-reflex), electromyography (EMG) signal amplitude of the upper trapezius during maximal muscle activity, and cervical ROM to help assess physiological changes and clinical effects of deeper massage compared to light touch.

The H-reflex is similar to the stretch reflex (knee jerk reflex), but differs in that it bypasses the muscle spindle and is used to assess monosynaptic reflex activity in the spinal cord. Electrical stimulation causing the H-reflex measures the efficacy of synaptic transmission as the stimulus travels along the Ia fibers, through the dorsal root ganglion, and is transmitted across the central synapse to the anterior horn cell, which fires it down along the alpha motor axon to the muscle. This measurement can be used to assess the response of the nervous system to various neurologic conditions, musculoskeletal injuries, application of therapeutic modalities, pain, exercise training, and performance of motor tasks.

In this study, even though the upper trapezius area was massaged, the H-reflex for this area is difficult to elicit, so the authors checked the motor neuron pool excitability in an outlying area that was not massaged: the flexor carpi radialis muscle (FCR), which generates a reliable reflex. They reasoned that massaging the trapezius and neck area would affect the cervical and brachial plexus and the median nerve, which innervates the FCR.

The H-reflex test did show a decrease in FCR α-motor neuron pool excitability compared to the light-touch and control groups. The fact that there was a decrease in neuron excitability in a non-massaged area suggests the possibility that massage was producing a centralized effect on the nervous system, affecting spinal-cord response in another area. This same neuronal possibility was expressed in the change in peripheral blood perfusion in non-massaged areas in the previous study.

Another finding was the decrease in EMG signal amplitude in the upper trapezius muscle with deep massage, which did not occur with light touch or control. The EMG change was probably due to the decrease in -motor neuron pool activation, which has an influence on electrical activity. Additionally, compared to light touch and control, deep massage increased ROM in all cervical directions.

One caveat is that all of the studies were performed on people without known pathology, but the neurological implications of deep massage affecting circulation and the nervous system are important. The fascial manipulation hypothesis is based on the release of restricted fascia that houses mechanoreceptors and proprioceptors, thereby influencing the CNS‘ effect on myofascia.

Everyone who seriously uses deep massage is aware of positive changes. Science may finally be proving why there are clinical results.

Deep Tissue Massage Helps Improve your Workout

Have you ever started a new workout routine and felt sore in the same place all the time? How did this hold you back from advancing and making the most of your weight training? The cause of the chronically sore muscles is a combination of lactic acid build up and muscular imbalance. Deep Tissue Massage Therapy is a great solution.

Whenever I go to the gym to work out I see a lot of people that need a good massage. There are many body types presenting many different conditions. I see the huge guys that need massage because their muscles are so hyper-tonic (chronically contracted), and at the opposite extreme, women over 40 that never worked out habitually throughout life and so their large back muscles and core muscles are weak, which causes low back or thoracic pain. I notice many people working with personal trainers that need Deep Tissue Massage Therapy to help them balance certain muscle groups, which would help them get more out of their training.

Lactic acid build up is the muscle soreness you feel when you start a new weight training routine or do something strenuous you don’t usually do, like kayaking or sprinting. This is the kind of sore feeling that we have all experienced, and it actually makes you feel like you did something. This lactic acid build up is common, harmless, and goes away quickly. It is easily treated with ice, and stretching. Deep Tissue Massage Therapy will help the lactic acid soreness go away more quickly too.

Muscular imbalance is the painful, constrictive feeling you get between your shoulder blades when you do rows, for example. Most people experience this feeling of muscle spasm at some point in their strength training routine, and it holds them back from advancing because it is not common lactic acid soreness, but a serious muscular imbalance that can lead to injury. Balancing muscle groups increases strength and flexibility; for example, the pecs are commonly short and hyper-tonic which protracts the scapulae causing neck and upper back pain.  Many common factors cause muscular imbalances; for example, repetitive motions at work, incorrect postural habits, scoliosis, old injuries, and emotional holding patterns.

A good massage therapist will be able to identify the areas of imbalance, release hypertonic muscles, and balance the whole group (both agonist and antagonist).   Deep Tissue Massage Therapy also hydrates the tissues, increases blood flow, and makes the fascia more open and supple, increasing the muscles’ potential for growth. All of this makes people stronger faster, makes you feel more energetic, and look fantastic. It can help you become more flexible and aware of how your body balances. It is important to get a good Deep Tissue Massage on off days so you can feel the benefits and realize that deep tissue massage is vital to your strength training routine, health and wellness.

