Frozen Shoulder

 

What is Frozen Shoulder?

Adhesive capsulitis, commonly known as frozen shoulder, is a condition that causes stiffness, pain, and a significant reduction in shoulder mobility. It is an inflammatory disorder that can severely impact daily activities, making even simple movements like reaching for an object or getting dressed difficult. The exact cause of frozen shoulder remains unknown however there are factors that contribute to the condition or make people more susceptible.

 

There are 3 stages of Adhesive Capsulitis (frozen shoulder)

  1. Freezing stage: during this initial phase, any movements of the shoulder cause significant pain, and the range of motion gradually decreases. As the inflammation becomes worse in the shoulder, the ability to do simple movements and activities gradually decreases. The freezing stage can last from 2-9 months.
  2. Frozen stage: While pain may decrease in this stage, shoulder stiffness with further increase and become worse which will further limit mobility of the shoulder. This stage can persist for 4-12 months.
  3. Thawing stage: This is the final stage, this is when the shoulder begins to gradually regain mobility and range of motion as the stiffness decreases. Over the time the shoulder will return to normal function. This process can take up to 5-24 months.

 

The prevalence and Risk factors for frozen Shoulder

This Condition primarily affects women around the age of 55, however men are also affected. Adhesive capsulitis or also known as frozen shoulder affects up to 8.2% of males and 10.1% on females therefore making females slightly more susceptible to the condition.

Some of the risk factors that studies have shown that increase the chance of developing the condition are gender (female), diabetes, trauma, and long periods of shoulder immobilization.

 

Signs and Symptoms /Diagnosis

The main signs and symptoms of frozen shoulder include: insidious shoulder pain, gradual loss of range of motion/ movement both actively and even passively, stiffness in the shoulder. Frozen shoulder can only be diagnosed through clinical evaluation like X-rays or MRIs which rule out other potential conditions.

 

Treatment / How Osteopathy Can Help

Here at the clinic, we cannot fix the condition however we can assist with pain management, and exercise to help sustain range of motion as much as possible. Studies show that patients who receive manual therapy have improved function and pain levels. Our aim with this condition is to maintain range of motion throughout the three stages then in the thawing stage, we can work with the patient to regain and increase their strength, Range of motion, and function overall.  Some of the techniques we use to do this may include needing, joint mobilisation, muscle release, and exercise prescription.

 

Summary

Effective management of frozen shoulder requires planning and management throughout the different stages of the conditions.  A well-coordinated care plan can significantly improve patient outcomes, reduce discomfort, and restore shoulder function over time.

By understanding more about what frozen shoulder is and the symptoms, risk factors, and treatment options for adhesive capsulitis, we can help you take proactive steps to seek early intervention and improve your quality of life. If you or someone you know is struggling with persistent shoulder pain, consulting a healthcare provider is the first step toward recovery.

 

References

Abudula, X., Maimaiti, P., Yasheng, A., Shu, J., Tuerxun, A., Abudujilili, H., & Yang, R. (2024). Factors associated with frozen shoulder in adults: A retrospective study. BMC Musculoskeletal Disorders, 25, Article 493. https://doi.org/10.1186/s12891-024-07614-8

 

Page, M. J., Green, S., Kramer, S., Johnston, R. V., McBain, B., Chau, M., & Buchbinder, R. (2014). Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, (8), Article CD011275. https://doi.org/10.1002/14651858.CD011275

 St Angelo, J. M., Taqi, M., & Fabiano, S. E. (2023). Adhesive capsulitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532955/

 Kim, J., & Lee, J. H. (2023). Effects of dynamic stretching combined with manual therapy on pain, range of motion, function, and quality of life of adhesive capsulitis. Healthcare, 12(1), 45. https://doi.org/10.3390/healthcare12010045

 

Understanding Neck Pain & Stiffness: An Osteopath’s Perspective Dr Andrew Welsh, PhD

Understanding-Neck-Pain
Understanding Neck Pain & Stiffness

Neck pain is a common issue that affects many people, often disrupting daily activities like working, driving, or even sleeping comfortably. In our modern, fast-paced lives, with prolonged screen time and increased stress, neck discomfort has become more common at our clinic. At Eclipse Health & Osteopathy, we take a whole-body approach to neck pain, focusing not just on the neck itself but also on related areas that might be contributing to the issue, as well as factors that may a play a role in limited movement, like the aging process, postures and repetitive strains.

What is Neck Pain & Stiffness?

Neck pain can range from mild stiffness to severe discomfort, affecting your ability to move your head freely. You might notice symptoms like muscle tightness, headaches, shoulder pain, or even tingling in the arms. While poor posture is a common cause, neck pain can also result from injuries, stress, or underlying medical conditions.

Neck pain can be classified as either acute (short-term) or chronic (long-lasting). Acute neck pain often results from muscle strain or sudden movements, while chronic pain may be related to ongoing posture issues, degenerative changes, or stress-related muscle tension.

In today’s busy and often stressful world, with limited opportunities for rest and recovery, stress can also play a significant role in neck pain. Clenching your jaw, tensing your shoulders, or sitting hunched over for extended periods can contribute to muscle tightness and discomfort.

The Value of the Osteopathic Approach

We focus on treating the whole person, not just the area of pain. Our goal is to help reduce discomfort and improve how your neck and body work together. We use gentle, hands-on techniques to ease tension, restore movement, and support your body’s natural balance.

Our approach may include:

  • Gentle stretches and exercises with the goal often being to improve neck mobility and strengthen supporting muscles (Gross et al., 2016).
  • Hands-on therapy commonly aiming to release muscle tension and promote better joint function (Bronfort et al., 2012).
  • Posture advice to help reduce strain on the neck and shoulders. A combination of manual therapy and stabilising exercises has been shown to improve forward head posture and rounded shoulders, reducing strain on the neck over time (Fathollahnejad et al., 2019).
  • Relaxation techniques to support overall wellbeing and help manage stress-related tension. Adding relaxation training to stabilisation exercises has been shown to lead to significant improvements in pain intensity, pressure pain threshold, cervical range of motion, and movement-related fear in individuals with chronic neck pain (Özer Kaya & Toprak Çelenay, 2019). Post-isometric relaxation techniques (often referred to as gently “push-and-relax”) have also been found to effectively reduce pain and disability in those with non-specific neck pain (Khan et al., 2022).
  • Measurement of movement using goniometry to assist in examination, treatment, and reassessment of progress (Norkin & White, 2016).

