Answers to frequently asked questions

 

Chiropractic questions and answers

On this page we have attempted to provide a fairly comprehensive question and answer to many frequently asked questions (FAQ) regarding chiropractic, massage therapy and dry needling as these disciplines are practised at Southside Health Care.  If you can’t find the answer to your question please give us a call on 08 8382 2255 or use the contact form.

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Chiropractic Q&A

What is chiropractic?

Modern chiropractic is an evidence based primary health care profession that focuses on the diagnosis and treatment (primarily, although not exclusively, by manual manipulation) of musculoskeletal disorders (primarily, although not exclusively, spinal).

Do you need a referral to see a chiropractor?

No.  Chiropractic is a primary health care profession, meaning that chiropractors are appropriately qualified in diagnosis and therefore do not need to work under the direction of any other health care professional.  If the chiropractor diagnoses or suspects a condition outside the chiropractic scope of practice then the patient will be referred on appropriately.

What conditions do chiropractors treat

The primary expertise of chiropractors is in the conservative (non-surgical) drug free treatment of back pain, neck pain and associated headaches.  Many other musculoskeletal conditions (joint or muscular conditions) and the general health or neurological consequences of these conditions fall into the scope of chiropractic. The following is a list of some of the more common conditions (in layman’s terms) treated by chiropractors:

 

  • Sports Injuries
  • Neck Pain
  • Pregnancy Back Pain
  • Muscular Pain
  • Scoliosis Management
  • Ankle Pain
  • Non Specific Low Back Pain
  • No Specific Neck Pain
  • Headaches
  • Migraines
  • Back Pain
  • Muscular Tension / Cramps
  • Jaw Pain  (TMJ Syndrome)
  • Pelvic Girdle Pain (Sacroiliac Syndrome)
  • Elbow Pain (Tennis Elbow  & Golfers Elbow)
  • Arthritis
  • Joint Strain
  • Muscle Strain
  • Heel Spur (Plantar fasciitis)
  • Disc Bulge / Tears
  • Frozen Shoulder
  • Tendonitis
  • Pinched Nerve
  • Shoulder Pain
  • Sciatica
  • Hip Pain
  • Foot Pain
  • Knee Pain
  • Bursitis
What types of treatments do chiropractors use?

After taking a thorough history, examining the patient, and arriving at a diagnosis the chiropractor will then obtain consent to commence treatment.  In most cases treatment consists of the following:

1. Soft tissue manipulation.  ie massage and / or stretching techniques for muscles or  tendons.  Other soft tissue modalities that are often used include dry needling and kinesio-taping.
2. Joint manipulation or mobilisation.  This is what chiropractors are famous for and where they have their greatest expertise.  Chiropractic manipulation is also known as an adjustment.  Mobilisation is generally a slower and very gentle method freeing up a joint; it does not take a joint outside of its normal range of movement.   For further explanation of chiropractic manipulation see subsequent FAQs.
3. Home management advice.  This will usually include a therapeutic exercise program, advice on home management of pain (such as ice & heat pack), and advice on daily activities such as posture, lifting, sport, work, sitting and sleeping position.

 

 

The following is a list of the specific techniques / modalities that we use at Southside Health Care:

Does a chiropractic adjustment hurt?

Most people are surprised how little it hurts; if at all.

What can I expect on the first chiropractic appointment?

The chiropractor will review the information that you’ve provided on your new patient form then take a full history (not only regarding your main presenting complaint but also some general health history).  A thorough physical examination will then be performed.  Following this the chiropractor will explain what has been found on examination and will make recommendations for treatment.  If X-rays or other imaging is required (in practice, they are usually not) then you will be provided with a referral.  Written informed consent to treatment will then be obtained and treatment will be provided.  At Southside Health Care we almost always provide treatment on the initial appointment.  The only reason that we would not provide any treatment on the initial appointment is if it were to be deemed that chiropractic intervention was not appropriate at all in your case.

What can I expect on subsequent chiropractic appointments?

The appointment will begin with an update on your history (ie. ‘What’s changed since your last appointment?’, and ‘Is your condition improving?’).  Re-examination is always performed before treatment is commenced.  Finally the chiro will give continued advice on home management and will advise if and when the next appointment will be required.

Do you have to get undressed for a chiropractic appointment?

