MSK Therapy Clinic FAQs

At TotalMSK, we specialise in treating Musculoskeletal / MSK related conditions and put the patient's interests first. Unfortunately, the musculoskeletal healthcare sector is vast and largely unregulated, which creates the opportunity for "bad" actors. Some within the musculoskeletal field do not put the patient's best interests at heart, and such a situation can even apply to some of the regulated professionals. The article on finding a good, ethical and moral MSK healthcare professional helps offer some pointers on what to look for and avoid when seeking treatment. We specialise in the assessment, treatment and rehabilitation of work and sports-related Musculoskeletal / MSK conditions. Our goal is to identify the root cause of symptoms and get you the patient out of pain and back to activity, as quickly as possible. TotalMSK has extensive in-house experience covering the treatment of a wide variety of Musculoskeletal / MSK conditions and Work Place Health and Safety and Mental Health in the workplace. Not only do we work from a musculoskeletal perspective, but our practitioners have extensive training in multiple advanced soft-tissue techniques too. In our experience and opinion, such a mix of training allows our practitioners to treat a wider variety of conditions effectively.

Our practitioners tailor treatments to you the patient's unique set of circumstances, and besides interventions, include preventative advice covering work and non-work-related activities. Initial consultations always look at multiple related aspects of the human body including; biological factors, social factors and psychological factors. Such factors include previous injury history, activity levels, previous conditions, stress, sleep, diet and much more. Stress within and outside of the workplace has become a significant issue over time, and besides having a physiological impact on the Musculoskeletal / MSK System, can also lead to Mental Health-related problems and other debilitating conditions. There are three articles on TotalMSK's blog covering the human stress response and the effects of this. Besides the expertise within TotalMSK, we also have a professional referral network. Meaning that should a specific issue not be of a Musculoskeletal / MSK nature, then a patient can be referred to an appropriate and suitably qualified professional. Other noticeable differences are:-

People often ask what the differences are between a Chiropractor, Physiotherapist and Osteopath. All three professions have a statutory regulator within the UK and have legally protected titles. Hence, it is illegal for anybody not trained and registered with the relevant regulatory body to profess to be or use the term Chiropractor, Osteopath, Physical Therapist or Physiotherapist. There are many similarities and some differences between the three professions. All three professions are Primary Care Health Practitioners and have to complete either a University degree or Masters level qualification. Each occupation also works with diagnosing and treating Musculoskeletal related conditions. Chiropractors and Osteopaths both learn manipulative techniques as part of their training and education, which typically comprises of a four year full-time Masters level qualification. Physiotherapy training usually takes three years full-time and results in a degree. The degree does not include training in manipulative therapy techniques (HVLA). Physiotherapists can complete further training and or a Masters and then can also use manipulative therapy techniques with patients.

Historically, Chiropractors have tended to use manipulative therapy techniques as the primary way of treating musculoskeletal-related conditions. Osteopaths have typically used a combination of manipulative therapy and soft tissue techniques. Physiotherapists have tended to use a combination of soft-tissue techniques and prescriptive exercise. However, these days, there is a considerable amount of cross-over or blurring between what practitioners might do within each profession. The fundamental differences these days probably relate to philosophy and thus, how practitioners in each profession might assess and treat a specific condition. The definitions for each occupation can be found below and are the actual text used on each regulators website.

The following list is not exhaustive, and other conditions can contraindicate a patient from having treatment. The list also covers other musculoskeletal related treatments offered by TotalMSK practitioners. However, treatment may still be suitable for a patient and may only actually be locally contraindicated. Local contraindications mean that a specific area either cannot be treated or that only particular therapies may be appropriate. Global contraindications may mean that it is not currently safe to treat you the patient with a specific technique at the time. There may be occasions where one may need to gain GP approval before commencing treatment. Getting GP approval tends not to be an issue. Just because it is not safe to use one type of technique, others may be entirely appropriate. Should you have any doubts or questions, then please contact a practitioner at TotalMSK. Our practitioners will be more than happy to talk you through any queries or concerns.

Typical types of Contraindications may include:-

• Open wound, fractures or dislocations.
• Myositis Ossifications.
• Deep Vein Thrombosis (DVT.)
• Varicose Veins (Local contraindication).
• Infectious skin diseases (bacterial, fungal, viral, herpes and lymphangitis).
• Severe Sunburn.
• Pregnancy and within the first trimester of pregnancy.
• Tumours.
• Cancers.
• Haemophilia and other bleeding disorders.
• Acute soft tissue inflammation (muscles, tendons, ligaments, organs and other underlying structures). Acute soft tissue inflammation is typically treated using R.I.C.E (Rest, Ice, Compression and Elevation) as a means of reducing inflammation and which is usually applied at the time of the initial injury.

One may experience some mild side effects after any Musculoskeletal / MSK therapy treatment. Such as MSK therapy techniques, Remedial Massage, Sports Massage, Dry Needling (DN) or Gua Sha/IASTM, which is perfectly normal. Not everybody is affected, but for those people that are the side effects typically occur within the first 12 - 48 hrs post-treatment and usually last between 48 - 72 hrs. These side effects tend to be the result of creating change within the body, which affects soft tissues, altering biomechanics/movement patterns and stimulating the bodies natural healing processes. One may or may not experience one or more of the following:-

• Aches, soreness, tenderness or stiffness.
• Different areas aching to those treated
• Emotional changes.
• Headaches.
• Feelings of relaxation or of being invigorated.
• Changes in sleep patterns.
• Dizziness or nausea.
• Spots.
• Altered bowel movements.
• Changes in urine output, colour or frequency.
• Body temperature changes.

In some cases and particularly when a condition or symptoms have been long-standing (chronic), one will usually notice that symptoms can appear to be worse after the first treatment. As previously mentioned, such side-effects typically last for up to between 48 - 72 hrs. However, patients can often notice positive or negative changes for up to seven to eight days, due to differences in biomechanics and the resulting tissue adaptations. Typically, in chronic conditions, there has been a great deal of time to enable dysfunctional tissue patterns to occur and indeed, physiological changes within tissue structures. Such changes can affect the Musculoskeletal / MSK system and result in altered movement patterns, aching, pain, restricted movement, and even affect other body systems. Hence, working on these dysfunctional tissues can make things worse in the short term.