Measuring neck ROM

Understanding-Neck-Pain

(© 2025 Dr Andrew Welsh, PhD)

The Importance of Measuring Movement

To better understand how your neck is functioning, we use goniometry, a method of measuring joint movement. This allows us to assess range of motion (ROM) at the beginning of treatment and track improvements over time.

According to Norkin & White (2016, p. 452-454), certain ranges of motion are necessary for daily activities. For example:

  • 40–50 degrees of cervical flexion (bringing the chin to the chest) is required for activities like looking down to tie shoelaces.
  • 60–70 degrees of cervical rotation (turning the head) is essential for driving and checking blind spots.
  • 40–50 degrees of cervical extension (tilting the head back) is needed for looking up at the ceiling.

Considering these approximate functional ROM requirements helps us to consider how to help each person to restore the movement they require to complete their daily tasks. In this way, we are not simply “rubbing sore spots” but trying to improve our capacity to perform activities and quality of life.

It is also common for people to believe that stiffness and reduced mobility are simply a normal part of aging. Multiple studies have researched this question, and while many agree that some neck movements tend to stiffen over the later decades of life, it is a little more complicated than that, with two studies finding that rotation (looking over your left and right shoulder) increases near the top of the neck as we reach older ages, perhaps to compensate for the common stiffening in the lower levels of our neck (Norkin & White, 2016). Importantly, research suggests that between the ages of 15 and 45, the neck range of motion does not significantly decline (Tommasi et al., 2009). In fact, flexion and extension movements (looking down and up)  were found to be very similar between younger and middle-aged adults, with only minor, non-significant differences (Norkin & White, 2016). So, for people in this age-bracket, on average, these findings challenge the belief that one must accept increasing stiffness or discomfort due to age alone. Instead, these findings highlight the importance of identifying other contributing factors, such as posture, muscular imbalances, and lifestyle habits, which may be more relevant to neck mobility and discomfort. This is what we aim to help people explore at Eclipse Health & Osteopathy.

How Hands-On Therapy May Help

Research has shown that hands-on therapy can benefit people experiencing neck pain. Techniques like gentle spinal mobilisation, soft tissue massage, and muscle relaxation can help ease pain and improve range of motion (Bronfort et al., 2012).

Several studies have compared the effectiveness of different manual therapy techniques—such as manipulation, mobilisation, muscle energy techniques (MET), and proprioceptive neuromuscular facilitation (PNF)—in alleviating neck pain and improving range of motion (ROM) (Sbardella et al., 2021).

  • Manipulation vs. Mobilisation: A Cochrane review evaluated the effects of manipulation and mobilisation for neck pain. Both treatment interventions produced similar pain relief and functional improvement outcomes, but further research is required (Gross et al., 2010).
  • Muscle Energy Technique (MET): A systematic review by Sbardella et al. (2021) assessed the efficacy of MET in reducing neck pain and improving cervical ROM. The analysis indicated that MET could effectively decrease pain and enhance ROM in individuals with both acute and chronic neck pain.
  • Proprioceptive Neuromuscular Facilitation (PNF): A recent study compared the effectiveness of PNF therapy to manual therapy in patients with chronic mechanical neck pain. The findings suggested that PNF was more effective in reducing pain and improving ROM and functional disability than manual therapy (Khan et al., 2022).
  • MET vs. PNF: A randomised controlled trial compared the efficacy of MET and PNF in individuals with chronic mechanical neck pain. Both techniques were effective in reducing pain and improving ROM; however, the study did not find a significant difference between the two methods, suggesting that either could be beneficial depending on individual patient needs (Khan et al., 2022).

 

Considering Osteopathy for Neck Pain?

If you are experiencing neck pain and looking for a holistic approach, osteopathy may be a beneficial option. At Eclipse Health & Osteopathy, we focus on helping you regain comfort and function by addressing the root causes of your discomfort. Our hands-on approach aims to improve mobility, ease tension, and support overall well-being.

Get in touch with us today to discuss how we can support your journey to better health.

 

References

  1. Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomised trial. Annals of Internal Medicine, 156(1 Pt 1), 1–10. https://doi.org/10.7326/0003-4819-156-1-201201030-00002
  2. Fathollahnejad, K., Letafatkar, A., & Hadadnezhad, M. (2019). The effect of manual therapy and stabilising exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskeletal Disorders, 20, 86. https://doi.org/10.1186/s12891-019-2438-y
  3. Gross, A., Miller, J., D’Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., Haines, T., Brønfort, G., Hoving, J. L., & COG (2010). Manipulation or mobilisation for neck pain: a Cochrane Review. Manual therapy15(4), 315–333. https://doi.org/10.1016/j.math.2010.04.002
  4. Gross, A. R., Paquin, J. P., Dupont, G., Blanchette, S., Lalonde, P., Christie, T., Graham, N., Kay, T. M., Burnie, S. J., Gelley, G., Goldsmith, C. H., Forget, M., Santaguida, P. L., Yee, A. J., Radisic, G. G., Hoving, J. L., Bronfort, G., & Cervical Overview Group (2016). Exercises for mechanical neck disorders: A Cochrane review update. Manual Therapy, 24, 25–45. https://doi.org/10.1016/j.math.2016.04.005
  5. Khan, Z. K., Ahmed, S. I., Baig, A. A. M., et al. (2022). Effect of post-isometric relaxation versus myofascial release therapy on pain, functional disability, ROM, and QoL in the management of non-specific neck pain: A randomised controlled trial. BMC Musculoskeletal Disorders, 23, 567. https://doi.org/10.1186/s12891-022-05516-1
  6. Norkin, C. C., & White, D. J. (2016). Measurement of Joint Motion: A Guide to Goniometry (5th ed.). FA Davis.
  7. Özer Kaya, D., & Toprak Çelenay, Ş. (2019). Effectiveness of relaxation training in addition to stabilisation exercises in chronic neck pain: A randomised clinical trial. Turkish Journal of Physiotherapy and Rehabilitation, 30(3), 145-153. https://doi.org/10.21653/tjpr.665131
  8. Sbardella, S., La Russa, C., Bernetti, A., Mangone, M., Guarnera, A., Pezzi, L., Paoloni, M., Agostini, F., Santilli, V., Saggini, R., & Paolucci, T. (2021). Muscle Energy Technique in the Rehabilitative Treatment for Acute and Chronic Non-Specific Neck Pain: A Systematic Review. Healthcare (Basel, Switzerland), 9(6), 746. https://doi.org/10.3390/healthcare9060746
  9. Tommasi, D. G., Foppiani, A. C., Galante, D., Lovecchio, N., & Sforza, C. (2009). Active head and cervical range of motion: effect of age in healthy females. Spine, 34(20), 2098-2103. https://doi.org/10.1097/BRS.0b013e3181afe826

