Martin McKenzie

“That second client you saw about his lower back pain, he called reception and wanted to know something…”

I broke into a slight panic. It was early in student clinic and I was trying to knock out as many hours as I could as quickly as I could to qualify. The kind of keenness that comes with being new at something, I was brimming with it. And a lack of experience. I was yet to understand exactly how to ‘over-work’ an area leading to aggravated symptoms. I was also yet to fully understand many other things, but the trust of what I had learned was being put into action on as many people as I could get to treat.

Several months before we were told: “Backs and necks. They’re the bread and butter of a manual therapist. Get good at them, you’ll see them a lot. Get good results and the client will send others”.

I was in the midst of attempting to be getting good at working on backs and necks. Full of keenness, and paper thin confidence. So the phone call was unexpected.

If I recall correctly he was a chef, and the long hours on his feet took a toll on his back. The long shifts, slight forward bend and unfavorable working environment can take a toll on anyone and he was more than a few years into the business of his craft. The college was located close to the city centre and the student clinic attracted a variety of people, business trade, and nearly everything in between. Perhaps our opening hours were suitable, maybe he worked nearby. Either way, that day, his lumbar spine ended up on my table.

In a nervously asked for more details: “Is everything OK? Is the client alright?” Fearing negativity, I braced for the reply.

“He wanted to know what the hell that was you did to his back. He hasn’t been pain free in years and wants to know what the treatment was so he can book in again.”

Even as a student with basic experience, Tui Na provided relief for someone who had been experiencing discomfort for years.

In 2014/15 it was estimated in that over 16% of Australians (4,000,000+ people) suffer from chronic back pain (https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001). A report from the Asia Pacific Journal of Public Health back in 2003 estimated the direct “cost of illness” of lower back pain (LBP) to be 1.02 billion AU dollars. The indirect cost was calculated at 9.17 billion AU dollars and “represents a massive health problem with a significant economic burden” (https://www.ncbi.nlm.nih.gov/pubmed/15038680).

Elbow Pain | Tennis Elbow – a crushing, unbearable pain on picking things up.

Unable to hold objects for a length of time, or suddenly drop them.
Opening a door is painful with intense elbow pain.
Shaking hands/cooking/using tools/painting is another level of pain Dante didn’t know about…

Tennis Elbow (Lateral Epicondylitis) is classified as pain that persists at the lateral (outside) elbow for more than six weeks. Although it is primarily a muscle strain, it is the attachment of the muscle to the bone via a tendon where the problem arises.

Our forearms are in constant use and certain repetitive movements, or movements that have additional load to them (like using a screwdriver) can irritate the tendon attachments at the outside of the elbow. This can lead to microscopic tears at the bone, which typically result in pain, swelling, muscle weakness and lack of confidence in using the arm.

It doesn’t necessarily require you to be playing tennis to acquire the problem. The risk factors increase with obesity, repetitive tasks, and for people between the ages of 45 – 54. As with an increase in exercise frequency, or commencing any new movement, it can take time for muscles and tendons to build strength and acquire thickness to cope with the new load placed on them. If your exercise regime has intensified either through weight or repetition, this can predispose the tendons to injury.

According to the Royal Australian College of General Practitioners, people suffering Lateral Epicondylitis can take a wait and see approach, with signs and symptoms improving usually within 6–12 months if the patient follows simple advice including:
• remain active and do not restrict arm or elbow movements
• do not perform movements and tasks that provoke pain greater than 3 out of 10 (where 10 is the worst pain imaginable)
• do not immobilise the elbow or upper limb
• do not lift an object with hands in the face-down position
(https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/HANDI/Physiotherapy-lateral-epicondylitis.pdf)

For those who cannot wait and see, manual therapies can be an effective treatment option for the problem. Tui Na addresses both the muscles and connective tissue that are related to the condition as well as the site of injury itself. While many manual therapies will work with the muscles only, we believe better results can be obtained with work that incorporates the tendons and other tissues that are notoriously stubborn to heal.

Tui Na has a variety of techniques that promote the flow of blood through the irritated site. Unlike many recommendations, Chinese Medicine does not advocate the use of ice in conditions such as these. While it numbs the pain, it constricts blood vessels which in turn delays the ability of tissues to heal. Muscle, or tissues of any sort, require blood flow to bring healthy nutrients to tissues, and to take waste products away.

