Manual Therapy
Manual therapy refers to any “hands on” treatment and can include a multitude of techniques. Each technique is selected based on the individual needs of the patient at the time of the treatment while keeping the big picture in mind.
Joint mobilizations
Joint mobilizations involve mobilizing a joint by stabilizing one part and moving the other. They are used to restore the normal movement of a joint, reduce pain, and improve joint mobility. There are different grades your physiotherapist may implement that range from grade 1 – grade 5. Lower grades involves more gentle approaches that are geared towards reduction of pain while higher grades focus on improving mobility with a grade 5 being a high velocity manipulation. The mobilizations usually are oscillatory in nature but can involve a longer hold stretch.
Each movement of a joint is associated with a certain “glide” or direction of the bones. Joint mobilizations help to restore this. For example if you are limited in raising your arm over your head, the physiotherapist may mobilize the shoulder joint a certain way and be able to change how far your arm goes in a matter of seconds. In other cases, joints can be quite stiff due to many different reasons and need much more time in order to make the necessary change in the surrounding tissues. The mobility of a joint will subsequently affect the muscle tension around the area and thus play an integral part of restoring full mobility.
Myofascial release
Myofascial release is a therapeutic technique that targets the fascia, a connective tissue that surrounds and supports muscles, bones, and organs throughout the body. It is aimed at areas of reduced mobility and involves the therapist holding down an area of tension with one hand while the other moves the restricted joint through a range of movement. This can improves the ability of the fascia and the underlying muscle to move easier and can contribute to an increased range of motion of the target movement as well as a reduction in pain if present.
As the myofascial restrictions are worked, patients may experience a variety of sensations, including warmth, stretching, or a mild discomfort. The therapist adjusts the pressure and technique based on the patient’s response to ensure a safe and effective treatment session. It is important to note that myofascial release is typically performed by trained professionals, such as physiotherapists, who have a deep understanding of the body’s anatomy and biomechanics. They assess the individual’s specific needs, tailor the treatment accordingly, and may combine myofascial release with other therapeutic modalities to maximize its effectiveness.
Soft tissue massage
Soft tissue massage is a form of hands on manual therapy used with the goal of relieving pain or discomfort as well as facilitating a “looser” sensation in the area. This can be caused by changes in the nervous system as a result of the changes in pressure over the skin and muscles. Massage used in physiotherapy is usually directed at areas of muscle tension or tightness as well as areas that may facilitate a specific movement.
There are many forms of soft tissue massage used by physiotherapists which include effleurage (long, overlapping strokes), deep tissue (may include the use of hands or forearm to provide deeper pressure to the targeted area), and cross-fibre massage (deep strokes perpendicular to the the muscle orientation). Each of these are selected based on the individual needs of the patients.
While generally considered safe, there are certain contraindications and precautions to be aware of, such as acute inflammation, open wounds and fractures. This is very important as many people opt to go for a massage after they sustain an acute injury. When experiencing redness, warmth in the area, and visible swelling; soft tissue massage can actually make the situation worse. A thorough assessment by the physiotherapist is necessary to ensure the safety and effectiveness of the intervention. If this form of manual therapy can be beneficial in longer durations, the physiotherapist will refer you to a trusted massage therapist for conjunct treatment to tackle the case as a team.
Soft tissue massage is sought out by various populations, including athletes, who have suffered an injury as well as those looking to maintain tissue health to facilitate performance. Therefore this manual therapy technique can be beneficial in the rehabilitation portion as well as in the injury prevention plan.
Trigger point release
Trigger point release is a hands on technique used by many health care professionals to improve the health and thus the movement of a muscle. The technique involves scanning the muscle for any areas of tightness sometimes referred to as “knots”. Once a particular area has been targeted, the therapist puts pressure on that spot for a prolonged period of time. The patient is then encouraged to breathe and let go or relax the areas as best as possible.
The pressure administered by the therapist is directly related to the patient’s ability to relax. If the therapist puts too much pressure the muscles tense up in a protective response which does not lead to any change. The therapist must then adjust the pressure in order to find the balance between putting enough pressure to make a change while ensuring the ability of the muscle to relax. It’s a little bit like a dance.