Headaches From Muscle Tension in Neck

The Link Between Neck Pain and Headaches

Neck pain can be a real pain in the neck -quite literally! But did you know that neck pain can also be a major trigger for headaches? This often-overlooked connection can lead to chronic headaches that can significantly impact your quality of life. Today, we will explore the link between neck pain and headaches and offer some tips for managing and preventing them.

Understanding the Connection

Neck pain and headaches are often intertwined, as the muscles, nerves, and blood vessels in the neck are closely connected to those in the head. When there is tension in the muscles and/ or fascia or restriction from the joints in the neck, it can lead to referred pain in the head, resulting in headaches. This type of headache is often referred to as a cervicogenic headache.

Common causes of neck pain that can lead to headaches include poor posture, muscle tension, injuries, and underlying conditions such as arthritis or degenerative disc disease. In some cases, even stress and anxiety can manifest as neck pain and headaches.

Managing Neck Pain-Related Headaches

If you are experiencing headaches due to neck pain, there are several strategies you can try to help manage and prevent them:

1. Improve Your Posture: Maintaining good posture throughout the day can help alleviate strain on your neck muscles and reduce the likelihood of headaches. Make sure your computer monitor is at eye level, sit up straight, and avoid slouching.

2. Stretch and Strengthen: Regular stretching and strengthening exercises can help improve the flexibility and strength of your neck muscles, reducing the risk of tension and pain. Simple exercises like neck rolls, shoulder shrugs, and chin tucks can be beneficial.

3. Use Proper Ergonomics: Whether you are sitting at a desk, driving, or using your phone, it is important to ensure that your body is properly aligned. Adjusting the height of your chair, using a supportive pillow while sleeping, and taking breaks to stretch and move around can all help prevent neck pain and headaches.

4. Apply Heat or Cold: Using heat packs or cold compresses on your neck can help reduce inflammation and alleviate pain. Experiment with both to see which works best for you.

5. Practice Relaxation Techniques: Stress and anxiety can exacerbate neck pain and headaches. Incorporating relaxation techniques such as deep breathing, meditation, or yoga into your daily routine can help manage stress and reduce muscle tension.

Seeking Professional Help

If your neck pain and headaches persist despite trying these strategies, it may be time to seek help from a healthcare professional. An Osteopath, physical therapist, chiropractor, or massage therapist can help identify the underlying cause of your pain and create a personalised treatment plan to address it.

In some cases, your physician may recommend additional treatments such as medications, injections, or surgery to alleviate your symptoms. It is important to work closely with your healthcare team to find the best approach for you.

Preventing Neck Pain-Related Headaches

Prevention is always better than cure when it comes to neck pain-related headaches. Here are some tips to help prevent them from occurring in the first place:

1. Stay Active: Regular physical activity can help improve your posture, strengthen your muscles, and reduce stress – all of which can help prevent neck pain and headaches.

2. Stay Hydrated: Dehydration can lead to muscle fatigue and tension, exacerbating neck pain and headaches. Make sure to drink plenty of water throughout the day to stay hydrated.

3. Get Plenty of Sleep: Poor sleep posture or inadequate sleep can contribute to neck pain and headaches. Aim for 7-9 hours of quality sleep each night and use supportive pillows and mattresses to prevent neck strain.

4. Limit Screen Time: Spending long hours hunched over your phone or computer can strain your neck muscles and lead to headaches. Take frequent breaks, adjust your screen height, and use ergonomic accessories to reduce the strain.

5. Listen to Your Body: Pay attention to your body’s signals and take action if you start to feel tension or pain in your neck. Ignoring these warning signs can lead to more severe issues down the road.

 

Final Thoughts

Neck pain-related headaches can be a real nuisance, but with the right strategies and interventions, you can manage and prevent them. By addressing the root cause of your pain, making lifestyle changes, and seeking professional help when needed, you can take control of your headaches and improve your quality of life.

If you are struggling with neck pain-related headaches, don’t hesitate to reach out to a healthcare provider for help. Remember, your health and well-being are worth investing in!

 

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common condition, affecting approximately 3% to 6% of adults in the general population it is also known as median nerve entrapment. Carpal tunnel syndrome occurs when the median nerve is compressed by a ligament that runs directly across the wrist, with nerves running under it. This leads to the entrapment of the median nerve. While the median nerve extends down the entire arm, the affected area is specifically at the wrist, just before it reaches the palm. (Sevy et al, 2023)

 

Why Does it Occur

The reason why carpal tunnel or median nerve entrapment occurs can be due to a range of potential factors that decrease the space between the ligament (flexor retinaculum)  and the structures underneath (muscles, tendons, and nerves) then the ligament begins to press on other structures like the median nerve which leads to pain felt at the fingers, wrist, and forearm. These risk factors include: inflammation of structures that pass under the flexor retinaculum (carpal tunnel ligament) which can be caused by:   repetitive hand movements, history of wrist injuries, obesity, arthritis (Rheumatoid arthritis), Hormonal changes like menopause, pregnancy or diabetes and age.  (Sevy et al, 2023)

 

Signs and Symptoms

Some signs and symptoms include numbness and tingling in the thumb index and middle finger on the palmar aspect of the hand, weakness and pain gripping objects, pain worse at night in the wrist and hand that can prevent sleep and swelling in the fingers.