Many Musculoskeletal / MSK therapy techniques create microtrauma during the treatment. Dysfunctional tissues then have to heal and adapt to these changes regarding function and biomechanics. Allowing the tissues to heal correctly is necessary if one wishes to return them to as a near-normal functional state. Hence, after treatment, one may notice other regions of the body aching and not just the treated areas. Also, dysfunctional movement patterns can develop over time due to "lack of use, misuse, overuse and abuse" (Leon Chaitow, Osteopath). Such changes, will impact multiple other tissues and create change in these too, especially in chronic cases. By treating these dysfunctional Musculoskeletal / MSK patterns, one is enabling the tissues of the body as a whole to work as intended. Hence, these other tissues may have been inactive for an extended period and so are likely to ache when they start getting used correctly. Side effects can often be minimised by following the aftercare and home care advice provided by the therapist at the end of the treatment session. The Basic Running / Sports Injury Prevention article briefly covers tissue adaptation. The principles equally apply to the prevention of and the rehabilitation of Musculoskeletal / MSK injuries in general. There is also a far more detailed article about Adaptation in a Musculoskeletal Context, which has relevance for injury prevention, rehabilitation and aftercare.

The initial Musculoskeletal therapy consultation is a requirement of being treated for many reasons. Primarily, it is to establish if it would be safe to treat you the patient and if Musculoskeletal therapy care would be suitable. If it is unsafe to provide care for you, then you will be referred to a suitably qualified medical practitioner for further investigations and or treatment. The consultation is also to ensure that you get the best individualised treatment for your unique personal history. Your background information will be unique to you regarding medical, emotional, physical and lifestyle aspects, often referred to as BioPsychoSocial factors. One can view overall health from multiple constructs such as Physical, Mental, Emotional, Social, Environmental and Spiritual, with each part affecting the next. Hence, your treatment plan needs to take into account your unique history. Finally, the consultation is a requirement of regulated health professions, professional associations and also insurance companies. All suitably qualified practitioners will conduct initial consultations and keep patient record card information. If a therapist or practitioner is not doing this, then there are good reasons for concern.

It is vitally important to be completely open and honest during the initial and confidential consultation process. Practitioners will be interested in all aspects of health, even if the patient does not view them as relevant. In essence, there are a vast number of possible variables affecting how and why symptoms may have occurred. Such variables may include medications, habits, previous injuries, operations, diet, stress, other medical conditions, existing on-going treatments etc. Each variable is like a small piece of a giant jigsaw puzzle. Hence, the more a practitioner understands regarding a patient's unique health circumstances, the better they can help. There is also an aspect of patient safety, as certain existing conditions or medications may contraindicate some methods of treatment. There are usually multiple ways to achieve the patient's desired end outcome via a combination of suitable techniques. There may be a contraindication for one method and not another, with patient safety being paramount.

Once somebody has undergone an initial Musculoskeletal therapy consultation, then one does not usually have to experience the same process again. However, there are circumstances where it may be necessary and is viewed as best practice by professional associations. For example, if a patient has not been seen or treated by a specific practitioner or anybody working for the same said clinic in a six-month given period. In essence, a considerable amount can happen within six months, including, injuries, changes in medications etc. A regular appointment will not provide ample time to gather any additional details needed to assess and treat safely. An accident or other severe trauma may also mean that a patient has to undergo another initial consultation process. Besides being viewed as "best practice", the initial consultation process is designed to protect you the patient and ensure that you receive the most appropriate treatment.

Yes. If the child is under the age of 16, then written permission is required from either a parent or guardian, before providing any treatment. One can give written parental consent during the initial consultation process. Also, a responsible adult should attend and be present while the child/patient is receiving treatment. These measures are viewed as best practice by professional associations and health profession regulators.

Yes. However, you should speak with your existing therapist or professional before seeking further treatment, which is partially out of courtesy. In some cases, differing therapies may be counterproductive or not advised in conjunction with one another. In other cases, therapists can work effectively with other disciplines to achieve an overall common patient goal. However, various professionals/therapists need to coordinate treatment in such cases.

On average, our practitioners have found that most patients only need between two and three treatments to resolve most Musculoskeletal / MSK-related conditions of a non-complicated or chronic nature. The two to three-treatment figure includes the initial consultation and typically applies to one specific problem. Hence, if somebody has multiple ailments, then on average, it may take 2-3 treatments to resolve each one. The number of sessions needed can depend on a wide range of factors, as can the frequency of any maintenance treatment:-

• Injury History
• Age
• Gender
• Chronicity of Condition(s)
• Following aftercare advice
• Other relevant conditions
• The number of individual conditions
• Diet and lifestyle

Our practitioners have found that the combination of techniques used at TotalMSK tends to result in better patient outcomes and a quicker symptom resolution.

Many patients might question the relevance of maintenance treatment. The simple answer is that our bodies constantly adapt to various forces, such as gravity, daily. Forces impart loads on our entire musculoskeletal system. Our tissues will "adapt" to these forces over time, and one may typically notice these changes as restricted movement, tension, pain or a combination of symptoms. The article on Soft Tissue Adaptation goes into far more detail. Many patients find maintenance treatments highly beneficial in countering some of the adaptations caused by the day-to-day stresses and strains of modern-day life. The frequency of such maintenance treatments can also vary from 4-6 weeks to bi-annually. Most people think nothing of maintaining their car, house or appearance but neglect their musculoskeletal health and wellbeing.

Frequently Injury prevention is more about developing strategies to reduce or mitigate risks of injury. The vast majority of injuries are preventable to a large extent. Simple things such as diet, hydration levels, warming up, cooling down, self-maintenance, recovery, avoiding overtraining, footwear, technique, etc., play a part. A much more detailed explanation can be found here How can you help prevent injuries?