The pressure is held for as long as it takes to make a change in the tissue and actually feel the muscle let go. This can be 3-4 breaths or as long as 3-4 minutes depending on the situation.
The goal of this technique is to improve the extensibility of the muscle in order to improve the quality of movement. A mobility test may be performed before this technique is administered and then again afterwards in order to determine whether or not a change was made.
If the muscle releases effectively this can lead to a feeling of relief if this trigger point was a source of pain for the patient. Each trigger point has common referral patterns that can be at the source of the trigger point or in a different area which makes things interesting. For example the glute minimus trigger point can refer all the way down the leg and mimic “sciatica”. This is where a proper assessment of the nervous system as well as the musculoskeletal system is necessary for a proper diagnosis and thus an effective treatment plan.
Joint Manipulations
Joint manipulations is a high velocity thrust used in order to improve mobility of a specific joint. See above in the joint mobilizations section for more detail on the technique involved.
Manipulations can often produce a “crack” or “pop” sound which is referred to a cavitation. This can provide pain relief as well as provide a short term release of the surrounding musculature. A physiotherapist must complete additional coursework in order to be placed on the spinal manipulation roster. This is a restricted activity that must first be approved by Physiotherapy Alberta based on proof of accepted course completion.
This technique is available through our physiotherapist. It is important to note that the pros and cons of each treatment technique will always be weighed out in order to provide safe and effective treatment specific to the patient. For example, in cases where there is a hypermobility or too much movement, manipulation may not be appropriate as the goal of this technique is to further improve mobility. Patient safety will always be a priority when deciding which technique may be most beneficial for the individual.
Dry Needling
Dry needling is a treatment option within physiotherapy that can provide many therapeutic benefits as part of a multi-modal approach to care. There are many types of dry needling including “trigger point dry needling (TDN) ” in which “intrasmuscular stimulation (IMS)” is a subcategory of, as well as “acupuncture”. At Inspire Health & Performance, Mike has completed advanced course work in trigger point dry needling in order to facilitate the best possible outcomes for his patients.
Trigger point dry needling has been shown by evidence to help reduce pain and improve function in the short term as one part of a conventional physiotherapy approach.1 Just like any tool, it is more useful as part of the big picture versus as an isolated treatment modality. TDN is used to treat myofascial trigger points (MTPs) which are hypersensitive areas often identified by a painful nodule within a band of taught muscle fibres. Myofascial trigger points can cause pain in the area, referred pain, as well as affect the motor response of the muscle when subjected to mechanical deformation.1 This includes being stretched, compressed, or contracted. Trigger point dry needling helps alleviate this discomfort and return the muscle to a more functional state.
The technique used with trigger point dry needling is fairly quick and can be completed on several different spots within a session. The skin surface is first cleaned and then a small needle is inserted into the target spot. The needle is moved up and down in a piston like fashion before it is removed. It can feel slightly achy as the needle goes in however some patients report not having felt it at all. At times when a myofascial trigger point is hit, the muscle contracts in order to then let go and release. This can reduce pain and improve the overall function of the muscle.
The current evidence for dry needling is moderate to low in relation to reducing pain as well as reducing pain related disability. This has been shown specifically in areas of the neck, low back, shoulder, knee, foot, and elbowand has a short term analgesic effect.1,2,3,4,5,6 The evidence listed below reference positive benefits for conditions including chronic neck pain, low back pain, lateral epicondylagia, plantar fasciitis, heel pain, non-traumatic shoulder pain, and patellafemoral pain syndrome. Our belief is that dry needling can improve the condition of a muscle and provide pain relief. This sets the patient up for success for the movement and exercise component that comes after.
In summary, trigger point dry needling can be a useful tool as one part of a physiotherapy treatment plan. Your therapist will review the risks and benefits of this modality prior to completing this technique so you can make an educated decision that is best for you.
References:
1Chys, M. et. al. (2023). Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med. Feb 2;12(3):1205.
2Llurda-Almuzara, L. et. al. (2021) Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-Analysis. Pain Med. Jul 25;22(7):1630-1641.