 

Treatment options

Some of the different treatment options for carpal tunnel/Median nerve entrapment include:

Ice therapy can be used to reduce the inflammation that is pressing on the median nerve. The ice helps constrict the (flexor retinaculum ligament) to give the median nerve more space and less compression therefore decreasing pain. (Laymon et al, 2015)

Surgery: In the surgery, they will cut the flexor retinaculum which forms the roof of the carpal tunnel which prevents the nerve from being compressed or entrapped. (National Library of Medicine, 2024)

Wrist splints: Wrist splinting and immobilising the hand and wrist can provide support and allow the body to time to recover. Night splinting is a useful strategy to decrease pain.  This can help decrease the irritation/ inflammation of the structures that pass through the carpal tunnel.

(Karjalainen et al, 2023)

Exercise therapy: Forms of exercises that can be implemented in the rehab of carpal tunnel to decrease pain and improve function. Exercise can also be used as a tool to measure progress. Some of the exercises are stretching in the forearm flexors and nerve glides.

Ergonomic changes:  Ergonomic changes in everyday tasks or at work can improve symptoms and limit reaggravation which will help the condition improve and recover at a faster rate. Some ergonomic changes include: using tools to pick things up limiting gripping motions, using an open-handed grip to pick things up, using both hands rather than one hand, Lifting lighter loads, altering bottle feeding positions, and many more. By implementing these strategies this can improve quality of life and speed up the recovery process. (Conor et al, 2012)

Steroid injections: Corticosteroid injections are used to provide temporary relief however they have not shown promising long-term effects. The steroid injection is a more effective way to be administered than oral steroid tablets. (National Library of Medicine, 2024)

 

When to go for surgery

As osteopaths, we recommend initially adopting a conservative treatment approach. However, if the condition persists and the pain becomes severe or significantly impacts daily activities, surgical intervention may be necessary for optimal patient outcomes.

 

How can osteopathy help?

As an osteopath we can help with a conservative approach to the management of the condition through the use of a range of techniques and approaches these include:  soft tissue massage, ergonomic changes within your daily activities to help take the pressure and reduce inflammation on that area, Dry needling, joint mobilization, nerve glides, and joint manipulation. These techniques aim to decrease your pain, increase function, and get you back to normal function as fast as possible. 

 

References:

Institute for Quality and Efficiency in Health Care (IQWiG). (2024). Carpal tunnel syndrome: Learn more – How effective are steroids? In InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279598/

Karjalainen, T. V., Lusa, V., Page, M. J., O’Connor, D., Massy-Westropp, N., & Peters, S. E. (2023). Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2023(2), Article CD010003. https://doi.org/10.1002/14651858.CD010003.pub2

Laymon, M., Petrofsky, J., McKivigan, J., Lee, H., & Yim, J. (2015). Effect of heat, cold, and pressure on the transverse carpal ligament and median nerve: A pilot study. Medical Science Monitor, 21, 446–451. https://doi.org/10.12659/MSM.892462

O’Connor, D., Page, M. J., Marshall, S. C., & Massy-Westropp, N. (2012). Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2012(1), Article CD009600. https://doi.org/10.1002/14651858.CD009600

Sevy, J. O., Sina, R. E., & Varacallo, M. A. (2023). Carpal tunnel syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448179/

 

Shoulder Pain

 

Shoulder Pain: Causes, Symptoms, and Treatment Options

Shoulder pain is a common complaint that can be caused by a variety of factors. Whether you have injured your shoulder during physical activity or are experiencing chronic pain, it is important to understand the underlying causes and treatment options available to you. Today, we will discuss the causes, symptoms, and treatment options for shoulder pain.

Causes of Shoulder Pain

Shoulder pain can be caused by a wide range of factors, including:

  • Rotator cuff injuries: The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Injuries to the rotator cuff can occur due to overuse, trauma, or degeneration over time.
  • Shoulder dislocation: Dislocating your shoulder can lead to pain, swelling, and instability in the joint.
  • Frozen shoulder: Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint.
  • Tendonitis: Tendonitis is inflammation of the tendons in the shoulder, often due to overuse or repetitive motions.
  • Arthritis: Arthritis can cause pain, swelling, and stiffness in the shoulder joint.

Symptoms of Shoulder Pain

The symptoms of shoulder pain can vary depending on the underlying cause. Common symptoms include:

  • Pain: Pain in the shoulder joint that may be sharp or dull.
  • Stiffness: Difficulty moving the shoulder joint, especially when raising your arm.
  • Weakness: Weakness in the shoulder muscles, making it hard to perform daily activities.
  • Swelling: Swelling and inflammation in the shoulder joint.
  • Popping or clicking: Audible sounds or sensations when moving the shoulder joint.

Treatment Options for Shoulder Pain

There are several treatment options available for shoulder pain, depending on the underlying cause and severity of the symptoms. Some common treatment options include:

  • Rest: Taking a break from activities that aggravate your shoulder pain can help reduce inflammation and promote healing.
  • Ice and heat therapy: Applying ice or heat to the affected area can help reduce pain and inflammation.
  • Physical therapy: A physical therapist can teach you exercises to strengthen the muscles in your shoulder and improve range of motion.
  • Medication: Over-the-counter pain relievers or prescription medications may be recommended to manage pain and inflammation.
  • Injections: Corticosteroid injections can help reduce inflammation and pain in the shoulder joint.
  • Surgery: In severe cases, surgery may be necessary to repair damaged tissues or improve joint function.
  • Osteopathy: an Osteopath can help you to release the area and the surrounding tissues, and provide advice and support to aid in the management of Shoulder issues

Preventing Shoulder Pain

While some causes of shoulder pain cannot be prevented, there are steps you can take to reduce your risk of developing shoulder problems. Some tips for preventing shoulder pain include:

  • Warm up before exercising: Stretching and warming up before physical activity can help prevent injuries.
  • Practice good posture: Maintaining proper posture can reduce strain on your shoulder muscles and joints.
  • Avoid repetitive motions: If possible, avoid repetitive movements that can strain your shoulder joint.
  • Use proper lifting techniques: Lift heavy objects with your legs, not your shoulders, to reduce the risk of injury.
  • Stay active: Regular exercise can help strengthen your shoulder muscles and improve joint flexibility.

Shoulder pain can be a frustrating and debilitating condition, but with the right treatment and preventative measures, you can manage your symptoms and improve your quality of life. If you are experiencing shoulder pain, it is important to consult with a healthcare professional to determine the underlying cause and develop a treatment plan that works for you. The Osteopaths here at Eclipse Health and Osteopathy can help you to understand the cause of your pain and assist in relieving or managing the condition. We aim to keep you doing what you love.