Generally not.  Most of the therapies applied by the chiro are actually best done through one layer of light clothing.  On examination the chiropractor may require some disrobing, for example to better visualise a spinal curve (scoliosis) or to check a joint for swelling or inflammation.  Some of the modalities used do require the skin to be exposed, for example dry needling.  Where disrobing is required it is usually only the involved area that needs to be exposed.  Patient gowns are provided where necessary and patient modesty is respected at all times.

What should I wear to the chiropractor?

Whatever is comfortable.  Be aware that you will have to lie on a treatment table and roll into different positions so tight restrictive clothing should be avoided.  If you wear a long dangling  necklace or ear rings to the chiro, they will have to be taken off before treatment.

What is sports chiropractic?

Sports chiropractic is a branch of chiropractic with a focus on providing care in the conservative management, rehabilitation and prevention of sports injuries for people involved in physical pursuits ranging from elite athletes to occasional recreational participants.  This is achieved through the application of multiple treatment approaches that include the following.

  • Manipulation
  • Mobilisation
  • Soft Tissue Therapies (Massage, PNF Stretching etc.)
  • Prescription of specific rehabilitation exercises
  • Nutritional advice
  • Strapping (especially kinesio-taping)
  • Dry needling
  • Physiological therapies (such as ultrasound)

Sports chiropractors apply these approaches for both ‘rehab’ and ‘prehab’.  Rehab refers to injury management and the facilitation of return to sporting activity.  Prehab, also known as pre-event conditioning, involves the pursuit of improved neuromusculoskeletal functioning to prevent injuries and optimise athletic performance.

As with general chiropractic, sports chiropractors have special expertise in working with spinal conditions, but are trained and experienced in working with the entire musculoskeletal system.

Do chiropractors put bones back into place?

No.  In a nut shell, chiropractors free up stiff joints.  Although the phrase “I put my back out” is in frequent use and when you go to the chiropractor it feels as if the adjustment is putting a bone back into place, it is actually improving the function (movement) of a joint that is not functioning (moving) as well as it could.  If a bone was literally out of place it would be a dislocation and therefore a medical emergency.

Do chiropractors align spines?

No.  This is a common misconception.  It is quite common for patients to present with a wry neck or a postural lean to one side due to muscle spasm and pain.  As the chiropractor works with the patient, improving joint function, relieving pain and muscle spasm the patient will straighten up but it is not because the chiropractor has aligned their vertebrae back into the correct position.

What is an adjustment (chiropractic joint manipulation) and how does it work?

There are many different ways to adjust a joint but what they all have in common are that they use a mechanical thrust to improve the function (movement) of a joint that is not functioning (moving) as well as it could.  As well as improving the function of the joint, an adjustment also produces a reflex muscle relaxation around the joint.  The most commonly used type of adjustment is the manual spinal adjustment where the chiropractor uses his or her hands to deliver a quick but relatively gentle thrust to a vertebra to improve the function of joints between the vertebrae.  Manual adjustments can also be used for joints other than spinal joints.  Manual adjusting usually results in an audible popping noise (see explanation of this in a FAQ below).  Other adjusting techniques use specialised chiropractic equipment (mechanically assisted adjusting).  These techniques do not result in a popping sound.  Drop piece is a commonly used example of mechanically assisted adjusting.  Drop piece uses a section of the chiropractic table that pops up about 5cm and then drops away again when a force is applied.  Other examples of mechanically assisted adjusting techniques are Impulse and Activator adjusting.  Both of these techniques use a small hand held mechanical instrument to deliver a very fast but low force thrust to the vertebra or other bone.  Impulse and Activator adjusting are good alternatives to manual adjusting when very gentle treatment is required.

What is the popping / cracking noise often heard with a manual chiropractic adjustment?

Most joints of the body consist of two bones meeting each other in an enclosed space surrounded by a fibrous capsule synovial joints.  The friction that normally occurs when the joint moves is reduced by a small amount of lubricating fluid in the joint space synovial fluid.  Normally this fluid has some air dissolved within it.  When the two bones are pulled away from each other, the pressure within the joint capsule is reduced causing the dissolved air to come out of solution, forming a bubble.  The bubble formation allows the joint to pop open, often with an audible sound.  This is analogous to gas dissolved in a bottle of Champagne; when pressure in the bottle is reduced by loosening the cork, gas comes out of solution, forming bubbles and the cork pops open.  The formation of a bubble when a knuckle is being popped has been filmed on video MRI.  The bubble is that little black space that appears in the between the white bones at the end of the video.