Musculoskeletal therapy clinic treatment costs can vary considerably, as can treatment times. Prices in the Brisbane area can easily range from $75 to over $130, which tends to be dependent on the type of treatment and duration. Initial consultations often take longer than follow-up appointments and, as a result, cost proportionally more. Please see the bookings link for current treatment costs, appointment durations and any clinic promotions.

The word holism originates from ancient Greek and means, (entire, total, all or whole). The concept of holism and its relation to health and wellbeing has existed since ancient times. Prominent historical figures who have advocated such an approach to health include Hippocrates and Galen. Holistic health is a philosophy or approach to medical care which views the whole as more than the sum of the parts. The holistic approach also aims to look at the complexed relationship between mind, body and soul and which in turn affects the end treatment. This type of approach to health has only really started being integrated and gaining significant support in mainstream health in the last 30 years. Today an individualised treatment approach is being advocated in many parts of mainstream medicine. Historically, general medicine has applied a particular treatment for a specific condition, and this has taken minimal account of individual differences. However, there have always been questions as to why two individuals with similar ailments could undergo the same treatment and yet have differing outcomes. Taking a holistic approach about how to treat the patient is undoubtedly making a difference in mainstream medicine.

Another area of research and which also takes a more holistic view of the individual is the biopsychosocial model. This model stems from "social cognitive theory" and dates back to the late 1970s, though it is gaining much interest from a mainstream medical perspective. The model looks at how biological, psychological and social factors affect health and well being and thus has implications for treatment. In essence, a problem in one of these areas can lead to problems in the others and vice versa. A criticism of the biopsychosocial model is that it is an oversimplification of human health. Other models or constructs of health have sought to expand on the initial ideas of the biopsychosocial model and can include; Physical, Mental, Emotional, Social, Environmental and Spiritual. Each of these central aspects of health may further be subdivided, and there is still a lack of consensus on the exact main areas. Some models also include Financial health. The article on Biotensegrity and how everything is connected explains in further detail the importance of the holistic view of health.

Although the idea of evidenced based practice sounds great, it is essential to understand some of the inherent limitations of research, which form part of any evidence base. The musculoskeletal health field covers various conditions, professions and treatment methods. Some soft tissue therapy methods have existed for millennia, while others are essentially adaptions and repackaging of ancient techniques, with other methods being new due to technological advances.

The critical thing to understand is that all research requires funding, as conducting research is essentially a job costing time and money. Research rarely occurs for ideological reasons, such as to further human knowledge and understanding. Usually, there is some form of financial incentives, such as to save money, promote a particular profession or, more frequently, to earn a significant return on investment. It would be fair to say that politics, influence, power, protectionism and money all have and continue to play a part in research funding. There are many examples of general medicine operating protectionist practices and calling out anything that does not fit within the medical model view of all things health as quackery, citing a lack of evidence. However, general medicine has a long history of performing procedures without evidence. Many soft tissue therapy techniques did not involve higher education training, and general medicine argued Universities would legitimise quackery by enabling courses to gain higher education accreditation. The Physiotherapy profession, who were historically massage therapists, chose to align with the view of general medicine and fit within that model early on.

The Chiropractic and Osteopathy professions chose not to limit themselves to the narrow view held by the medical model at the time. Research into the fields of Chiropractic and osteopathy only started gaining traction once the courses became accredited at the higher education level. There is now some high-quality research on the efficacy of techniques from both professions for various conditions. However, some within the medical profession still refer to Chiropractic and Osteopathy as quackery and believe there is no place for teaching such subjects in a higher education setting due to the legitimisation argument. There are still far fewer higher education institutions teaching Chiropractic or Osteopathy than Physiotherapy. Again, the number of institutions teaching a specific subject impacts the overall available research related to said area. Equally, more recent changes in how academic institutions get funding impact the courses taught and, thus, research. Big Pharma can afford to put large sums of money into research, which can change resource allocation priorities. Hence, there is often little incentive to research many soft tissue therapy techniques, especially ones which do not promote a specific profession and with learning at a higher education level. Also, general government research funding is likely to go to more pressing priorities than research into soft tissue therapy techniques. Such a situation can mean little to no research exists for some soft tissue therapy techniques, yet practitioners and their patients know such techniques work. Although this is evidence, it is extremely low on the academic evidence hierarchy.

Unsurprisingly, most research within the medical field, in general, is funded by the Pharmaceutical sector. General medicine and the Pharmaceutical industry have become inextricably linked and are worth astronomical amounts financially to each sector. In many respects, it is not in the Pharmaceutical sector's interest to fund research in, for example, myofascial release techniques to treat headaches or migraines. Over-the-counter headache or migraine medication sales are simple, easily accessible and worth billions of dollars per year to the Pharmaceutical sector. Equally, sometimes people find it easier to take a pill rather than seek hands-on-treatment and take preventative measures such as making simple lifestyle changes. The long-term effects of prolonged use of such medications are now more researched and publicised.

Many soft tissue therapy techniques lack ownership per se, so almost anybody can claim to have learnt and then practised such methods. Some such techniques may have origins within a particular profession, but that does not stop others from using such treatment methods. There are some patented or trademarked soft tissue therapy techniques, many of which have a basis from other non-patented or trademarked older techniques. It would not be possible to trademark or patent the original techniques. So often, there is little incentive to spend time and money researching to benefit others using the methods. There are many commercial advantages for patenting and trademarking techniques for the owners including marketing benefits and treatment differentiation, research funding, financial income and branding opportunities. Patents and trademarks for soft tissue therapy techniques can bring a steady income for the owner of such protections through providing training in the methods. Many such techniques also require additional training every year, two or three years, to remain valid and for trained practitioners to continue using the named technique. There is a vested interest in people owning the protections for such techniques to conduct research to market and promote the methods over other techniques. Such a strategy means patients are likely to seek out practitioners using well-branded and marketed techniques. The pull of consumers searching for the technique then encourages practitioners to pay to learn and use the methods. Having a branded technique does not mean that the older or original technique is less effective in practice, just less well-marketed.