While Tennis Elbow can be a stubborn condition to resolve of it’s own accord, we have found Tui Na to be clinically effective in addressing the immediate signs and symptoms of pain, restricted movement and loss of grip strength.

It might be something worth looking into if an unhappy elbow persists.

To read more on other arm and hand related conditions, see RSI, Carpal Tunnel or De Quervain’s Syndrome articles

Recognising and treating Thumb Pain (De Quervain’s Syndrome)

Thumb Pain, or as it is correctly known as, De Quervain’s Syndrome is inflammation of the two tendons that move the thumb, and the sheath they run through. Commonly seen as an R.S.I. injury, the causes can be varied but are mainly due to repeated movements from work, hobbies or lifestyle. Higher risk factors include those over 40 years of age, and females. Pregnancy is also an increased risk factor.

Diagnosis of the De Quervain’s Syndrome is normally obtained from a physical examination including the Finkelstien’s orthopedic test. X-rays or other medical examination may be used to rule out other possibilities such as fracture, arthritis or other casues.

Corticosteroid injection, splinting, rest, ice and NSAID’s are the common methods of treatment, with surgery being a final option.

A friend of mine asked about treatment for her thumb pain and wrist discomfort.  As a hairdresser she was never really able to give the arm a rest and the increasing pain in the cutting hand was reaching an unbearable level. Her doctor had recommended surgery.

We began treatments once a week and discovered that pain reduction was quickly achieved, improved movement was restored and quality of life generally was better. Including sleep. The pain would wake her frequently throughout the night.

The only problem was her work. There was little chance of her being able to take a break to allow the wrist and forearm to settle. So we moved the treatments to twice a week, with very good results.
Surgery was avoided.

A wonderful thick French accent filled the room when he spoke. Unbearable pain from his left wrist often woke him up at night. He couldn’t pick anything up in that hand, support weight, or complete small tasks that had been once so easy. Was there anything that could be done?

It turned out that decades of holding a painting palette had taken a toll on that thumb, wrist and forearm. He is a painter, restores artwork and also specialises in gilding, the art of applying gold leaf to objects. We started treatments once a week but after 3 weeks there was little change. With so many years of work contributing to the condition we decided to get an x-ray of the joint to determine how bad things were.

The report wasn’t good.

The thumb joint had degenerated significantly, there was significant arthritis and very little cartilage left. Even with this news we proceeded with treatments, twice a week, just to see if things would change.

Thankfully it didn’t take long.

After all of the years of painting with brushes, he had moved to computers and electronic methods of achieving the same quality work that his clients knew him for. The thumb and forearm were not being used while being treated, and the shift in treatment frequency from once to twice a week brought about a quick change. Sleep improved with the reduction in pain. Small tasks, once impossible, were now easily achieved. Thing were looking good, and it wasn’t long before I was able to say goodbye to the lovely French gentleman and wish him well.

But not before grabbing a business card. I had just found the person to illustrate the channels we needed for the book we were writing.

For more information on other arm/hand related issues go to the RSI, Tennis Elbow and Carpal Tunnel Syndrome blogs.

Carpal Tunnel

Associated pain and numbness

Carpal Tunnel Syndrome (CTS) is the entrapment of the median nerve inside the common tendon sheath through the wrist. Common signs and symptoms are pain, numbness, tingling, loss of strength and a progressive loss of muscle tone. The median nerve controls the movement of the thumb, first and middle fingers, so these are most affected. Pain is usually worse at night, and most of the clients I have seen have experienced pain that wakes them in the early morning. It is the most common of the nerve compression syndromes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314870/

It is easy to have sympathy, I have had this condition twice. It’s no fun.

“I wish you were in Queensland right now, my wrist and hand are terrible”.  Well, as a matter of fact…

Diagnosis of Carpal Tunnel Syndrome is usually based off signs and symptoms but may include diagnostic imaging such as x-ray to rule out any other possible causes such as fracture. In some cases, an electromyogram or nerve conductivity test may be used to confirm the diagnosis. Increased risk factors include being female, pregnancy, obesity, diabetes, rheumatoid arthritis and neurological conditions. Any work related task that involves the wrist being bent on either direction for prolonged periods is also a risk factor https://emedicine.medscape.com/article/1243192-overview

In the case of my friend on the phone, it was drumming.