 

In a spinal adjustment the joints that pop open are the little joints at the back of the spinal column known as the facet joints.  The bubble will re-dissolve back into the joint fluid in about half an hour, but the end result of the adjustment is that a stiff joint has been freed up and a reflex muscle relaxation of surrounding muscles is achieved.

Is it necessary to hear a pop / crack for a manual adjustment to be successful?

No.  Patients often do prefer to hear the crack as there is a certain degree of satisfaction of hearing the bone click back into place (even though bones going back into place is actually a myth – see above FAQ).  As chiropractors, we generally prefer to hear the sound as we then know that the joint has successfully popped open (cavitated) to free up the movement of a stiff joint.  However sometimes a joint is simply too stiff to cavitate but improved joint movement can be still achieved and it doesn’t mean the adjustment has failed.  Very good results can also be achieved by using mechanically assisted adjusting techniques or mobilisations that do not normally produce any joint sound.

Can I go to a chiropractor and not be cracked?

Yes.  Chiropractors use many interventions that do not involve any joint sounds.  Often it is not appropriate or necessary to use manual adjusting.  Sometimes it is simply the preference of the patient not to have this done.

Does joint cracking cause arthritis?

In a word, no. The aim of a chiropractic adjustment is to free up a stiff joint.  It is possible that people who habitually crack their own knuckles or self manipulate their neck or back could do some damage in the long term by over stretching ligaments around joints that are already moving perfectly well.  Similarly if a chiropractor was to manipulate the same joints several times a day for years on end it could end up doing damage, but when applied appropriately it does not.

Is chiropractic safe?

Yes, very.  Chiropractic has an excellent safety record.  However, no health treatment, including chiropractic is completely free of potential adverse effects. The vast majority of adverse events following chiropractic care are mild and transient. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness, stiffness or aching (similar to the muscle ache experienced after strenuous or unaccustomed exercise) or develop a headache. Current research shows that the minor discomfort or soreness following spinal manipulation typically fades within 24 hours.

The risks of serious adverse events associated with chiropractic are very small.

Occasionally new patients express concerns that the chiropractic manipulation may inadvertently break a bone.  Normal healthy human vertebrae are far too strong for the forces involved in manipulation to come anywhere near breaking.  These concerns may be alleviated by understanding that the cracking noise associated with manual manipulation is simply due to a bubble forming within the joint (see the FAQ on this subject).  Essentially, the only circumstance where it is possible for a manual manipulation to break a vertebra is when a severe bone softening disease such as osteogenesis imperfecta is present. In practise this is extremely rare, with only a handful of cases ever reported.  A more common, though still rare adverse event due to manual manipulation is the fracture of a rib.  Again, the forces involved in manual manipulation are not high enough to fracture normal healthy ribs.  When it does occur it is usually in the presence of undiagnosed osteoporosis.  If a patient is known to have osteoporosis, the chiropractor will appropriately modify techniques used to eliminate this risk.

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well educated professional such as a chiropractor, is a remarkably safe procedure. Some reports have associated high velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection (tear). However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care with chiropractor, GP or physiotherapist —but that care provided is not the cause of the injury. The best evidence indicates that the incidence of arterial injuries associated with high-velocity upper neck manipulation is extremely rare—about one case in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.

When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favourably with even the most conservative of other treatment options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin, Voltaren or Nurofen, as well as prescription painkillers (opioids) such as codeine, Endone or  Tramadol —are arguably significantly greater than those of chiropractic manipulation. According to the American Journal of Gastroenterology, people taking NSAIDS are three times more likely than those who do not to develop potentially fatal, adverse gastrointestinal problems such as haemorrhage (bleeding) and perforation. That risk rises to more than five times among people over the age of sixty. Further, it has been reported that overdose of commonly prescribed opioid painkillers is among the leading causes of accidental death in many western nations.

What qualifications do chiropractors hold?