Although research provides useful insight, the methodology required to conduct good research in the musculoskeletal health field in many respects is not very real-world. Good research, such as a Randomised Clinical Trail (RCT), involves limiting variables, which is essential for the rigorous testing of a hypothesis. An RCT might involve recruiting a (sample size) or set number of participants fitting particular demographics and with a specific condition. The entire group of participants might then get randomly assigned to an experimental group and a control group, with an equal number in each group. Both groups may then appear to have some form of treatment, though only the experimental group receive the actual treatment or technique under investigation. Technically by limiting variables, any statistically relevant differences between the control and experimental groups should relate to the treatment technique under investigation. The sample size of the initial group can then make a difference in how well the RCT results apply to the broader population of people with the specific condition. Such research may then add to the evidence base for treating a particular condition in a specific way.

Limiting all the variables is essential to producing good, repeatable research, the reality of musculoskeletal conditions is very different. No two individuals are the same, and no two injuries are the same either and research methodology takes little account of individual differences, which are relevant to assessment and treatment. Two people could have the same diagnosed MSK injury/condition, though the exact injury mechanism (how the injury came about) will be different. Equally, previous historical injuries, hobbies and interests and a range of other factors have a role in some injuries and certainly treatment and recovery. Hence, providing the same standardised intervention/treatment for patients with the same condition is not always the best option. The best approach for one patient might involve several treatment types or interventions, though the research still has relevance.

Most Allied Health Professionals must complete a research component as part of their higher education qualifications, though this research tends to be profession-specific and aimed at furthering the profession. Some musculoskeletal professionals, such as Chiropractors, Osteopaths and Physiotherapists, learn many styles of soft-tissue therapy. Allied health professionals may or may not learn myofascial release methods as part of their higher education training. Some professionals will undertake further training in myofascial techniques after qualifying in their chosen profession. However, such soft tissue therapy techniques are not very profession-specific, meaning there is a low likelihood of somebody studying Chiropractic, Physiotherapy or Osteopathy researching the method.

Holistic/Swedish massage is a traditional form of massage which uses many methods to either relax or to stimulate the body, depending on the desired effect. The techniques used include; (effleurage, petrissage, frictions, tapotement, vibrations, joint mobilisation and holding). Further details about such techniques can be found here.

Massage is not usually painful provided the tissues are warmed up, and one applies the techniques correctly. However, deep tissue massage techniques can sometimes cause considerable pain, though this pain is tolerable, and patients often refer to this pain as "good pain". A good therapist should have well-developed palpation skills and be able to sense how tissues respond during treatment and work with the body, not against it. Working with the patient and their body means the therapist can adjust pressure and technique to minimise discomfort during treatment. Correctly used deep tissue techniques should not cause tissue damage (bruising). However, such forms of treatment look to produce some microtrauma in congested tissues. It is often necessary to break down fibrous adhesions within dysfunctional tissues. Treatment aims to restore normal or as near normal tissue function. There is some confusion amongst some massage therapists as to what massage therapy can achieve. Massage does not break-down scar tissue, calcium deposits within tissues or release lots of toxins. Soft tissue therapy techniques can improve tissue tension affecting scar tissue, but a scar is a scar, and even general medicine cannot yet turn scar tissue into normal tissue.

It is possible for Massage Therapy treatment to make things worse, much like any manual therapy. Sometimes, there are contraindications to treatment types or techniques, meaning a therapist should use only certain methods, not treat a specific area, or avoid treatment altogether. Massage therapy has a limited scope of practice, and there is very little diagnostic training. Hence, a therapist could easily treat symptoms they do not understand, do not know how to treat and are not qualified to treat, making things worse. Treating somebody who is local or globally contraindicated can also prove dangerous for the patient.

Massage can also make things seem worse within the first 72 hours post-treatment. Massage therapy takes many forms, which involve manipulating tissues to varying degrees. In many respects, one can liken massage to a workout for the tissues treated. Treating tissues can also affect how they move, affecting other body parts (Biotensegrity and how everything is connected). Much like after a good workout, one may notice treated muscles aching over the coming days or other areas aching. Changes in how tissues move result in other tissues having to work more or differently, and tissues must Soft Tissue Adaptation to the extra demands placed on them. Hence, it is usually best not to do strenuous activity while the body adapts. When working with athletes in competitions, one usually adapts the soft tissue therapy techniques one uses to maximise performance-based competition schedules. It would be extremely easy to hamper performance if one did not know what they were doing.

Dry Needling is just one treatment tool within a professional's toolbox and can prove very effective when used in the right circumstances. Individual and unique patient circumstances, treatment goals and practitioner's experience all play a part in deciding the best approach. Some practitioners charge additionally for the use of Dry Needling as part of treatment; sadly, this can sometimes result in some questionable decision-making processes. As with most treatments, the need for multiple interventions is common to produce the best results.

Dry Needling and acupuncture are considered invasive forms of treatment due to the necessity to pierce the skin. Anything that cuts or punctures the skin has additional risks to treatment methods that do not. Dry Needling also has other associated risks, though all risks are managed extremely well and minimised through a combination of methods. Education and training are highly relevant, as safe Dry Needling requires detailed knowledge of anatomy and physiology. In Australia, the base level of training required to complete a course in Dry Needling is a Diploma in Remedial Massage Therapy. Surprisingly, there can be vast differences in acquired knowledge between practitioners completing such courses at different training providers, though the qualifications are the same. Equally, training in Dry Needling can vary, such as course duration, techniques and scope. Most courses involve some level of theory and practice, with courses varying from one day, though two days is common, too far longer. Practitioners are only insurable for learning undertaken during the courses they attend. There are limits on what one can practically learn during a weekend course. Competent practitioners should always explain the risks and rationale for using any treatment technique, with the patient having the final say. Further details on possible risks can be found here possible risks of Dry Needling

There is the potential to injure nerves while performing dry Needling. However, one could say similar when stubbing one's toe or accidentally hitting a thumb. A practitioner's anatomical knowledge, training, experience and technique all help minimise the risks. Needle angle, depth and speed of technique application also minimise risks. There can be slight anatomical differences between people, so even a competent practitioner could come into contact with a nerve or vein. If a needle comes into contact with a nerve, the patient will likely feel a sharp electrical pain radiating from the needle along the nerve. Such a situation is not likely to cause damage. A competent practitioner would remove and reposition the needle in such a situation. Damage is more likely if the practitioner attempts to insert the needle further, causing more nerve pain. Unlike the spinal cord, peripheral nerves can heal and try to regrow/reconnect after injury. There is no reason why a clinically competent trained practitioner should come into contact with the spinal cord. Hence, one might initially lose some sensation after a bad toe stubbing, only for the senses to return days or weeks later.

