What is Myotherapy?


I am often having to explain what it is I do as a myotherapist, there seems to be some confusion where we are placed in the healthcare system compared to phsiotherapist’s, osteopaths, massage therapists, and chiropractors.  The actual definition of myotherapy can be found on the Myotherapy Australia website; this article is about my role as a myotherapist, what I do, and who I help.

As an evidence-based practice, it is mandatory for myotherapists to be up to date with the latest research.  This is a vast area and includes pain management, injury management, education, and rehabilitative exercises.  Myotherapists are generally known as hands-on therapists with a strong knowledge of the muscular system.  This is true but it is only a fraction of how we treat.  To showcase the diversity of what we treat, here is a typical day in my clinic (names have been changed):

John - Chronic Low Back Pain
John has been in significant pain for over 20 years. Following spinal fusion surgery his neural symptoms reduced but his myofascial pain is constant.  He has tried everything from massage, physio & yoga to pilates.  Our first session was spent with me listening to John's concerns and his struggle with the pain.  John also had some stress within his life, understanding the role stress can play in chronic pain is a real eye-opener for many people.  John is determined to keep going down the 'natural' path and wanted to avoid the use of medications and invasive interventions, as long as he could.  My role in this situation was to listen to John's concerns and help him with the pain where possible.  From our conversation, I understood he got significant relief from manual therapy, so this is what we did. Using a combination of massage and mobilisations I managed to give John some back pain relief.  Combining our sessions with his daily strength exercises allows him to lead a manageable lifestyle.  Guiding John to investigate further the link between stress and chronic pain is also part of our sessions.

Kylie - Masters Swimmer: Shoulder Pain
Kylie is a masters swimmer training 3-4 times a week as well as competing throughout the season. She presented with left-side shoulder pain which she was noticing during training sessions. She did not feel the pain outside of the pool, and it was not affecting her sleep.  After assessing her movement and looking at her training over the last few weeks we noticed there had been an increase in both load and intensity.  To avoid the shoulder pain turning into a chronic condition, we discussed reducing the load and possibly avoiding certain strokes until the pain subsided.  Using manual therapy, I treated the muscles I considered to be contributing to the pain and provided a coupe of isometric exercises for her to do prior and during training to help with pain.  Once the pain has subsided we will work on a shoulder strengthening program to avoid recurrence. 

Sue - Headaches and Neck Pain
Sue is a writer and presented with ongoing headaches and neck pain.  During her initial visit, we discussed her day to day habits, including when the headaches and neck pain are most prominent, sleep habits (position, pillow, sleep hygiene), exercise routine, desk set-up, medication intake and work habits (time at desk, breaks etc).  Sue's history highlighted some easy lifestyle changes she could make outside of the clinic which I was confident would dramatically improve her pain and reduce her headaches.  Along with education and some simple exercises, we did a movement assessment and treated the muscles I suspected to be largely responsible for Sue's headaches and neck pain.  Sue left with increased movement through the neck and shoulders and some homework before our next appointment. 

Joan - Shoulder Pain & Rotator Cuff tear
Joan is retired and enjoys gardening, she has had persistent and increasing pain in her right shoulder for many months. The discomfort came on initially after pulling out some stubborn tress a year ago and has not improved.  An MRI scan revealed tears in two of her rotator cuff muscles, as well as bursitis.  Our appointments initially focused on pain management and maintaining then increasing shoulder movement.  Once we had achieved this, we added strengthening exercises to the routine.  Joan's movement has now been restored, and she is mostly pain free. This has not been a quick fix but with pererverence, monitoring, and commitment she has managed to avoid the surgery she was determined not want to have.  Joan now sees me monthly for a general hands-on treatment to ease muscle tension around the shoulder complex as well as re-visiting her exercises when required.  She also visits her trainer at the gym twice a week who works with her on her shoulder strength, which is imperative to remaining pain free.

Steve - Low Back: Suspected Bulging Disc
Steve hobbled into the clinic, literally bent over in pain, he said his back had "gone out".  This had happened before so he knew it would get better eventually but hoped to get some relief by seeing a myotherapist.  His pain was local around his right-side lumbar area; he had no pain down his legs, no numbness or pins and needles. 
Our first session was spent with Steve mostly standing as sitting was too painful, we discussed the lead up to this event and his previous history of back issues.  I saw John on Day 3 of the pain, he had spent the first few days doing very little as the pain was too great.  We devised a plan, including gentle mobility exercises, regular walking, minimum sitting/driving, and if he did need to sit, to use support as directed.  We also spoke about how backs can't "go out", how strong and resilient our backs are, and how important it is to get back to normal daily activity.  In the meantime, Steve used heat on the muscles which helped reduce his pain, did some gentle exercises I gave him and tried to stay as mobile as he could tolerate.  Back pain like this can be scary, especially if you have not experienced it before.  In the majority of cases this is short term and with the right education and tools provided by your therapist you can get back to full movement as soon as possible.

No pain or injury can be fixed with manual therapy alone; it may ease the symptoms but in most cases it is a short-term solution.  In Myotherapy, the use of manual therapy (massage, mobilisation, dry needling) is one tool that is often used together with education and exercise (strengthening/mobility).  Understanding that pain and/or injury requires a multi-dimensional approach for recovery will mean your road to recovery will be more successful.

In summary, a myotherapist treats a wide variety of issues from acute to chronic pain. My goal as a myotherapist is to provide my patients with the knowledge and tools to take ownership of their condition, an understanding of what is going on puts you on the right path to recovery.