Australian chiropractors are well trained, government registered health care professionals.  At least five years’ university study is required in Australia.  There are four Australian universities that provide chiropractic education, RMIT University in Melbourne, Macquarie University  in Sydney, Murdoch University  in Perth and Central Queensland University in Mackay, Brisbane & Sydney.  The chiropractic degrees conferred by these universities differ slightly and have varied over the years but currently are usually a three year under graduate bachelors degree followed by a three year masters degree.

Are chiropractors doctors?

Chiropractors are not medical practitioners.  The courtesy title doctor (eg Dr Jones, Chiropractor) is commonly used by chiropractors and is approved by AHPRA  (the government body that regulates health care in Australia).  This is similar to the use of the courtesy title Dr by dentists, veterinarians and osteopaths.  The use of this title stems from the fact that chiropractors (and the other professions that use it) have always been primary care health providers; in that they are qualified to diagnose and treat patients without referral from, or supervision by, another health profession.  This ability to practise autonomously essentially defines the difference between a doctor and therapist or technician.  The term ‘doctor of chiropractic’ is sometimes used, and is entirely interchangeable for the word ‘chiropractor’.

Is chiropractic covered by private health insurance?

Yes, most private insurance policies with extras will cover chiropractic.

At Southside Health Care we have HICAPS on the spot health care claims so that, in most cases, we will be able to swipe your card and you will only need to pay the gap.  We are a Bupa Members First Provider, meaning that if you have Bupa health insurance you will get a higher rebate with us than with most chiropractors.

Can chiropractors bulk bill to Medicare?

Under the Medicare system, allied health providers (including chiropractors) are only able to bill to Medicare if the patient has been referred by their GP under a Medicare EPC health plan (sometimes also called a CDM plan).  Such a referral will cover up to five appointments per year. To be eligible for an EPC referral, you need to have a chronic health condition. For more information contact us or see the Medicare website .

At Southside Health Care, our chiros are fully registered with Medicare and we are happy to bulk bill patients who have a Medicare EPC health plan which has chiropractic referral.

Can you see a chiropractor when pregnant?

Yes, absolutely.  There is all the more reason to see a chiropractor during pregnancy.  The additional weight and forward shift of the body’s centre of gravity make lower back pain more common during pregnancy.   In the latter stages of pregnancy a hormone called relaxin is released.  Amongst other effects, this hormone softens the cartilage of the sacroiliac joints  which form part of the birth canal in preparation for delivery.  This can lead to pelvic instability and lower back pain which can be addressed by your chiro.

 At Southside Health Care we have specialised treatment tables that have drop away abdominal sections, allowing pregnant patients to lay face down right up to full term.

What is kinesio-tape (kinesiology tape)?

Kinesio-tape also known as kinesiology tape is a modern elastic (usually brightly coloured) form of strapping tape.  Being elastic, it does not provide the same level support that is provided by traditional rigid strapping tape but is much more comfortable to wear, doesn’t limit range of motion and can be left on for days at a time.  Kinesio-tape is used in applications where a strong support is not required.  For example, rigid tape is generally better for supporting a sprained joint, while kinesio-tape is generally better for rehabilitating an inflamed muscle.  Kinesio-tape has been shown to improve proprioception (joint & muscle position sense) which can aid with injury rehabilitation and possibly improve sporting performance.  Its elastic properties can also be used to aid lymphatic drainage.   Kinesio-tape is often seen in sporting applications but is also used for general patients from paediatrics to geriatrics.

Do chiropractors ever break necks, backs or other bones?

Occasionally new patients express concerns that the chiropractic manipulation may inadvertently break a bone.  Normal healthy human vertebrae are far too strong for the forces involved in manipulation to come anywhere near breaking.  These concerns may be alleviated by understanding that the cracking noise associated with manual manipulation is simply due to a bubble forming within the joint (see the FAQ on this subject).  Essentially, the only circumstance where it is possible for a manual manipulation to break a vertebra is when a severe bone softening disease such as osteogenesis imperfecta is present.  In practise this is extremely rare, with only a handful of cases ever reported.  A more common, though still rare adverse event due to manual manipulation is the fracture of a rib.  Again, the forces involved in manual manipulation are not high enough to fracture normal healthy ribs.  When it does occur it is usually in the presence of undiagnosed osteoporosis . If a patient is known to have osteoporosis, the chiropractor will appropriately modify techniques used to eliminate this risk.

