Sheree Evans | Remedial Massage Specialists – 0405 398 447

Common Conditions

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Please note: if you are suffering from any of the following conditions (or think you may be) then we suggest you consult your health care practitioner. The advice given here is only of a general nature and specific cases require specific treatment. Sheree Evans | Remedial Massage Specialists hold no responsibility. Please always consult with your doctor.

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Achilles Tendonitis
Achilles tendonitis is a common condition amongst active people and may result from several factors such as sudden changes in activity, inadequate stretching, mechanical alignments difficulties, hard exercise surfaces, etc. Massage can be an effective alternative to the traditional treatments such as cortisone injections. The Achilles tendon is the strongest tendon in the body and the tensile loads placed on it are extremely high. It attaches the calf muscles (the gastrocnemius and soleus) to the calcaneus for forward movement and upward propulsion. The loads are also extreme when the calf muscles are used for deceleration and shock absorption. It is of fundamental importance in nearly all activities such as walking and running and is a common area for acute strain and over-use. Achilles tendonitis may be the response to microtears in the tendon caused by repetitive stretching of the tendon. Blood supply to the tendon is relatively low and so Achilles tendonitis is difficult to overcome. Early treatment is important and athletes should resist trying to run through the pain. Some studies have indicated that collagen degeneration in the tendon may be a critical contributor to pain in the Achilles tendon and Achilles tendonitis is especially common in athletes over thirty because of the degenerative changes that take place which make them tighter and weaker. The potential for developing Achilles tendonitis is magnified by variations in blood supply in the different regions of the tendon. Problems are more likely to occur when the blood supply is poor and the flow of nutrients for tissue repair is limited. The lower portion the tendon has poorer blood supply and is generally where degeneration occurs first. The onset of Achilles tendonitis is gradual and pain occurs with use, there may be swelling over the tendon. There may be creaking in the tendon (crepitus) which can be felt when moving the ankle backwards and forwards. If, as commonly happens, the athlete ignores the conditions then there may be pain and stiffness before, during and after exercise and the tendon can become tender to the touch. Distance runners are particularly vulnerable to developing Achilles tendonitis. Interestingly Achilles tendinitis can develop in some people without the stress of repetitive motion (or biomechanical dysfunction). One family of antibiotics (fluoroquioiones) can cause similar degenerative process to the collagen in the tendon as repetitive overuse. The antibiotics affect the Achilles tendon more than any other tendon in the body and continued use of them has been linked to ruptures of the Achilles tendon. The most important factor in treating Achilles tendonitis is to eliminate the factors that caused the inflammation/collagen degeneration in the first place. The athlete will have to change activity, training surfaces, shoes, etc in order to stop aggravating the tendon. Stretching of the calf muscles is also commonly used to reduce the amount of tension on the tendon. Cortisone injections used to be a common treatment method but the practice is not as frequent as they may have detrimental effects on the collagen structure of the tendon, leading to tendon rupture. Massage Techniques for Achilles Tendonitis.
Massage can be a highly effective method for addressing Achilles tendonitis where the therapist aims to reduce the tensile load on the tendon by massaging the calf muscles and by deep friction applied directly to the tendon to encourage collagen production. The calf muscles should be massaged using compression broadening techniques and by deep longitudinal stripping to assist in reducing tension in the lower limb and hence decrease the tension on the Achilles tendon. Myofascial trigger point work to the calf muscles can also be effective. Deep friction massage is applied directly to the affected tendon to stimulate collagen production in the damaged region. The areas around the tendon should be massaged with considerable pressure to clear congestion, break up adhesions and to improve circulation around the tendon. Applying deep strokes up the tendon when it is in a slightly stretched position may assist in releasing some adhesions between the tendon and the inside of the sheath. The application of ice following deep friction massage to the Achilles tendon is a good precautionary measure as the massage may result in inflammation.