As with many other strain injuries, the common methods of treatment are rest, splinting, ice, corticosteroid injection with surgery used in severe cases.

I was visiting Brisbane, scouting in the event of moving interstate to study acupuncture. I don’t recall how we came to be in contact that day but he was up from Melbourne and had called in on a former band mate. On his break from rehearsing and playing, his left wrist had begun to cause some issues. The hand was painful, pins and needles would wake him early in the morning and taking a grip on objects was challenging. The drums were proving difficult. During our brief chat on the phone the signs and symptoms sounded familiar enough. With some scrawled treatment notes in my pocket I made my way round to say hello, catch up, and see if Tui Na could do anything to help.

There’s a good chance you know someone that has been through this condition. Even worse, you might have had it yourself. Early in my student clinic time, a Canadian carpenter introduced me to this condition. He could not pick up a large coin first thing in the morning. The pain was excruciating, often keeping him awake from 4am onwards. At work his hand felt better as the morning progressed, his grip became stronger, but it was a cycle that had been on repeat for a long time. His shoulder and elbow had become effected as well as the body compensated in an attempt to take load off the affected joint. Over the weeks the signs and symptoms improved even though he was unable to take a break from work.

My drummer friend had a quick and positive outcome. It’s not always the case but Tui Na can tackle some conditions that other massage styles are not able to. With a good understanding of anatomy and physiology as well as the benefits from the energetic side of Chinese Medicine, results can be swift even in the conditions that are notoriously stubborn to treat.

See other blogs for more information on RSI, Tennis Elbow and De Quervain’s Syndrome

Chinese Medical Massage | How does Tui Na work, and what is it about?

Chinese Medical Massage, known as Tui Na can be thought of as Acupuncture without needles.

This is the easiest way to describe the manual therapy branch of Chinese Medicine. It is probably the oldest physical treatment on the planet; the grandparent of massage, osteopathy, chiropractic, physiotherapy and any practiced bodywork, yet it is still relatively unfamiliar to the majority of people.

‘Tuna with an “i”? Toooweeenaaa… whaaa’?

Chinese Medicine has five branches: Acupuncture, Herbs, Tai Ji Chuan (Tai Chi), Qi Gong, and Tui Na. They all have a common foundation of theory based on Taoism. Think of it as a form on ‘Naturalism’, a view of the world based on the observations of Nature and our place within it.

Most people are familiar with the idea of Acupuncture and the system it is based on. Although we cannot be certain, we think it’s safe to assume that the use of hands came first, the application of needles came later. As Chinese Medical Massage is based on the same system, it can address the signs and symptoms of typical muscle aches and pains, back and neck problems but can also be used for signs and symptoms of other medical conditions: Gynaecological, gastro-intestinal, insomnia, respiratory, stress conditions like anxiety, migraines and many others.

How does it manage to address so many areas?

Let’s leave out the concepts of Chinese Medicine for a moment.

Tui Na is performed through clothes and uses many varying techniques to influence a body to heal itself. Tui Na literally means “Push” and “Hold/Grasp”; the terms are descriptive of the techniques being used. These are only 2 of the 26+ techniques that can be applied during a treatment. Each technique will elicit a different response from the body being worked on, so it stimulates the nervous and vascular (blood) systems in a range of ways western massage styles do not. Most massage styles use pressure and flowing strokes with oil on skin to achieve their results.

If we introduce the eastern concepts, Tui Na works with the body tissues as well as the energetic system that is the basis for Chinese Medicine. In this way, Tui Na addresses the structure (tissues, ligaments, RSI – Repetitive Strain Injury, fascia), assists in restoring proper function (range of movement of joints) and the energetics of the body (regulation of Yin and Yang using acupoints, channels and ‘organs’ of Chinese Medicine).
All of this is to assist the body in correcting or healing itself.

Over thousands of years of practice and observation, highly effective treatments were worked out for specific conditions. If needed, treatments can be adjusted for each client as they present.

What has been refined over millennia of application is a thorough system of bodywork that can approach a range of conditions ailments.

• It is not just a “nuts and bolt” approach.
• It is not just using a “hippie energy system”.
• It is a highly effective system of bodywork using the energetic system of Chinese Medicine that has a broad application for many conditions that are suffered throughout society.

Perhaps a possible solution to many of the conditions we suffer has been hiding in plain sight from a different culture. It’s not so much foreign, it’s just unfamiliar.