By understanding the causes, symptoms, and treatment options for shoulder pain, you can take the necessary steps to address your symptoms and prevent future injuries. Remember to listen to your body and seek medical attention if you experience persistent or severe shoulder pain.

Enhancing Neck Mobility and Comfort: by Dr Andrew Welsh, PhD, Osteopath

Enhancing Neck Mobility and Comfort: by Dr Andrew Welsh, PhD

Experiencing neck pain and stiffness can significantly impact daily activities, from working at a desk to participating in sports. Dr Andrew Welsh (PhD), an Osteopath with 24 years of clinical practice and a recent addition to the team at Eclipse Health and Osteopathy, aims to assist individuals in improving neck mobility and decreasing discomfort. Andrew has dedicated recent years to post-graduate study and research in Europe, culminating in a PhD focused on spinal quantitative assessment and exercise prescription.

Understanding Neck Range of Motion (ROM)

The cervical spine’s range of motion is crucial for functional movements and overall quality of life. Quantitative assessment of neck ROM provides valuable insights into mobility limitations and guides tailored interventions.

 

  • Normal Neck ROM Values: According to Norkin and White (2016), typical cervical spine movements in healthy adults are approximately:
    • Flexion (forward bending): 60 degrees
    • Extension (backward bending): 75 degrees
    • Lateral flexion (side bending): 45 degrees
    • Rotation: 80 degrees
  • Age-Related and Pain-Related Changes:
    • Age-Related Changes: Cervical spine mobility tends to decline with advancing age. A study by Yukawa et al. (2012) found that cervical ROM decreases significantly with age, particularly in the lower cervical spine (C2–C7). Kuhlman (1993) also observed similar findings. The elderly group had approximately 12% less flexion, 32% less extension, 22% less lateral flexion, and 25% less rotation. The elderly group also had a wider variation of cervical range of motion values than the younger group, highlighting the importance of understanding age-related ROM changes and their potential impact on daily activities like driving or looking upward. Studies suggest that targeted interventions, such as stretching and mobilisation exercises, can help mitigate these age-related declines (Gross et al., 2015).
    • Pain-Related Changes: Research indicates that neck pain is associated with reduced ROM. A systematic review by Thoomes-De Graaf et al. (2020) found that total active ROM significantly decreases in individuals with neck pain compared to healthy controls, particularly in flexion and rotation. A systematic review by Reid et al. (2014) highlighted that manual therapy can significantly improve cervical ROM and pain in patients. Additionally, a systematic review by Miller et al. (2010) demonstrated that manual therapy combined with exercise provides greater improvements in pain, ROM, and quality of life in individuals with chronic neck pain compared to either intervention alone.

Impact of Modern Technology and Workplace Ergonomics

Prolonged use of electronic devices and suboptimal workplace ergonomics can contribute to neck discomfort.

  • “Tech Neck”: The term “Tech Neck” describes neck pain associated with extended periods of looking down at screens. This posture can lead to muscle strain and joint discomfort.
  • Office Ergonomics: Improper workstation setups are linked to increased neck pain among office workers. Adjusting monitor height, chair support, and keyboard placement can alleviate strain.

Benefits of Exercise and Manual Therapy

Combining exercise with manual therapy may offer benefits for individuals experiencing neck pain.

  • Exercise Programmes: Regular exercises focusing on neck flexibility and strength aim to enhance range of motion and reduce discomfort. A systematic review by Gross et al. (2015) suggests that specific exercises can be beneficial for mechanical neck disorders.
  • Manual Therapy: Techniques such as mobilisation and manipulation, when combined with exercise, may provide improvements in pain and function. A randomised controlled trial by Reid et al. (2014) demonstrated that manual therapy techniques significantly improved cervical ROM and pain, highlighting its potential to enhance mobility and alleviate discomfort. Additionally, Miller et al. (2010) emphasised that combining manual therapy with exercise leads to greater outcomes in terms of pain reduction, functional improvement, and overall patient satisfaction.

Dr Andrew Welsh’s Approach

At Eclipse Health and Osteopathy, Dr Andrew Welsh employs precise measurement tools, including Swiss and German-made goniometers, to assess cervical spine mobility. This quantitative assessment informs personalised treatment plans that may include:

  1. Comprehensive Evaluation:
    • Utilising precise measurement devices to identify specific limitations in neck movement.
    • Assessing factors contributing to discomfort, such as posture and ergonomic habits.
  2. Individualised Interventions:
    • Developing exercise programmes tailored to improve flexibility and strength.
    • Incorporating manual therapy techniques aimed at enhancing mobility and reducing pain.
  3. Ergonomic Guidance:
    • Providing advice on optimising workplace setups to minimise strain.
    • Educating on posture correction strategies to prevent “Tech Neck.”

Take the Next Step

If neck pain or stiffness is affecting your daily life, you may benefit from a consultation with Dr Andrew Welsh. By providing a thorough assessment and tailoring care to your individual needs, he seeks to assist patients in addressing neck discomfort and improving overall function. Further research continues to advance our understanding of neck mobility and treatment options, and personalised approaches remain a cornerstone of effective care.

 

References

  • Gross, A., et al. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews, (1).
  • Kuhlman, K. A. (1993). Cervical range of motion in the elderly. Archives of Physical Medicine and Rehabilitation, 74(10), 1071–1079. https://doi.org/10.1016/0003-9993(93)90064-h
  • Miller, J., et al. (2010). Manual therapy and exercise for neck pain: A systematic review. Manual Therapy, 15(4), 334–354.
  • Norkin, C. C., & White, D. J. (2016). Measurement of Joint Motion: A Guide to Goniometry (5th ed.). Philadelphia, PA: F.A. Davis Company.

 

Rediscover Your Mobility with Precision: by Dr Andrew Welsh(PhD), Osteopath

Rediscover Your Mobility with Precision: by Dr Andrew Welsh (PhD), Osteopath

Are you living with chronic back or neck pain that affects your ability to move freely? An Osteopath with 24 years of clinical practice and a new addition to the team at Eclipse Health and Osteopathy, Andrew aims to assist you in working towards reducing pain and improving your ability to engage in daily activities, hobbies, or sports. Much of Andrew’s recent years have been spent in Europe pursuing post-graduate study and research, including completing his PhD, presenting at conferences, and he is a course presenter for Sports Medicine Australia.