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Blackberry Thumb
Computer operators have long suffered from repetitive motion injuries. Users of handheld gadgets are now suffering from similar conditions. Indeed a repetitive stress injury of the thumb which results from overuse of small handheld equipment is now known as “BlackBerry” thumb. For some individuals the pain of BlackBerry thumb becomes so intense that people can not even use their thumbs to press the buttons on TV remotes. There are no detailed statistics on how many people are suffering from this condition but there is anecdotal evidence that doctors are seeing a significant increase in its incidence. Executives and users of small handheld gadgets are increasingly using devices with keyboards that are only designed for thumb tapping. Ergonomics and experts on hands are worried about overuse injuries. Indeed the American Society of Hand Therapists has issued a consumer alert, warning users of small gadgets that heavy thumb use can lead to swelling of the sheath around the tendons in the thumb. The thumb is one of the least dexterous digits and is not meant to be rigorously worked out. A potential solution for users who type more than a sentence with their thumb is to use an external keyboard that connects to the gadgets. If you begin to notice tenderness around your thumb then it may be a good idea to apply ice to the tender area (for no more than 10-15 minutes at a time). Treatment for BlackBerry thumb may include wearing a splint and undergoing physical therapy. Massage can also provide some relief.

Baker’s Cyst
A Baker’s cyst is an uncomfortable condition that most often occurs in adults over 55 or in children between around 4 and 7 years of age. It is estimated that around 20% of people with other knee problems may end up suffering from a Baker’s cyst. Generally symptoms of a Baker’s cyst are relatively slight unless the cyst becomes so large as to extend into the calf muscles or if it bursts. Massage therapy can assist those suffering from a Baker’s cyst by relieving the swelling and discomfort associated with the cyst. A Baker’s cyst is a swelling at the back of the knee. The entire knee joint is enclosed within a capsule which is lined with a membrane and filled with synovial fluid that lubricates the joint. It is suggested that some people have a small pouch at the back of the knee with is created by extra tissue. When these people suffer a knee injury, then the body’s response is to secrete more synovial fluid into the knee which tends to accumulate and fill this pouch causing the Baker’s cyst.
Baker’s Cyst – Symptoms
- In some individuals, a Baker’s cyst causes no discomfort or pain and has no obvious symptoms. When symptoms do occur then the most common ones observed are: A round mass or swelling behind the knee joint which may be soft or hard and is most apparent when the person is standing.
- A sense of pressure behind the knee which may go down into the calf muscle.
- Pain in the knee and a restricted range of motion.
- Persistent pain and tenderness post exercise Causes for a Baker’s Cyst
The most common cause of a Baker’s Cyst is after an injury when damage to the knee capsule results in a build-up of synovial fluid as referred to above. The specific injury can include a torn cartilage, arthritis or even an infection in the knee joint. For those children who develop a Baker’s cyst occasionally there may be no obvious reason for the cyst to have developed. Diagnosis of a Baker’s cyst
Suitably trained medical practitioners use a number of tests that are used to diagnose a Baker’s cyst. These include:
- A physical examination of the knee + medical history
- A popular easy diagnostic tool is to turn off lights and shine a flashlight through any lump. Presence of a red glow indicates that the lump contains fluid.
- Magnetic imaging resonance (MRI)
- X-rays of the knee do not show a cyst but can indicate other trauma or arthritis damage to the knee. Treatment of a Baker’s Cyst
If there is little or no pain then there may not need to be any active treatment and a doctor will just monitor the cyst over time. If treatment is indicated then the options include:
- Treatment for the underlying cause, such as medication for arthritis or surgery for torn knee cartilage
- Avoid doing anything that can aggravate the knee joint
- Injections of Cortisone.
- Aspirating the cyst with a needle to drain off the fluid
- Surgery to remove the cyst entirely (extreme cases) With any treatment plan for a Baker’s cyst then rest and elevation is generally recommended to reduce the chance of the cyst returning. For children then the approach of watching and waiting is recommended as the cyst often subsides spontaneously. Massage Therapy and Baker’s Cyst
As the cysts are normally located in the popliteal region which is generally considered as an area contraindicated for most massage techniques then a massage therapist should not apply any deep pressure directly onto the cyst. The role of the massage therapist is more aimed at alleviating the underlying knee problem. Massage to the area superior to the cyst can have therapeutic benefits i.e. balancing the muscles that influence the knee joint such as hamstrings and adductors. It is suggested that lymphatic drainage techniques may assist in reducing swelling and facilitating recovery through increasing the rate of absorption of the excessive synovial fluid.