3Mar Herna´ndez-Secoru´n et al. (2023). Effectiveness of Dry Needling in Improving Pain and Function in Comparison with Other Techniques in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis. Pain Research and Management Volume 2023, Article ID 1523834, 14 pages
4Navarro-Santana, M. et. al. (2020). Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clin Rehabil. Nov;34(11):1327-1340.
5Navarro-Santana, M. et. al. (2021). Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Phys Ther. Feb 4;101(2):pzaa216.
6Rahou-El-Bachiri, Y. et. al (2020) Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis. J Clin Med. Jun 29;9(7):2044.
Cupping Therapy
Therapeutic cupping is an ancient technique that is becoming more common today in rehabilitation as well as in sport . This is the technique the swimmer Michael Phelps popularized and since then athletes in other sports such as Lebron James have utilized this therapeutic tool.
There is a growing body of evidence that supports the use of therapeutic cupping as a way to decrease pain, improve mobility, and increase blood flow2. In a recent 2023 study by Ayman, A. et al. they concluded that therapeutic cupping “is a useful intervention to be performed in musculoskeletal and sports rehabilitation because it decreases pain level and increases pain threshold with a low incidence of adverse effects”1. The study showed low to moderate evidence to support cupping with some of the best results coming in low back pain patients.
There are many different techniques used to administer cupping. At Inspire Health & Performance we use silicone cups that when applied on oil or cream, provides a negative pressure that draws the skin, fascia, and muscle layers upwards1. This provides many physiological benefits including increasing blood flow to the area, decreasing pain, and improving mobility.
The cups may be placed in one area for a short period of time, which can produce the dark circles commonly seen, or the cup can be moved around in either a circular or linear path which can produce spotting on the skin. The dragging technique can be a little uncomfortable however allows the therapist to cover a bigger surface area in less time in order to make faster improvements in the targeted area. This technique also allows each of the muscle, fascia, and skin tissue layers to move freely which contributes to overall mobility. The spots or dark circles usually go away in 1-3 days but have been reported to take longer to fade. They generally aren’t painful and look worse than they are. The technique of choice will of course be determined by the therapist based on an individual need and patient comfort is always taken into consideration.
Some of the evidence for therapeutic cupping is supported in conditions such as low back pain (low to moderate evidence), neck pain (low to moderate evidence), carpal tunnel syndrome (low evidence), plantar fasciitis (low evidence), and stiffness of soft tissue (low evidence)1. This is summarized in the 2023 systematic and evidence based review cited above. In clinic the application of cupping has showing significant results and some patients have reported immediate benefits in pain reduction and increased mobility after a 1-2 min technique. Cupping is used to treat conditions that require improved mobility and therefore the application goes above and beyond the specific conditions listed above (cue: shoulders!).
Overall the application of therapeutic cupping has been growing in evidence and is generally considered a safe technique to use1. As with every technique, the risks and benefits will be explained to you and you will always have a choice. Therapeutic cupping can be a great way to improve the way you move and help get you a little closer to your goals.
1Ayman A. et al. (2023) Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review, Journal of Back and Musculoskeletal Rehabilitation 36, 3–19
2Markowski A et al. (2014) A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. J Altern Complement Med. 20: (2): 113-7.
Taping
Taping can be a helpful aid in the rehabilitation process in order to mitigate pain, improve participation in activities, and support desired postures. The type of tape used is important in order to facilitate these specific goals. Although taping can be quite helpful, it is always used as a small part of a complete plan of care.
Pain management is crucial early after an injury in order to promote movement when safe to do so. When a tissue has been injured it requires time to heal however the requirements of our day to day lives sometimes do not allow for this. For example, if you have a sprained ligament in the ankle, walking can be quite pain provoking. Depending on the severity of the sprain, movement can be very helpful in certain ranges and pain generating in others. Tape can allow more control over the range of motion of the joint in order to offload the stresses on that healing ligament and allow day to day activities like walking to be completed with less pain. In this example the tape acts as an external stabilizer to the body (like a brace) while recovering from an injury and can be viewed as a temporary support to buy time in order to build muscle and/or allow the tissue to heal. This use can be applied for any injury or condition that involves hypermobility (more than the desired range of motion) and at times can remove pain completely after application. Think of tape like a hug for the healing tissue.