Dr Andrew Welsh Osteopath

Copyright © 2025 Dr Andrew Welsh. All rights reserved.

Understanding the Importance of Mobility in Managing Pain

Back and neck pain are common concerns, with many people experiencing limitations in their daily lives. Chronic non-specific low back pain (NSCLBP) can be particularly challenging, but research suggests that improving spinal flexibility and strength may contribute to better outcomes.

  • Age and Spinal Mobility: A systematic review by Intoloa et al. (2009) highlights that lumbar range of motion (ROM) tends to decrease after the age of 40, particularly in flexion (forward bending), extension (back bending) and lateral flexion (bending to the sides). Interestingly, the study found that rotation tends to be spared in the aging process. This suggests that stiffness to twist, often blamed on age and dismissed as something one must “live with,” may not actually be a direct result of aging. Appropriate strategies may improve mobility in this plane for some patients.
  • Exercise for Chronic Pain: Research by Gordon and Bloxham (2016) suggests that exercise programs focusing on strength, flexibility, and aerobic fitness aim to improve movement and may help manage pain, supporting daily and recreational activities.

How Dr Andrew Welsh Works with You

Andrew integrates advanced Swiss and German-made precision measurement devices known as goniometers to assess spinal range of motion and develop personalised in-room therapy and exercise programs. His approach is designed to support individuals in addressing their unique needs and goals.

  1. Detailed Assessments:
    • Measurement tools provide precise data on spinal mobility and areas of stiffness or instability.
    • This information helps guide tailored intervention plans.
  2. Individualised Exercise Programs:
    • Drawing on evidence-based research, Andrew incorporates flexibility training, core strengthening, and aerobic conditioning to support spinal health.
    • For example, McGregor et al. (1997) noted that mobility-focused programs may benefit individuals with conditions like disc degeneration.
  3. Focus on Practical Benefits:
    • Exercises aim to improve your ability to perform everyday activities, such as bending or lifting.
    • Programs are designed to support hobbies and sports, encouraging safe and enjoyable participation.

What the Research Says

  • A 6-week aerobic exercise program was associated with a 20% reduction in discomfort for NSCLBP patients and improved their ability to manage daily tasks (Gordon & Bloxham, 2016).
  • Flexibility-focused exercises in women with chronic pain were linked to a 98% improvement in lumbar extension, showing the potential benefits of targeted stretching (Intoloa et al., 2009).
  • Core stability exercises in a study showed reductions in back pain by up to 76.8%, highlighting the role of strengthening deep abdominal and spinal muscles (Gordon & Bloxham, 2016).

Take the Next Step

Andrew’s approach is centred on supporting your journey toward better mobility and improved participation in activities that matter to you. Using Swiss and German-engineered measurement tools and evidence-informed exercise plans, he aims to provide guidance tailored to your needs.

Consider booking an appointment if you’d like to explore how these strategies might work for you. This initial step can help determine the suitability of a program designed to support your spinal health and mobility goals.

References

  • Intoloa, P., Milosavljevic, S., Baxter, D. G., Carman, A. B., Pala, P., & Munn, J. (2009). The effect of age on lumbar range of motion: A systematic review. Manual Therapy, 14(6), 596–604.
  • McGregor, A. H., McCarthy, D., Doré, C. J., & Hughes, S. P. (1997). Quantitative assessment of the motion of the lumbar spine in the low back pain population and the effect of different spinal pathologies on this motion. European Spine Journal, 6(5), 308–315.
  • Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare, 4(2), 22.

Jaw Pain

Understanding TMJ Disorder and Jaw Pain: An Osteopath’s Perspective

Temporomandibular Joint (TMJ) disorder can affect the joint that connects your jawbone to your skull. This small but essential joint plays a significant role in daily activities like talking, eating, and even breathing. When something isn’t quite right with this joint, it can lead to discomfort, limited movement, and impact your quality of life. At our clinic, we take a whole-body approach to TMJ issues, focusing not just on the jaw but also on other areas of the body that might be contributing to the problem, including potential sources of jaw pain.

What is TMJ Disorder?

TMJ disorder (sometimes called TMD) refers to problems affecting the jaw joint and nearby muscles. You might notice symptoms like jaw pain, clicking or popping sounds, headaches, earaches, or difficulty opening and closing your mouth. While dental issues can sometimes play a role, muscle and joint problems are often key contributors, leading to significant jaw pain.

TMD can be due to issues inside the joint itself (intra-articular), like inflammation or wear and tear, or outside the joint (extra-articular), such as muscle tension or poor posture. Understanding the cause of your jaw pain is important in finding the right approach to help.

In our modern, busy, and often stressful lives, with limited time for rest and recovery, stress can also play a significant role in contributing to TMD. Clenching or grinding your teeth (often unconsciously during sleep) is a common stress reaction, which can overwork the jaw muscles and lead to discomfort or pain, exacerbating jaw pain issues.

The Value of the Osteopathic Approach

We look at the bigger picture when it comes to TMJ problems. We aim to help reduce discomfort and improve how your jaw and body work together. We use gentle hands-on techniques to help ease tension, improve movement, and support your body’s natural balance, specifically targeting areas that may be causing jaw pain.

Our approach may include:

  • Gentle exercises to help improve jaw movement and strengthen supporting muscles.
  • Hands-on therapy to ease muscle tension and encourage better joint function.
  • Posture advice to help reduce strain on the jaw and neck.
  • Relaxation techniques to support overall well-being and help reduce muscle tension.

How Hands-On Therapy Can Help

Research has shown that hands-on therapy can be helpful for people experiencing TMJ discomfort and jaw pain. Studies have found that techniques like gentle joint movements, soft tissue massage, and muscle relaxation can help ease pain and improve jaw movement.

One study by Calixtre et al. (2015) highlighted how these methods can help reduce pain and improve how wide the mouth can open. Another study by Urbański et al. (2021) found that focusing on relaxing the muscles used for chewing can also bring relief from jaw pain.