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Carpal Tunnel
Massage therapy can be a very effective tool in treating Carpal Tunnel syndrome and often it is the missing link in conventional treatment that leads to a cure. At the very least, massage is an excellent preventative measure that can reduce the advancement to a more severe state. Treatment should not be limited to the wrist/forearm and should cover the area from the clavicles and scalenes, down the arm past the wrist to the palm of the hand.
There are several important factors to note when considering massage for Carpal Tunnel syndrome. Direct manipulation of the damaged nerve is highly detrimental and can easily cause other problems. Direct pressure on the carpal tunnel region should be applied rarely and always with great caution.
In non-severe cases, myofascial stretching over the flexor retinaculum has proved helpful in reducing the aggravating symptoms although this technique should not be used if it aggravates the symptoms. In some cases, overuse and hypertonicity of the flexors of the wrist and fingers may be the main problem and attention to these muscles is essential (beginning with gentle pressure – too little is better than too much). Deep longitudinal stripping and compression-broadening strokes can be used on the forearm flexors in an attempt to regain optimum tone in these tissues. As mentioned above, it is important to address all the regions of the upper arm and neck as the median nerve may be compressed in a number of other locations. Indeed, in some cases the median nerve may be entrapped in one of these other locations and not in the carpal tunnel though the symptoms may be identical. Too often, median nerve entrapment is not thoroughly treated because attention is focused only on the carpal tunnel and not on those related areas. Studies have shown that Carpal Tunnel syndrome symptoms are lessened following massage therapy (1). Massage lead to a significant reduction in pain and reduced symptoms as well as improved functional capabilities such as increased grip strength.
Please note, caution must be used when massaging of muscles for Carpal Tunnel syndrome. Any techniques that simulate or aggravate the pain for the client must be avoided. The following information should be only after consulting your medical practitioner.

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Frozen Shoulder?
The term “Frozen Shoulder” refers to a painful condition of the shoulder that can severely limit its range of motion and so giving the impression that the shoulder is “frozen”. The condition affects women more than men, and occurs most frequently in women aged from 45-65. Health-care practitioners prefer to use the term “adhesive capsulitis” as while the term “frozen shoulder” is common, it isn’t entirely accurate. There are several problems in the shoulder that may be painful and limit the range of motion in ways similar to adhesive capsulitis. An important method of distinguishing adhesive capsulitis from other shoulder problems is to evaluate the way in which motion is restricted at the shoulder joint. In the glenohumeral joint, the capsular pattern for motion to be limited is first in external rotation, then in abduction and finally in medial rotation. Thus if a client has difficulty bringing the arm up in abduction but has no problems externally rotation the shoulder then it is unlikely that the client has adhesive capsulitis. The glenohumeral joint has the greatest range of motion of any joint in the body. When the shoulder is in a neutral position (with the arm by the side), there is some slackening of the glenohumeral joint capsule on the underside which is necessary to allow full range of motion of the joint. When the arm/shoulder is moved to other positions, the underside of the capsule becomes taut. Adhesive capsulitis develops when a portion of the joint capsule adheres to itself and prevents full movement of the joint. As the capsule is highly innervated, it is extremely painful when the adhesions pull on the tissues of the capsule. Adhesive capsulitis is generally categorized into primary and secondary. In primary adhesive capsulitis there is no obvious cause for the condition – clearly frustrating for practitioners. There may be some correlation between a significant emotional trauma and the development of primary adhesive capsulitis. Secondary adhesive capsulitis will often develop as the result of rotator-cuff tears, arthritis, shoulder trauma, surgery, bicipital tendinosis, etc. With these injuries, there appears to be a process of fibrosis that is initiated by these other conditions. As such, the individual is usually limiting motion in the shoulder at the same time the fibrosis is occurring and the fold on the underside of the joint capsule is never fully elongated. Thus begins a vicious cycle as the adhesion causes limitation to shoulder movement and pain, thus worsening the problem. Subscapularis trigger points have also been suspected of causing secondary adhesive capsulitis. This may result from irritation of the attachment site of the subscapularis which is close to the capsule. Local inflammation at the attachment may then cause fibrous adhesion in the capsule. Frozen shoulder is often divided into three stages:
Freezing. Onset is usually between 2 to 6 months and this period is characterized by a gradual decrease in range of motion and an increase in pain. Frozen.This stage occurs for between 4 and 12 months after initial onset. Motion will remain extremely limited although there may be a gradual decrease in pain levels. Thawing.In the thawing period, there is a gradual return of range of motion and decreased pain. This stage can vary from a few months to several years. Treatment and Massage of Frozen Shoulder
Treatment should always be directed by a trained health-care practitioner who is suitably qualified to diagnose adhesive capsulitis. Most treatments begin with a relatively conservative approach aimed at increasing the range of motion of the glenohumeral joint. Simple movements such as letting the shoulder hang like a pendulum may encourage a gradual increase in range of motion. With adhesive capsulitis, if exercise is too vigorous then further damage and inflammation of the joint capsule may occur. Massage techniques used to treat frozen shoulder should encourage relaxation of the muscles surrounding the shoulder. Simple effleurage and broad cross-fibre sweeping strokes are often used to assist in restoring proper movement to the joint. As discussed above myofascial trigger points in muscles such as subscapularis may also play a role in adhesive capsulitis. These may be treated with static compression or compression with active movement. Another area that massage therapists may wish to consider is to encourage the elongation of the adhered capsular tissues. This is achieved by gentle stretching motions such as a passive stretch in lateral rotation where the client is taken to the point where discomfort begins and then held there. The client is encouraged to breathe deeply and relax the shoulder as much as possible. After holding the stretch for up to 30 seconds, the client is returned to the neutral position before repeating the procedure a few times. If conservative treatment is not successful, a more aggressive stance may be taken of forced manipulation of the shoulder joint whilst the shoulder is anesthetized. Whilst this can produce dramatic improvements in the range of motion, it is extremely painful.