Realistically, the answer could be either yes or no. Most professional therapists have many tools available to treat specific situations or achieve patient goals. Dry Needling and massage are two types of tools available to a practitioner, and there are also many forms of dry Needling and massage. Dry Needling tends to be very specific, as it works with myofascial trigger points and can be good for treating such issues. That said, other forms of myofascial release can work equally well. Although dry Needling may produce relaxation in the treated tissues, massage therapy may produce better overall relaxation. Hence, it depends on the treatment objectives and individual patient circumstances.

Dry Needling does not have to be painful, and one may not even feel the needle enter or leave the skin. Practitioner experience, training and technique play a huge part in what one may feel. Equally, the fine solid core filament needles used in Dry Needling are very different to hollow hypodermic needles. Needles used in Dry Needling are almost hairlike in thickness and not designed to cut, unlike hypodermic needles. Even with injections, the skill of the professional performing the procedure can affect what we feel. Besides the physical differences between a dry needle and a hypodermic, Dry Needling is a more gentle and gradual process. The skill and technique of a competent practitioner mean that one can palpate (feel) differences in tissue response via the needle and needle handle. Surprisingly, most massage therapy courses fail to teach palpation as a specific skill, and it takes years to develop the skill even when taught. Hence, there are many reasons why Dry Needling can prove painful, though it does not need to be.

As with many treatment modalities, one can experience effects instantly. The overall effects may last for a week or slightly longer. It is essential to understand that changes in one part of the body affect other areas (Biotensegrity and how everything is connected). Hence, creating a release or multiple releases in one place will change how everything moves elsewhere in the body. Also, how long the effects can last often depends on aftercare advice and whether or not one follows it. Aftercare might include prescriptive exercises or habitual changes etc. Aftercare advice is often as important as any treatment in furthering the effects of the treatment. Equally, a treatment plan may involve several treatments, and just because symptoms appear to have subsided does not mean everything is back to normal. There can be a tendency for some patients/patients to purely seek initial symptom resolution rather than finish a short treatment plan (3-5 treatments). Often symptoms can mask underlying issues, which cause the symptoms and need addressing to prevent reoccurrences. A practitioner may reduce the initial treatment plan based on patient progress and once they are confident of resolving any underlying issues.

Trigger point dry needling works best on conditions involving myofascial trigger points and associated pain. However, other myofascial release techniques do not involve needles and can achieve similar results. Dry Needling works well on muscles that can be hard to reach or when other methods can prove particularly unpleasant/uncomfortable. For example, the Gluteus Minimus and medius are very deep, and treatment for issues such as Temporomandibular Joint Pain (TMJ) can prove unpleasant with other myofascial release methods.

As with many forms of manual therapy, treatments change how tissues function, affecting mobility and perceived pain. Most treatment involving direct work on tissues results in some localised inflammatory response after treatment. Typically, such a response is not instant and becomes apparent a day or two after treatment. Much like exercise, there can be a delayed reaction and aching sensation. Typically, one notices any inflammatory response within the first 72 hours after treatment. Hence, things can appear better, worse or vice versa at any time within the first 72 hours. Also, treatment aims to change how tissues function and one area affects another (Biotensegrity and how everything is connected). Equally, the body adapts to injuries, impacting tissue function and movement. Treating tissues to restore correct function in one area means that others areas must move differently. One might notice such changes within the first few days after treatment and up to eight days post-treatment. Examples of changes might be other areas of the body aching when doing activities or tissues feeling fatigued at first. Again, symptoms may feel better or worse, and vice versa, while the body adapts to the changes. Exactly, what one can feel depends on many factors, including general health, previous injury history, unresolved injuries, following aftercare etc.

The number of sessions can vary due to many factors, including specific symptoms/conditions, injury history, unresolved injuries, habitual behaviours, activity levels, diet, following aftercare advice etc. However, three to five sessions are fairly common, though most good manual therapists do not use Dry Needling as a purely standalone treatment. Hence, Dry Needling is just one treatment method or tool in the toolbox and used in conjunction with other techniques. For example, aftercare advice and prescriptive exercise are essential to restoring normal tissue function. Failing to follow advice often means treatment plans can take longer and thus more sessions.

If a Dry Needle comes into contact with a nerve, one typically feels an instant sharp and electrical pain travel along the length of the nerve. Unlike hollow hypodermic needles, which cut into tissues, the needles used in Dry Needling are very different. The filament needles used in Dry Needling are extremely thin, have a solid core, and pierce rather than cut. The design of the Dry Needles reduces the risk of causing nerve damage, and the technique is much more gradual than an injection. Hence, if a competent therapist contacts a nerve, they would remove the needle and apply another needle in a different area. Suppose one were to continue pushing a needle into a nerve. In that case, the patient continues to feel the electrical type of pain, and there is then a possibility of causing nerve damage.

Symptoms can appear worse or better after Dry Needling, as with many other forms of manual therapy. Treatments to soft tissues can create a slightly localised inflammatory response, which is normal and can make things appear worse in certain areas. More importantly, treating affects how we move due to the changes it creates within tissues (Biotensegrity and how everything is connected and Soft Tissue Adaptation to activity and injury). Changes in how we move can often make things seem worse in many areas while the body adapts to biomechanics' differences. Taking up a new physical activity or doing an activity one has not done for ages usually leads to lots of aching within the first few days post-activity. A good example might be skiing, which uses the leg muscles very differently from normal activities. The body has to rapidly adapt to the changes required of it, which usually involves some aching.