Related Areas That May Affect TMJ

  1. Neck and Upper Back:

Poor posture, especially from spending long hours at a desk or on devices, can lead to tension in the neck and upper back. This tension can sometimes affect how your jaw moves and feels, potentially leading to increased jaw pain.

  1. Shoulders:

Tightness or imbalances in the shoulders can pull on the neck and jaw, contributing to discomfort and jaw pain.

  1. Muscles Involved in Jaw Movement:

Several muscles help your jaw move, including the ones inside your mouth and those in your neck and head. If these muscles are tight or not working well together, they can cause jaw pain or clicking sounds.

  1. Pain from Other Areas:

Sometimes jaw pain isn’t coming from the jaw itself. Issues in the neck or head can send pain signals to the jaw area. This is why we take a whole-body approach to find the root cause of jaw pain.

When to Seek Further Advice

While TMJ discomfort is often due to muscle or joint issues, there are times when further medical checks are essential. If you notice any of these signs, it’s a good idea to speak with your doctor:

  • Unexplained weight loss or tiredness
  • Worsening headaches
  • Numbness or tingling in the face
  • Severe or constant pain
  • Swelling around the jaw or neck

Osteopaths recognise that in some cases, it might also be helpful to work with other healthcare professionals like dentists or speech pathologists to ensure you’re getting the most complete care. Research by Brighenti et al. (2023) suggests that a team approach can be beneficial when managing TMJ disorders and associated jaw pain.

How We Assess and Support TMJ Function

When you visit us with jaw discomfort, we take the time to look at how your jaw, neck, back, and shoulders are moving. We want to understand how everything is working together so we can offer the most suitable care for you.

If you’re experiencing TMJ discomfort or are curious about how osteopathy might help with your jaw pain, we’d be happy to chat with you. We’re here to support you on your journey to feeling better—feel free to reach out and book a consultation.

Let’s work together to help you move and feel your best!

References

  1. Calixtre, L.B., Moreira, R.F.C., Franchini, G.H., Alburquerque‐Sendín, F., & Oliveira, A.B. (2015). Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: A systematic review of randomised controlled trials. Journal of Oral Rehabilitation, 42(11), 847-861.
  2. Urbański, P., Trybulec, B., & Pihut, M. (2021). The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders. International Journal of Environmental Research and Public Health, 18(24), 12970.
  3. Brighenti, N., Battaglino, A., Sinatti, P., Abuín-Porras, V., Romero, E.A.S., Pedersini, P., et al. (2023). Effects of an Interdisciplinary approach in the management of temporomandibular Disorders: A scoping review. International Journal of Environmental Research and Public Health, 20(4), 2777.

What is Bursitis?

What are bursa?

Bursa are synovial fluid filled sacs that are approximately 4cm in diameter and 2mm thick.

Busa are located in many joints of the body such as the subacromial/subdeltoid bursa in the shoulders, olecranon bursa in the elbows, trochanteric bursa in the hip, prepatellar and infrapatellar bursa of the knee and the retrocalcaneal bursa in the ankle.

They aim to help the bones, tendons, ligaments and muscles in the joints to glide and move smoothly and decrease friction.

What is bursitis

Bursitis is inflammation and irritation of the bursa.

Symptoms include pain, tenderness, decreased joint range of motion. This can be particularly prominent on any compression of the bursa such as when laying on that side to sleep, overhead movements and more.

Bursitis can commonly occur with tendonitis of other muscles that attach to the site such the rotator cuff or gluteal muscles.

Bursitis can be diagnosed using ultrasound or MRI.

An acute bursitis can take anywhere from 4-6 weeks to heal if there is no re-injury or aggravation

Why does bursitis occur

Bursitis can occur as a result of a traumatic injury to an area or as a repetitive movement in activities such as carpentry, painting, gardening, shovelling and sports such as tennis, golf and baseball.

You are more likely to develop bursitis if you have conditions such as arthritis, gout, immune deficiencies such as HIV and diabetes, autoimmune conditions such as rheumatoid arthritis, scleroderma and lupus. Trauma and infection also predispose you to greater risk of bursitis.

How can you prevent bursitis?

As an athlete make sure you are warming up properly for 5 to 10 minutes prior to exercise and warming down properly after exercise and maintaining proper recovery strategies.

Use good equipment such as braces, shoes and pads to protect your joints.

Maintain a healthy lifestyle through exercise and diet by eating foods rich in vitamins, antioxidants, fibre, omega-3 and other anti-inflammatory foods. Avoid foods containing excess sugar and saturated fats.

What are the medical treatments for Bursitis

Medication that can be used for treatment includes nonsteroidal anti-inflammatory drugs (NSAIDS) to decrease acute pain, corticosteroid injections into the affected area and if the bursa is infected antibiotics.

Surgical treatment such as an arthroscopy in which the bursa will be drained and scar tissue removed.

What are some conservative treatments for Bursitis

Activity modification to avoid aggravating movements may be suggested. This can include overhead motions with the arms, running or laying on the side of bursitis of a hip, kneeling, bending and squatting for bursitis of the knee.

Exercise to strengthen the surrounding musculature as well as mobility to ensure that the joint and other compensatory mechanisms are working to the best of their ability may also be prescribed.

Some practitioners may choose to use ultrasound therapy or TENS machine for treatment however results are varied.

Seeing an Osteopath can also help with the symptoms of bursitis.

What will happen when you come to an osteopathic appointment?

When you come to an osteopathic appointment there are three stages of consultation. We will ask you about your injury, the mechanism of how you did it, what movements hurt, what makes it better. From there we will assess the area and test for impingement that may be caused by bursitis as well as other tests for the muscles and joints.

Through treatment we aim to decrease pain, increase range of motion and achieve specific patient set goals. Treatment can involve muscle energy techniques that focus on the muscle, joint mobilisation, fascial release, ligament release and more. After treatment we may prescribe exercises and refer you back to your doctor for scans if we think further investigation is required.