Fibromyalgia
Fibromyalgia is a chronic condition that is characterised by a wide range of conditions including muscle, bone or joint pain and fatigue. Fibromyalgia reportedly affects women significantly more than men (estimated ratio of about 9 females to every one male sufferer) and around 3% of the population may be affected. It is most often diagnosed in those between the ages of 20 and about 50 although it is not contagious. Fibromyalgia in itself is not life threatening nor is it progressive. However there may well be periods where the symptoms flare up and there is always day to day variability in the degree of the symptoms. Recent studies indicate that genetics may play a role in the likelihood of an individual suffering from fibromyalgia.
The main symptoms of fibromyalgia are widespread chronic pain in the muscle, bones and joints with the muscles tender to even light touch. Chronic sleep disturbances are also typical in those suffering from Fibromyalgia, which may lead to impaired concentration (“brain fog”). Other symptoms that have been reported include:
# myofascial pain
# irritable bowel syndrome
# chronic fatigue
# genitourinary symptoms
# headaches, etc Diagnosis The American College of Rheumatology categorises fibromyalgia by a number of criteria that include
# Pain in at least 11 of 18 specific body checkpoints
# Joint inflammation is typically not observed and blood tests for inflammatory conditions are rarely positive
# Poor quality of sleep
# General Fatigue and lethargy
# Poor mental abilities
# Mood swings(although it may be that depression and anxiety are more often the result than the cause of Fibromyalgia). Diagnosis should be confirmed by a suitably qualified health care practitioner. Fibromyalgia has been believed to be either an inflammatory condition and or a psychiatric one but neither of these appears to be likely. The most recent scientific research indicates a physiological aspect to fibromyalgia as traditional. Treatments
There is no universal cure for fibromyalgia and most treatments are aimed to manage the condition through lifestyle, medication, diet, gentle exercise, massage, etc. A typical approach has been to offer low doses of sedating antidepressents to improve the quality of sleep which may expand the nature of the fibromyalgia. These antidepressants may have the added benefit for those suffering from depression. Other new drugs have shown significant efficacy in the treatment of Fibromyalgia pain and other symptoms. These include milnacipran which is a serotonin-norepinephrine reuptake inhibitor (SNRIs). Studies have typically determined that gentle exercise improves fitness and sleep quality and may reduce pain and fatigue in some Fibromyalgia sufferers. Stretching is recommended to counteract muscle stiffness. However, strenuous activity should normally be avoided as it may increase the muscle/joint pain already present. Fibromyalgia and Massage
Massage therapy is considered to be one of the best treatments for fibromyalgia. In fact, in a survey completed by fibromyalgia sufferers, massage therapy was rated the best fibromyalgia treatment option. The benefits of massage therapy specifically for fibromyalgia include:
- reduced pain
- improved sleep patterns
- increased flexibility and range of motion
- lowered stress levels and improved mood/reduced depression
- reduced stiffness In a 1996 study, fibromyalgia sufferers reported a 38% decrease in pain symptoms after receiving just ten, 30 minute massage sessions along with significant improvements in the quality of their sleep. There is little doubt that massage therapy can reduce the pain and stiffness associated with by fibromyalgia. One school of thought is that sufferers of fibromyalgia cannot repair their muscles and connective tissues properly due to lack of quality sleep. Fibromyalgia muscle may be viewed as achy and tight and may well be microscopically damaged. The improved blood flow to the muscles that comes about as a result of massage along with the probable release of endorphins, serotonin, etc may account for why appropriate massage can offer pain relief for fibromyalgia sufferers.