Dry Needling can be completely painless, though often one feels a level of localised muscle contraction. Competent therapists can feel tissue responses via the needle handle and can control the level of muscle contraction the patient feels. Good therapists will work with the patient to avoid or limit any possible pain. What one feels during treatment often depends on the therapist's skill, training, technique and experience. Equally, there are different types of Dry Needling techniques, and some can prove painful, such as "pecking" and "electrostimulation". Hence, treatment can vary between professionals.

As with many manual therapies, people can react differently to a treatment. How somebody reacts post-treatment depends mainly on each individual's unique circumstances. Factors such as injury history, unresolved injuries and how long symptoms have been present can all impact how one reacts to treatment. It is generally not advisable to do strenuous exercise after treatment, though light exercise such as walking can be good. One tends to notice a level of aching within the first 72 hours after treatment as the body adapts to changes. Treatments affect tissues and how we move (Biotensegrity and how everything is connected), so tissues need time to adjust to new demands. Hence, it is best to give tissues the time they need rather than overload them. Much like vigorous exercise, one can ache within the first 72 hours post-workout, and it is best to avoid overtraining to avoid injury.

The therapist's skill, technique, training and experience can significantly affect what one feels during and after treatment, including pain. Often one may notice some level of aching within the first 72 hours, much like after exercise. Aching occurs due to tissues and joint structures working or moving differently after treatment. Changes in movement increase and change the demands placed on tissues within the treatment area and elsewhere. The may also be a localised inflammatory response within the needled tissues, which is perfectly normal. The first 72 hours after treatment is when one is likely to notice the most change. However, pain perception is also affected by many other things, based on research.

There are many differences between Dry Needling and Acupuncture. Differences include duration and level of training, treatment philosophy and scope of practice. Dry Needling purely treats Myofascial Trigger Points or Trigger Points within muscles. Acupuncture treats many possible conditions, including addictions, fertility, etc. Further details on some of the differences can be found via the link Differences between Dry Needling and Acupuncture.

Dry Needling works extremely quickly on myofascial trigger points, and one can usually feel a melting sensation as tissues release and shortly after applying a needle. Often one feels a slight tensioning of tissues around the needle followed by a feeling of relaxation in the area. Specific conditions and symptoms can occur for many reasons, and factors around individual circumstances can hugely impact treatment plan duration. Dry Needling is just one tool in the toolbox of a good therapist, and prescriptive exercise and aftercare advice is hugely important too.

There is no need to rest after Dry Needling, though everybody can react differently to a treatment. Reactions to treatment can differ due to each person's unique circumstances, including medical history, habits, following aftercare advice and more. Even differences between individual therapists such as technique, approach, knowledge and experience can make a huge difference. Typically, one might notice some level of aching within the first 72 hours post-treatment as the body gets accustomed to changes in tissues and movement. It is often better to do some light exercise after treatment, such as a gentle walk, rather than rest. Performing such an activity gives the body chance to feel and adapt to the changes created by treatment.

Nerve pain can occur for multiple reasons. The underlying cause of nerve pain dictates whether dry needling is likely good or beneficial for nerve pain symptoms. If the reason for symptoms of nerve pain has myofascial origins, then dry needling could be a good treatment option. Equally, other myofascial release techniques may prove just as good in such cases, as not everybody likes needles. Such methods would reduce tension/pressure impacting nerves and causing pain symptoms.

It is essential to understand that different types of arthritis and these impact joint structures. Dry Needling, much like other soft tissue therapy techniques, can reduce tension within tissues, effectively reducing compressive forces acting on joint structures. Dry Needling can help in many cases of arthritic pain by reducing loads on joints, though it will not resolve the condition's root cause. Other soft tissue therapy techniques would help on the same basis as Dry Needling.

It is possible to release trigger points using various soft tissue therapy methods. Techniques tend to work differently, with some methods working indirectly on trigger points and others working directly. Equally, individual patient circumstances can dictate when it is appropriate or safe to use one technique over another. Examples of techniques include Dry Needling, Neuromuscular Therapy, Soft Tissue Release, Myofascial Release, Positional Release Technique, IASTM, Muscle Energy Techniques and more.

General soft tissue massage involves the manipulation of soft tissues. The four basic massage strokes are (effleurage, petrissage, frictions and tapotement). The strokes work differently, and a good therapist can apply the techniques in different ways to achieve the desired effect. Unlike more specialised forms of soft tissue therapy, soft tissue massage education provides little training covering the assessment and treatment of specific conditions.

Soft tissue damage tends to be painful due to multiple sensory cells within soft tissues. Damage to sensory cells within soft tissue can result in pain. Tissue inflammation can also apply pressure to sensory cells in and around the trauma area, resulting in pain.

Soft tissue takes different amounts of time to heal based on injury severity, injured tissues, and many other factors. It is not so much a case of speeding up injury healing, which takes time. It is more a case of ensuring the optimal soft tissue healing environment and avoiding further injury during the healing process. Further damage interrupts the tissue healing and repair process. Also, the final soft tissue repair quality is usually worse after repeatedly injuring the area during the healing process.

Many factors dictate how long soft tissues take to heal, including the level and type of trauma and which tissues need to heal. Minor injuries may take a few days, other injuries strains (muscles, tendons) weeks to months and ligaments months. If further damage occurs during healing, times can extend even further. See the more detailed description about soft tissue repair

Before doing anything to reduce the swelling in soft tissues, it is vital to understand the reason for symptoms of swelling in soft tissues. Swelling could be the sign of infection or another underlying medical condition requiring attention. Provided the reason for symptoms of the swelling is known, methods to reduce soft tissue swelling typically include Rest, Ice, Compression and Elevation (R.I.C.E). In the case of soft tissue injuries, R.I.C.E. is a relatively short-term solution, typically up to 72hrs post-injury. Effectively, the idea is not to stop the tissue healing process but reduce the overall inflammatory response.