Massage Relieves Migraines Naturally

Migraines are debilitating headaches caused by change in an individual’s nervous system. Doctors also believe that migraines are caused by vast changes in blood flow to the head. There are many factors that contribute to migraine headaches, including hormonal changes, diet, stress levels and environmental factors. In addition to severe headaches, migraine sufferers might struggle with symptoms such as nausea, sound and light sensitivity and dizziness. Some patients who suffer from migraines turn to massage therapy to ease their pain.

Some patients choose clinical massage therapy to combat their migraines because it is natural and non-invasive. The therapy quiets the central nervous system by relaxing tight muscles and reducing stress, common migraine triggers. When migraine patients consult with a medical practitioner, they discovered that over-the-counter medications might actually cause more migraines if not used properly. Natural treatments like clinical massage therapy limit the risk of rebound headaches caused by medication. Some patients who go for clinical massage therapy for their migraines find immediate relief. Other patients find relief after sessions that span several weeks.

A professional therapist can teach the patient about massage techniques they can use when pain hits. A study cited in “Annals of Behavioral Medicine” found that adults who suffer from migraine headaches and went for clinical massage therapy regularly had a significant decrease in headache occurrences.

Clinical Massage Can Help The Respiratory System

There aren’t very many people who, at first glance, would think of the lungs and respiratory system as gaining any great benefit from clinical massage therapy, but those people are far from accurate. Clinical Massage therapy, when conducted by a skilled practitioner, can create some wonderful and helpful results when it comes to your lungs and ability to breathe more efficiently.

The respiratory system’s function is to allow oxygen exchange through all parts of the body. The space between the alveoli and the capillaries, the anatomy or structure of the exchange system, and the precise physiological uses of the exchanged gases vary depending on organism. In humans and other mammals, for example, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles. Molecules of oxygen and carbon dioxide are passively exchanged, by diffusion, between the gaseous external environment and the blood. This exchange process occurs in the alveolar region of the lungs.

Other animals, such as insects, have respiratory systems with very simple anatomical features, and in amphibians even the skin plays a vital role in gas exchange. Plants also have respiratory systems but the directionality of gas exchange can be opposite to that in animals. The respiratory system in plants also includes anatomical features such as holes on the undersides of leaves known as stomata.

To have a great benefit on the respiratory system, the muscles around your torso, including the diaphragm (your main respiratory muscle) and intercostals muscles (between the ribs) must be massaged. Most people don’t immediately think about these muscles when considering whether or not they want to have a massage. You need to have an established and trusting relationship with


your clinical massage therapist before allowing him or her to work in this area of your body, due to sensitivity and emotional issues that can arise when working near the chest. Females, especially, need to be cautious, due to the proximity of the breast tissue. A good therapist, however, knows how to use proper draping (covering) techniques to avoid exposure and will discuss any sensitive issues or concerns with you prior to the massage.
Clinical Massage therapy impacts the respiratory system by increasing your pulmonary functions. The loosening of the often tight respiratory muscles allows them to move more freely which will in turn aid your breathing by allowing the lungs to expand and contract without inhibition. Your ability to inhale and exhale will be enhanced, allowing oxygen an easier path into your body and carbon dioxide and easier path out.

Relaxed respiratory muscles contribute to a lower respiratory rate, or number of breaths you take per minute. If your muscles aren’t constricted, your lung capacity will increase. You’ll find yourself taking longer and deeper breaths instead of short and shallow breaths. For the same time, those who generally feel short of breath, also known as dyspnea, should not feel short of breath as much or as often.

Another great benefit on the respiratory system is the decrease in asthma attacks experience by those who have had regular massage therapy. This relates back to the relaxation of the muscles and the improved pulmonary function. We’ve given the lungs a chance to relax and work more efficiently and individuals who have regular massage treatments find that they are less dependent on their inhalers or asthma medications.

Clinical Massage therapy also helps to reduce tension around the larynx by reducing the tension in the muscles of the neck and throat region. Singers and public speakers take note – you use more muscles when you speak and sing thank you think – taking care of these muscles might just help you increase the longevity of your career!

Certain massage techniques can and will help increase fluid discharge from the lungs by loosening phlegm, especially when certain tapping or tapotement techniques are done on the back. Unfortunately, if you have a respiratory ailment that causes fluid buildup in the lungs, you shouldn’t approach this as a therapy without the aid of a trained respiratory therapist. A good clinical massage therapist will not start banging on your back with the intention of loosening phlegm without a strong knowledge base concerning your medical history. Otherwise, massage may be an excellent addition to the therapies you are using to control your respiratory illness.

With that said, I’ll again remind you that you should always check with your doctor and/or clinical massage therapist to determine if massage is right for you. Always disclose your full medical history to your clinical massage therapist. Until next time, be safe and relaxed!

Osteopathic Pain Relief Centre Singapore


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