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ITB Syndrome
Iliotibial Band Syndrome is an injury most frequently associated with runners and it is one of the more common causes of knee pain in runners (always occurs on the outside of the knee). Running on hills and cambered road surfaces are suspected as being a significant contributing factor although it can also be caused by cycling or doing squats whilst weight-training. With proper diagnosis and treatment then Iliotibial Band Syndrome (ITBS or ITBFS, for Iliotibial Band Friction Syndrome) can normally be effectively managed although recovery may take some time.
# The iliotibial band (ITB) is a strip of connective tissue on the lateral side of the thigh, which extends from the outer part of the pelvis, over the hip and knee, and connects into the lower leg with an insertion just below the knee. During running the ITB assists in stabilising the knee as it moves from behind the femur to the fore during each stride. There can be constant rubbing of the ITB over the lateral femoral epicondyle (the bump on the side of the thigh just above the knee) which when combined with repetitious bending and straightening of the knee during running may cause the iliotibial band to become irritated or inflamed. Iliotibial Band Syndrome symptoms vary from a sharp sensation just above the knee joint to inflammation or thickening of the tissue at the point where the ITB moves across the femur. It is not uncommon that any pain is not immediately present during activity, but can increase over time, especially when the foot impacts the ground. Pain can sometimes occur below the knee, where the band joins to the tibia. Occasionally Iliotibial Band Syndrome can also occur where the ITB attaches to the hip, though this is less common as a sports injury. This occurs frequently during pregnancy as the Relaxin hormone loosens connective tissue whilst the mum-to-be gains weight. There are a number of factors that contribute to the occurrence of Iliotibial Band Sydnrome. These include:
- Running on the camber of a road can bends the downhill leg inward and cause stretching of the ITB whilst rubbing against the femur
- Substantially increasing running distance in a short period of time
- Insufficient warm-up (r cool-down )
- Too much downhill running or running up and down stairs
- Abnormalities in the anatomy and the legs and feet. Treatment As with any injury, you should consult your health care practitioner for diagnosis and for recommended treatment plan. Treatment generally requires modification to activity, massage, and stretching of the ITB and strengthening of the affected limb. The objective is to reduce any friction of the ITB as it glides over the femur. Most runners with low mileage respond well to of anti-inflammatory medicines and stretching; however, runners who are used to doing a high-mileage often require a treatment program that is somewhat more comprehensive. The initial goal should be to reduce the impact of inflammation by using ice and anti-inflammatory medications. Activities that requires repeated bending and straightening of the knee should be avoided. After the immediate symptoms have settled down a runner with acute ITBS should consider reducing weekly running distance by about 50% for a couple of weeks, (only running on the flat). If there is no re occurrence of pain then can slowly begin to increase distance. If ITBS pain returns then you should stop running immediately for a minimum of 2 weeks. If the pain and inflammation are still there then another month of rest is recommended. One common trick for reducing the risk of the problem reoccurring is to change your running route as a frequently traversed route may place increased stresses on the ITB of a particular leg.