What soft tissue damage feels like will vary and depend on the soft tissues injured and the severity of the injury.

The general term soft tissue release relates to manual soft tissue therapy techniques, which aim to treat areas of tension, pain and restricted mobility. Normal movement involves tissues sliding over one another, though tissues can become dysfunctional and slightly stuck together for many reasons. The inability of tissues to slide as normal creates restrictions, which impacts mobility and often results in pain. Releasing such restrictions frees tissues to move again, increasing mobility and reducing pain. However, Soft Tissue Release (STR) release is the specific name of a myofascial release technique sometimes known as "Pin and Stretch". See the full description here What is Soft Tissue Release?

Soft Tissue Release (STR) essentially works by changing muscle anatomy attachment points (origin and insertion). The method involves the therapist applying a soft tissue lock to the muscle area under treatment. A stretch is performed on the tissue either passively by the therapist or actively by the patient. The stretch is maintained until the therapist palpates (feels) a myofascial release. A more detailed description can be found here How does Soft Tissue Release work?

The soft Tissue Release (STR) technique is performed by the therapist effectively changing the attachment points of muscles (origin and insertion points). The therapist applies a soft tissue lock to the tissues under treatment and then uses a specific stretch to create a release in myofascial tension. A more detailed description can be found here How is soft tissue release performed?

Neuromuscular Therapy (NMT) or Technique is a form of myofascial release which works specifically with myofascial trigger points (MTrPs). The therapist uses palpation skills to find and release trigger points within tissues. Once located, the therapist applies a specific pressure level to the trigger point. A single release usually happens in under 20 seconds and produces a melting sensation relating to tissue tension or pain. See the more detailed explanation What is Neuromuscular Therapy?

The simple answer is yes, you can do trigger point therapy on yourself, though there are limits on the results one can achieve. Although there may be many massage tools for performing trigger point therapy on yourself, the correct technique and application can prove challenging. Some areas of the body are easily accessible, so self-treatment is easier. The back, neck and shoulders can be much more complex, and it can be easy to make symptoms worse. Equally, there are contraindications to using trigger point therapy, meaning one needs to know the underlying cause of symptoms. It is not just a case of finding a sore or tight spot and then applying pressure to it. Further details can be found here Is it possible to do trigger point therapy on yourself?

Positional Release Techniques (PRT) is a form of manual therapy originating from Osteopathy. The techniques are gentle and non-invasive and easily performed by a professional therapist with the correct training and experience. Effective use of the methods requires detailed knowledge of anatomy, physiology and biomechanics. Equally, training in palpation and patient assessment skills is crucial. A more detailed description can be found here What is Positional Release Technique?

Positional Release Techniques (PRT) can prove highly effective at treating acute muscle spasms and associated pain. When applied by a competent professional and in the right circumstances, it is often possible to provide almost instant muscle release and relieve pain. The techniques can prove highly effective in relieving chronically tense tissues by releasing and resetting muscle tone. The following link provides a more detailed explanation What is Positional Release Technique used for?

Muscle Energy Techniques (MET) have origins in Osteopathic medicine and are a form of manual therapy. The technique aims to treat dysfunctional tissues and restore normal tissue function. One applies the method from a set position established by the practitioner. The therapist then asks the patient to contract specific muscles in and in a direction dictated by the treating therapist. See the more detailed version here What is Muscle Energy Technique?

Muscle Energy Techniques (MET) work by using principles of muscle anatomy and physiology to reduce muscle tension by using power from the patient's muscles. The techniques rely on the action of muscle spindles and Golgi tendon organs within the dysfunctional muscles under treatment. A practitioner effectively applies a stretch to the muscle(s) under treatment from a set stretch position. The therapist then instructs the patient to contract the muscle under treatment or the opposing muscle, depending on the technique. This process allows one to stretch the tissues under treatment effectively. See the detailed explanation How does Muscle Energy Techniques work?

A suitably trained professional can use Post Isometric Relaxation to treat and stretch dysfunctional tissues. After a strong, sustained muscle contraction, there is a window where the muscle needs to recharge before another such contraction. During this small window, the muscle is relaxed, allowing a therapist with the correct knowledge and technique to stretch the tissues. Read more here What is Post Isometric Relaxation?

Reciprocal Inhibition relies on anatomical and physiological movement principles to release and stretch dysfunctional tissues. Movement requires muscles or groups of muscles to work together to move levers (bones) attached to joints. Movement requires muscles to contract and relax alternatively to enable movement. A suitably trained professional can use that principle to release and stretch dysfunctional tissues. Read more details on the workings of Reciprocal Inhibition here What is Reciprocal Inhibition?

While there is much anecdotal evidence that Myofascial release (MFR) works, there is far less high-quality research. A lack of funding partly explains the lack of research, which typically requires some return on investment. Large pharmaceuticals fund much of the research in general medicine and can then sell various drugs. That said, medicine and anatomists have taken much more of an interest in fascia. Research into the fascia network has only been ongoing for a few decades. The research is going some way to shaping our understanding of the importance of the fascial network in many areas, though a lot is still not fully understood.

There are many forms of Myofascial Release (MFR), as there are forms of Massage. Most forms of Myofascial Release work directly or indirectly with trigger points, whereas massage therapy generally does not. Also, massage therapy strokes and techniques are often reasonably superficial and performed rhythmically. Myofascial Release usually involves delving much deeper into tissues with slow and sustained movement.

A component practitioner using Myofascial Release (MFR) will know when it is safe to use any given technique and when it is not (contraindicated). Sometimes it may not be safe to use a specific technique with a patient. In other cases, a technique may be safe for one part of the body but not others.