References:

What You Need to Know About Knee Bursitis – Well Heeled Podiatry. (n.d.). Retrieved June 27, 2024, from https://www.wellheeledpodiatry.com.au/what-you-need-to-know-about-knee-bursitis#:~:text=Activities%20like%20frequent%20kneeling%2C%20squatting%2C%20or%20bending%20the

Bennett, S., Macfarlane, C., & Vaughan, B. (2017). The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. EXPLORE13(5), 339–343. https://doi.org/10.1016/j.explore.2017.01.002

Bursa. (n.d.). Kenhub. https://www.kenhub.com/en/library/anatomy/bursa

bursa | Description, Types, & Function. (n.d.). Encyclopedia Britannica. https://www.britannica.com/science/bursa-anatomy

Chmielewski, R., Pena, N., Capalbo, G. (2013). Osteopathic manipulative treatment of pes anserine bursitis using the triple technique: a case report. AAOJ 23. Pp 34-38. https://www.researchgate.net/profile/Nicole-Pena-6/publication/287632071_Osteopathic_manipulative_treatment_of_pes_anserine_bursitis_using_the_triple_technique_A_case_report/links/5ff26ee5a6fdccdcb82a73d4/Osteopathic-manipulative-treatment-of-pes-anserine-bursitis-using-the-triple-technique-A-case-report.pdf?_sg%5B0%5D=started_experiment_milestone&origin=journalDetail&_rtd=e30%3D

Cleveland Clinic. (2020, May 29). Bursitis; Causes, Treatment & Prevention. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10918-bursitis

McCormack, J. (2023, October 10). Hip Bursitis Exercises To AVOID by a Physical Therapist. Flawless. https://flawlessphysio.co.uk/hip-bursitis-exercises-to-avoid/#:~:text=Walking%2C%20running%2C%20cycling%2C%20and%20many%20cardio%20exercise%20machines%2C

MSN. (n.d.). Www.msn.com. Retrieved June 27, 2024, from https://www.msn.com/en-us/health/condition/Bursitis/hp-Bursitis?source=conditioncdx

Sears, B. (2022, March 3). Bursae Are Small Structures That Protect Your Joints. Verywell Health. https://www.verywellhealth.com/bursae-anatomy-function-and-treatment-4686312

Lymphatic Drainage Sequence

Lymphatic system

Lymphatic Drainage 

Lymphatic fluid has a variety of functions. It is part of the immune system as it produces and releases lymphocytes – a type of white blood cells to protect against bacteria, virus’ and fungi. It absorbs nutrients from the intestines and moves them into the blood stream. It also gathers excess fluid and swelling and removes them.  

The path of lymphatic drainage is as follows: Blood capillaries -> Interstitial Fluid -> Lymph Capillaries -> Lymph Veins -> Lymph Ducts -> Large circulatory Veins

The fluid is moved through muscle activation of all muscles. You can assist this process by practicing breathing with your diaphragm (breathing into your belly) and also through muscle contraction.

It is not advised to perform lymphatic drainage if you have congestive heart failure, cardiac oedema, acute infections, acute DVT, malignancy, severe unstable hypertension or up to 6 weeks after surgery/trauma.

Patients with swelling not caused by these above conditions or with the condition lymphoedema can perform self lymphatic drainage in combination with other activities such as swimming for a minimum of one hour per day.

The following can all be done laying on your back.

Diaphragm Release

  1. Place hands on the lower ribs.
  2. Breathe in for four counts, hold breath for four counts, breathe out for four counts.
  3. Repeat 3 times.

Thoracic duct release

  1. Hand over the centre of the chest under the collarbones – keep this hand relaxed.
  2. Place your other hand over the top with firm pressure.
  3. With the top hand move the bottom hand in and down in the shape of a C
  4. Repeat this 5 times alongside slow breaths.

Axillary Release/Pec Release

  1. Pinch your pec muscles between your thumb and other fingers.
  2. Move your arm in a straight line diagonally towards the wall behind you. Only do this about 20 degrees and stop if there is pain.
  3. Bring the arm in front of the body diagonally trying to touch the opposite hip.
  4. Repeat until you feel the muscle relax. Try to not have your shoulder activated during this process.

Galbreath and Cervical Lymph node release

  1. Firstly, grab the ear and move it in a circle.
  2. With two knuckles either side of the jaw tracing until you reach your chin. From there trace back along the jaw and down the neck.
  3. Repeat 3 times.

Sinus release/facial drainage

Maxillary:

  1. Place your little fingers or thumbs either side of your nose just above the nostrils.
  2. Hold until you feel a softening and release then drag back towards the ear.
  3. Repeat 5 times.

Frontal:

  1. With your little fingers or thumbs hook under the brow bone.
  2. Wait till you feel a softening and then drag out following the brow bone back towards the ear.
  3. Repeat 5 times.

Inguinal release

  1. Find your hip bone and pubic bone. Following the diagonal line come to the mid point and press gently with your fingers.
  2. Bring your leg towards your head with your knee bent.
  3. Gently move your hip in a controlled circle until you feel the muscle under your hand start to relax.

Popliteal Release

  1. Begin seated. Bend and straighten your knee to assist in fluid movement.
  2. Contact the back of your knee with your fingers and the sides of your knee with the heel of your hand. Use both hands to encourage fluid movement by pushing to one side and then the other.

Massage:

You can help manually move fluid with your hands after doing all of these steps as the channels will be open.

Begin with your legs and work up, dragging the fluid past the immediate joints e.g. foot past ankle, ankle past knee, knee to hip. Take your hands off when you pass the individual joints and start again until you feel a decrease of fluid in the area – this will stop a backwash of fluid.

As Osteopaths we regularly see people with lymphatic congestion and do a lot of work to help with lymphatic drainage and restoring the body to a state where it can clear excess fluid. If you would like to know more or book an appointment call our clinic on 07 5613 3505

References:

BRMI | Therapeutics – Lymphatic Drainage & Massage. (n.d.). Bioregulatory Medicine | BRMI Bioregulatory Medicine Institute. Retrieved June 28, 2024, from https://www.brmi.online/lymph

Cleveland Clinic. (2023, July 31). What Does the Lymphatic System Do? Learn Its Function & How It Works. Cleveland Clinic; Cleveland Clinic. https://my.clevelandclinic.org/health/body/21199-lymphatic-system

Physiopedia. (n.d.). Manual Lymphatic Drainage. Physiopedia. https://www.physio-pedia.com/Manual_Lymphatic_Drainage

The Editors of Encyclopedia Britannica. (2019). lymphatic system | Structure, Function, & Facts. In Encyclopædia Britannica. https://www.britannica.com/science/lymphatic-system