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Plantar Fasciitis
Plantar Fasciitis is an inflammation of the plantar fascia, the fibrous tissue that runs along the length of the long arch on the sole of the foot. The longer that the plantar fasciitis remains untreated, the greater the possibility of a bone spur forming at the point where the fascia attaches to the calcaneous. The onset of plantar fasciitis may be gradual, often enabling a person/athlete to continue their normal activities for weeks or months. Pain is felt on the inner side of the sole of the foot, generally just in front of the fleshy part of the heel. Pain is worse when getting out of bed in the morning and can diminish during the day. Athletes who run with excessive pronation are at greater risk of developing plantar fasciitis as are athletes with flat feet (or knock-kneed). These conditions force the fascia to stretch more as the athlete runs and jumps, putting increased pressure at the point where it attaches to the calcaneous. Massage can have an extremely high success rate in treating plantar fasciitis, especially when the clients perform simple home regimens of plantar fascia softening and stretching regularly. However, regular and frequently treatments are required for optimal results.

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Runners Knee
The knee is a highly complicated joint. It is made up of the articulation between the lower leg and thigh (tibia and femur) and also the kneecap (patella) and thigh. One of the more common knee problems in running, chondromalacia patella, relates to what is referred to as the “patellofemoral complex” which consists of the quadriceps, patella and patellar tendon. Chondromalacia is a gradual onset condition that appears as knee pain that is felt under the patella. It is created by degeneration of the cartilage on the underside of the patella. During running certain mechanical conditions may predispose an athlete to the kneecap mistracking. The patella needs to track in the groove between the condyles of the femur and, if it does not, then there will be excess friction and wear on the underside of the kneecap. This will result in chronic anterior knee pain (in particular when ascending or descending stairs). This is sometimes referred to as the “Movie Sign”. When watching a movie a person will be sitting with the knee bent for a prolonged period and a sufferer of chondromalacia patella may experience pain on getting up that will gradually dissipate when they start moving around.
Whilst the pain is experienced in the anterior knee, the likely cause of “Runners Knee” lies in the feet and the thighs where, for one reason or another, they are not doing their jobs properly. When the knee joint is working efficiently then the patella moves smoothly and comfortably in the groove between the condyles of the femur. However, when the kneecap moves out of alignment and rubs against its side then over time the cartilage becomes worn. The main culprits for the kneecap moving out of alignment are weak quadriceps muscles and a lack of support from the foot.
One of the roles of the quadriceps is to hold the patella in place. Running tends to develop the back thigh muscles (hamstrings) more than those in the front (the quadriceps), and the imbalance is sometimes enough to allow the kneecap to pull and twist to the side. In particular there becomes an imbalance between the vastus lateralis and the vastus medialis (particularly the vastus medialis obliques – VMO) which results in lateral force on the patella. Another factor which can increase the risk of developing runner’s knee is the “Q” angle (Quadriceps). The Q angle can be considered as of the angle at which the quadriceps averages its pull. It is measured by drawing a line from the Anterior Superior Iliac Spine to the centre of the kneecap and a second line from the centre of kneecap to the patellar tendon insertion. Normal is considered to be less 12 degrees, abnormal is greater than 15 degrees. The athlete’s foot may also not be giving the required stability and for many runners their feet are making an incorrect motion each time they hit the ground. Overpronating (rolling of the foot in) or supinating (turning it out too much) coupled with the high number of repetitions of a serious runner are a recipe for knee problems. Testing for Chondromalacia
In order to test for chondromalacia, then your therapist may seat you on the edge of a massage table and place a moderate amount of compression on the patella. The therapist will continue to apply compression as you extend your knee. If pain is felt under the kneecap as you extend the knee, then it is possible that there is some degeneration and softening of the cartilage. Treatment of Chondromalacia
Chondromalacia is commonly treated by a combination of modifications to activity, rest and rebalancing the relationship between the quadriceps and the hamstrings. At an early stage running should be cut back to reduced stress on the knee and allow the joint to begin healing. Downhill running should be avoided whereever possible as the stresses on the knee are significantly greater. In order to strengthen the quadriceps (in particular the VMO), then straight leg raises are generally considered to be a good starting point as they strengthen the Vastus Medialis without significantly adding to stress on the underside of the patella. For example, they can be performed in sets of ten times for each leg. Begin with around five sets of ten and increase over time up to ten sets of ten. Just lie on a carpet or yoga mat on the floor and hold the exercising leg straight (and non-exercising leg bent to avoid undue stresses on the back). Massage is appropriate for lengthening tight posterior leg muscles (ie calf and hamstring muscles) which may make the foot pronate during activity. If any pronation is accompanied by an internal rotation of the leg then this can effectively increase the Q angle. Also releasing tightness in the iliotibial band (ITB) is considered to be important for chondromalacia. Appropriately fitted footwear and orthotics can be helpful in reducing the impact of patellofemoral dysfunction. Decreasing the rate of internal rotation of the tibia can reduce stresses applied to the underside of the kneecap and the need for the VMO to maintain proper tracking and positioning of the patella.