Myofascial Release is a means of reducing musculoskeletal tension and associated Myofascial pain. Tension in one section of the body can affect other areas due to fascia. Normal and well-hydrated fascia is strong, translucent and very slippery, enabling tissues to glide as we move. Fascia can become more sticky for many reasons, impacting how tissues glide over each other affecting movement and often creating pain.

There is a wide range of factors influencing how often somebody is likely to need Myofascial Release treatment. Individual and unique circumstances can play a considerable part and cover all aspects of health. Factors that can play a role include medical history, medications, unresolved traumas, habits, activity or inactivity levels, hydration levels, diet, following aftercare advice etc. Chronic conditions with symptoms existing for longer than three months often result in multiple changes to the fascia. Provided the professional treating the condition has identified the root cause and the patient follows the advice, there is not usually a need to repeatedly treat the same tissues. Hence, one treatment a week for 3 to 5 weeks is a good indicator for most issues, with a follow-up 4-6 weeks later.

Apparent excessive tension in fascia might be evident as pain, reduced mobility, tension, altered circulation or nerve sensation and even muscle spasms or cramps. Equally, some people seem plagued by injuries, and a common cause of this is previous unresolved injuries and related tissue adaptations affecting fascia and Biotensegrity and how everything is connected.

Some practitioners provide home treatment services. Self Myofascial Release (SMFR) is also an option in some cases, though there are limits on what one might achieve. It is important to know what you are treating, and self-diagnosis via the internet is not a good strategy. Occasionally, it is not safe or advisable (contraindicated) to use Myofascial Release techniques.

Myofascial Release is a means of reducing musculoskeletal tension and associated Myofascial pain. Tension in one section of the body can affect other areas due to fascia. Normal and well-hydrated fascia is strong, translucent and very slippery, enabling tissues to glide as we move. Fascia can become more sticky for many reasons, impacting how tissues glide over each other affecting movement and often creating pain. Myofascial Release aims to free up or flush the areas of stickiness within the fascia to enable normal function. Research has demonstrated that the fascia network plays a role in immunology, tensile forces throughout the body and a means of bodily communication. General medicine has known about chemical and neurological bodily communication systems for a long time. However, the fascial network as a form of communication is a more recent finding.

Massaging out trigger points is possible, though it tends to be very painful. A myofascial trigger point, by definition, consists of taught bands of hyperirritable muscle tissue fibres. There are also active and latent trigger points, so just treating the painful areas is a short-term strategy or fix. Typical Sports Massage therapy techniques a therapist might use to massage trigger points include Petrissage and Friction methods. The use of such techniques on trigger points may well explain why sports massage can have a reputation for being notoriously painful, though it does not need to be. Other treatment methods could produce better, faster and less painful results than massaging out trigger points.

As with many forms of manual therapy, Myofascial Release (MFR) creates change within the body. Soft tissue therapy has a localised effect on the tissue treated, often resulting in an inflammatory response, a natural part of the healing process. The inflammatory response increases pressure on tissues and cells affected, which can result in aching or pain. Treatment also has a more widespread or global effect on mechanics and Biotensegrity and how everything is connected throughout the body. Effectively, the body moves differently, meaning different demands on tissues. Additional demands on tissues can make them ache or feel fatigued while they adapt. Also, we learn movement patterns, which become second nature and changes in biotensegrity via treatment require new learning.

The amount of time it takes for fascia to release can vary considerably from 20 seconds or less to a few minutes. There are many different types of fascial release technique and knowing which technique to use when is largely down to individual practitioner training and experience. Other important aspects relate to practitioner general assessment and diagnostic skills, palpation and technique application. There are often differences in how practitioners work, even when trained by the same education provider and this can make a difference to the experience of patients/patients.

Yes, you can perform Myofascial Release (MFR), though there are limitations on what one can safely treat and the results. Self Myofascial Release (SMFR) can be a useful addition to one's self-maintenance routine. There are occasions where it is unadvisable or unsafe to use Myofascial Release, and the same applies to SMFR. Equally, it can prove difficult to access the tissues one wishes to treat while applying a technique correctly, which can lead to injury or worsening symptoms. Ideally, one needs to know what one is treating and just going off internet search results tends to result in poor outcomes. Internet results lack other important diagnostic information and testing. SMFR can work exceptionally well in the right circumstances with the correct application and is relatively easy to do. Treating other body areas is possible but is often much more challenging with mixed results. Hence, it is often better to see a professional.

Myotherapist is somebody trained in the practice of Myotherapy, a hands-on method of assessment and treatment. The use of a wide range of soft-tissue skills and hands-on therapy is well suited to the treatment of musculoskeletal (MSK) and myofascial pain. Although pain relief can prove relaxing, Myotherapy treatment focuses on dealing with the reason for symptoms of symptoms. See further details on What does a Myotherapy do?

The main differences between a Myotherapist and a Remedial Massage therapist relate to the additional skills, training and knowledge gained during a Myotherapy course. Typically, a Remedial Massage therapist will have completed a Cert IV in massage therapy and a Diploma in Remedial Massage Therapy. A Myotherapist will have completed the same training, plus an Advanced Diploma in Myotherapy or a Degree in Myotherapy. The extra training provides myotherapy practitioners with additional and more detailed knowledge of specific conditions, assessment methods (orthopaedic, neurological and movement-based), rehabilitation, and advanced soft tissue therapy techniques. See further details on What is the difference between Massage and Myotherapy?

Myotherapist training is either at Advanced Diploma or undergraduate degree level. It can take 2-3 years to complete and depends on the end Myotherapy qualification. Physiotherapy training and other primary and allied health care professionals typically train to degree level minimum, and sometimes masters. The more extended training period provides Physiotherapists with a greater depth and breadth of knowledge than that of a Myotherapist. Physiotherapists also have a broader scope of practice and can diagnose, much like other regulated health professionals. In many respects, a Physiotherapist is qualified to do everything within the remit of a Myotherapist and more. However, Myotherapist may have more practical experience of the soft tissue therapy (STT) treatment techniques taught on a Myotherapy course than a Physiotherapist. See further details on What is the difference between Myotherapy and Physiotherapy?