Lower pain levels contribute to increased levels of activity. This allows the target joint to move through range of motion which can accelerate the rehabilitation process. Each case is individual and specific guidelines will be given by the physiotherapist. There are times where range of motion needs to be restricted and other times where it needs to be facilitated. This will depend on the specific situation and therefore cannot be a “one size fits all” approach. Different types of tapes are used depending on the goal with more supportive tapes used to restrict certain movement while more pliable tapes may be used to facilitate movement in a different way. There have been reports of allergies to certain adhesives of the tape so careful monitoring of the area after application for redness, itchiness or any signs of irritation is recommended. We also suggest taking the tape off after 2-3 days and washing the area with soap and water to keep the skin underneath happy and healthy.
Another clinical use for tape is to facilitate a desired posture. Tape can help hold a certain position which may allow the patient to feel how that new posture changes their pain. It can act as a reminder to avoid provocative positions throughout the day as well which can prove to be quite helpful in mitigating pain or learning how to move or a hold a posture a different way.
Overall can be a helpful tool to facilitate healing, improve activity levels and reduce pain. It plays a role but is not to be substituted for the work that comes with a complete rehabilitation program. The goal is always to manage an injury in the short term and prevent further injury in the long term.
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Our Google Reviews
Since Mike helped my husband recover from and manage severe sciatic pain, I’ve been to him myself and have recommended him to multiple people. He is friendly, compassionate, considerate, and extremely passionate about his craft, and approaches physiotherapy from a total wellness perspective. I had issues with neck / shoulder pain and tension, as well as knee pain, and he helped me track the source of these issues from head to toe. He also took my entire lifestyle into consideration when building a program I could realistically execute. I trust him completely and would highly recommend him to anyone looking for a physiotherapist.
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I invited Mike from Inspire Performance to create and deliver a session on Wellness for the Rona Inc. Western Distribution network. Mike is knowledgeable, professional and easy to work with. He checked in often about the content of the presentation to ensure it was what we envisioned, and his communication was clear and timely. The content of the presentation was informative, concise and appealing to a diverse audience – he even developed a worksheet for the participants to work through during the presentation and it supported participant learning. I highly recommend Inspire Performance for their approach to wellness and their ability to engage learners on what can sometimes be an intimidating topic. Well done Mike and team!
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Mike’s commitment to his clients is second to none!
I have been working with Mike Azzopardi over the past 12 months, I now would consider him a friend. My history as an athlete provided numerous opportunities to works with many sports Physio and medical professionals. Mike’s commitment to adapt his knowledge along with the will and determination he has for his clients welfare results in the self inspiration, allowing his clients to meet their goals. I feel Mike cares for each and everyone of his clients. In a world where the basic human interaction are being forgotten mike methods I have found have been life changing in my ability to function.
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Mike is a committed coach who really listens to and works with an athlete to accomplish their goals. He helps strike a balance between what you want to do (run all the kilometers in my case) and what your goal is (get to the start line healthy and hopefully fast). He cares a lot and is very invested in his clients.
I started working with Mike as a physiotherapist after several injuries and then he started coaching me back to running. With his help and plan, I accomplished my goal of getting back to running a sub 3 hour marathon after not running a marathon for 1.5 years. I ran a 2:56:51 marathon at the 2023 Saskatchewan Marathon and was the second place female! Working with Mike was important part of making this happen.
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Over the years, I’ve had several physiotherapists due to sports injuries. Mike is knowledgeable and stays updated with the latest research. What also stood out to me was his holistic approach. Appreciate your support!
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Golf is a game where mobility and flexibility play pivotal roles in generating power, accuracy, and consistency. Among the most critical components of the golf swing is the rotation during the backswing. When a golfer’s ability to rotate becomes limited, often due to age, injury, or other mobility issues, it can disrupt the swing mechanics […]
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- Phone: (403) 679-3977
- Fax: (403) 679-3977
- Email: booking@inspirehealthcalgary.ca
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Calgary, AB T3M 2N3
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