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Scoliocis?
It is natural to have curvature in your spine when viewed from the side. These curves are typically present in the neck, upper back (thoracic) and in the lower back (lumber). These natural curves maintain the correct balance of the spine over the pelvis. When observing someone’s spine from behind it should appear to be straight. Scoliosis, by definition, is curvature of the spine when viewed from behind and affects about 1 in 1000 children. Scoliosis normally most often occurs in the thoracic or lumber spine, producing a deformity of varying degrees. A normal spine has a curvature of less than 10 degrees. A spine affected by scoliosis will have a curvature ranging from 10 to up to 90 degrees. The most obvious symptom for children with scoliosis is back pain and some are forced to wear a brace for most of their childhood. This interferes significantly on their ability to play, be involved in sports or any other activities associated with being a child as well as having a great impact on their self-esteem.

Most of scoliosis is idiopathic, which simply means that it’s cause is just not known. Whilst some scoliosis is be found in adults, about 80% of scoliosis emerges in adolescents, between the ages of 10 and 18. The condition affects girls more than boys. However scoliosis can also be functional rather than structural ie due to poor posture. Other types of scoliosis include neuromuscular conditions cerebral palsy, poliomyelitis, muscular dystrophy and spina bifida. Other hypothesised causes of scoliosis include connective tissue disorders, hormonal imbalances, genetic factors and emotional/physical stress. As children approach adolescence parents should observe signs such as shoulders that are not level, shoulder blade that is prominent, non-level hips or a propensity to lean to one side. In adolescents, a mild spine curvatures can very quickly worsen by 10 degrees (or more) in just a few month. Practitioners consider that early detection is vital. Apart from back pain other symptoms of scoliosis include laboured breathing, which may be caused by increased forces on the heart and/or diminished capacity of the lungs. In addition scoliosis may be intertwined with or cause the following: thoracic outlet syndrome, TMJ, carpal tunnel syndrome, plantar fasciitis, achilles tendonitis, strain or dysfunction of the sacro-iliac joint, headaches, digestive problems, etc. Diagnosis of Scoliosis
Scoliosis is normally diagnosed by the “Adam’s Forward-bend Test.” Since the curvature is more commonly in the thoracic spine, a visable hump in the rib cage is observed when bending forward. However an X-ray is usually require to confirm diagnosis and quantify the magnitude of any curvature. Empirically curves ranging from 20-25 degrees require monitoring. Any curve over 25 degrees in a child or adolescent will result in treatment. Treatment of Scoliosis
The typical medical approach to scoliosis ranges from examining the spine every few months, to bracing and/or surgery in extreme cases. The severity and position of the scoliosis, age, and the health of the patient are all considered by medical practitioners. It is considered a fact that the younger the patient, and the larger the curve, then it is highly likely the condition will get worse. Bracing is the treatment most often employed for scoliosis, is for curves of around 30-40 degrees. A brace (eg the Milwaukee brace) is used to prevent the progression of the spinal curve and they are generally worn for 23 hours a day. Structural integration and/or Rolfing can play a role in managing scoliosis by lengthening soft tissue on the concave side of the scoliosis, erector spinae, muscle group, hip flexors whilst strengthening the muscles on the weakened side of the body.

Sciatica?
Many people claim to suffer from sciatica but what is sciatica? Sciatica is a pain, usually in the back of the leg caused by compression, irritation, or inflammation of the sciatic nerve. The sciatic nerves are the longest and largest nerves in the body, running down the back of each leg and are about the diameter of your thumb. The sciatic nerve is actually composed of four or five smaller nerves that leave the spinal cord from the lower spinal column, join together and then travel down each leg. It then divides into numerous smaller nerves that travel to the thigh, knee, calf, ankle, foot and toes. When these nerves are irritated or affected by the inflammation of nearby soft tissues, then this is referred to as sciatica. There are several reasons why the sciatic nerve could become compressed, entrapped, or irritated. In “true” sciatica, the nerve roots can be compressed by herniated, degnerated or displaced lumbar spinal disc(s). This can be exacerbated by tight muscles and soft tissues in the lower back, buttocks or leg. There are also other conditions which can mimic sciaticic symptoms such as Piriformis Syndrome where the sciatic nerve is entrapped by the piriformis muscle in the buttocks. Piriformis Syndrome is sometime referred to as “back pocket sciatica” as pressure on the piriformis muscle and sciatic nerve can be caused by sitting on a wallet in the back pocket of a person’s pants. Another problem that can imitate sciatic pain is trigger points in the Gluteus Minimus muscle. The trigger points in this muscle can refer pain sensations down the back of the leg along the path of the sciatic nerve and also on the outside of the leg. People with sciatica suffer from a wide range of symptoms. The pain may come and go at different times, it may be a constant problem and then it may subside for hours or days for no apparent reason. Some people may feel only a dull ache travelling down the back into the upper leg. For others, it may be intense sharp shooting pains all the way down the leg into the foot and toes. Many factors can influence the pain of sciatica. If the sufferer sits in one position for long periods of time then the pain can increase. Long distance drivers and computer operators are particularly susceptible. Exercising, or even simple things like walking, bending, twisting or standing up may be difficult and painful. For some, the pain may change from side to side or be present in both legs. For others, back pain may appear before the sciatica emerges. In some severe cases, sciatica can impair reflexes, or result in the wasting of the calf muscles.
Treatments for Sciatica
The medical approach to dealing with sciatica is to treat the symptoms. This may include using painkillers, muscle relaxers or anti-inflammatory drugs such as NSAIDs . Traction, physical therapy or injections directly into the nerve roots may also be used. In severe cases, Surgery (such as microdiscectomy or lumbar laminectomy) is used to help relieve both pressure and inflammation. Massage Therapy
Massage Therapy and Bodywork can help Sciatica, Sciatic Nerve Pain, in particular the conditions which mimic sciatica such as Piriformis Sydrome. Massage therapy can relaxes muscles, releases trigger points and abnormal tissue adhesions, and improve posture to relieve the pressure on nerve roots and other sensitive structures. Other Manual treatments (including physical therapy, osteopathic, or chiropractic treatments) can help relieve the pressure. Chiropractic and Osteopathic techniques are often used in conjunction with treatment by a Massage Therapist. Use a Tennis Ball
The knots in the muscles of the hip and buttock can be effectively treated with a tennis ball. Simply lie on a tennis ball such that it presses on deep, sore points and just wait for the feeling to fade. However please be aware that the piriformis muscle is so unusually reactive and the use of a tennis ball to massage the piriformis needs to be gentle and conservative. Jump in the Spa to Relax the Area with Heat
Whether the pain is caused by the crushed sciatic nerve itself, or just by tight muscles, the muscles need to relax. Hot tubs, with jets, are ideal for sciatica. Check Your Posture
The types of sciatica that are related by excessive sitting may be influcenced by the ergonomoic design of work station and/or chair. It may be worth experimenting with your chair and the layout of your work station. A simple option is to use a timer to remind yourself to get our of your chair at regular intervals such as every fifteen-twenty minutes.
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Tennis elbow
Tennis elbow refers to an inflammation of the tendon of the forearm extensor muscles where they join to the bony knob on the outside of the elbow (lateral epicondyle). The onset of tennis elbow is generally gradual with pain felt directly over the lateral epicondyle. Pain may increase when the wrist is flexed against resistance. Tennis elbow needs to be addressed early otherwise scar tissue can build at the insertion point of the muscle on the epicondyle, making the condition difficult to alleviate. A tight supinator muscle is the main culprit in tennis elbow. However, softening of all of the arm muscles by massage is beneficial. Massage is most effective when the therapist does not try to do too much; frequently spaced multiple sessions are safer and more beneficial. Consistent home stretching and strengthening is also essential for the long term recovery.
Please note: if you are suffering from this condition (or think you may be) then you should consult your health care practitioner. The advice given here is only of a general nature and specific cases require specific treatment. Sheree Evans | Remedial Massage Specialists hold no responsibility. Please always consult with your doctor


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