Do chiropractors cause strokes?

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well educated professional such as a chiropractor, is a remarkably safe procedure. Some reports have associated high velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection (tear). However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care with chiropractor, GP or physiotherapist —but that care provided is not the cause of the injury. The best evidence indicates that the incidence of arterial injuries associated with high-velocity upper neck manipulation is extremely rare—about one case in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.

What is chiropractic?

Modern chiropractic is an evidence based primary health care profession that focuses on the diagnosis and treatment (primarily, although not exclusively, by manual manipulation) of musculoskeletal disorders (primarily, although not exclusively, spinal).

Do you need a referral to see a chiropractor?

No.  Chiropractic is a primary health care profession, meaning that chiropractors are appropriately qualified in diagnosis and therefore do not need to work under the direction of any other health care professional.  If the chiropractor diagnoses or suspects a condition outside the chiropractic scope of practice then the patient will be referred on appropriately.

What conditions do chiropractors treat

The primary expertise of chiropractors is in the conservative (non-surgical) drug free treatment of back pain, neck pain and associated headaches.  Many other musculoskeletal conditions (joint or muscular conditions) and the general health or neurological consequences of these conditions fall into the scope of chiropractic. The following is a list of some of the more common conditions (in layman’s terms) treated by chiropractors:

 

  • Sports Injuries
  • Neck Pain
  • Pregnancy Back Pain
  • Muscular Pain
  • Scoliosis Management
  • Ankle Pain
  • Non Specific Low Back Pain
  • No Specific Neck Pain
  • Headaches
  • Migraines
  • Back Pain
  • Muscular Tension / Cramps
  • Jaw Pain  (TMJ Syndrome)
  • Pelvic Girdle Pain (Sacroiliac Syndrome)
  • Elbow Pain (Tennis Elbow  & Golfers Elbow)
  • Arthritis
  • Joint Strain
  • Muscle Strain
  • Heel Spur (Plantar fasciitis)
  • Disc Bulge / Tears
  • Frozen Shoulder
  • Tendonitis
  • Pinched Nerve
  • Shoulder Pain
  • Sciatica
  • Hip Pain
  • Foot Pain
  • Knee Pain
  • Bursitis
What types of treatments do chiropractors use?

After taking a thorough history, examining the patient, and arriving at a diagnosis the chiropractor will then obtain consent to commence treatment.  In most cases treatment consists of the following:

1. Soft tissue manipulation.  ie massage and / or stretching techniques for muscles or  tendons.  Other soft tissue modalities that are often used include dry needling and kinesio-taping.
2. Joint manipulation or mobilisation.  This is what chiropractors are famous for and where they have their greatest expertise.  Chiropractic manipulation is also known as an adjustment.  Mobilisation is generally a slower and very gentle method freeing up a joint; it does not take a joint outside of its normal range of movement.   For further explanation of chiropractic manipulation see subsequent FAQs.
3. Home management advice.  This will usually include a therapeutic exercise program, advice on home management of pain (such as ice & heat pack), and advice on daily activities such as posture, lifting, sport, work, sitting and sleeping position.

 

 

The following is a list of the specific techniques / modalities that we use at Southside Health Care:

Does a chiropractic adjustment hurt?

Most people are surprised how little it hurts; if at all.

What can I expect on the first chiropractic appointment?

The chiropractor will review the information that you’ve provided on your new patient form then take a full history (not only regarding your main presenting complaint but also some general health history).  A thorough physical examination will then be performed.  Following this the chiropractor will explain what has been found on examination and will make recommendations for treatment.  If X-rays or other imaging is required (in practice, they are usually not) then you will be provided with a referral.  Written informed consent to treatment will then be obtained and treatment will be provided.  At Southside Health Care we almost always provide treatment on the initial appointment.  The only reason that we would not provide any treatment on the initial appointment is if it were to be deemed that chiropractic intervention was not appropriate at all in your case.

What can I expect on subsequent chiropractic appointments?

The appointment will begin with an update on your history (ie. ‘What’s changed since your last appointment?’, and ‘Is your condition improving?’).  Re-examination is always is preformed before treatment is commenced.  Finally the chiro will give continued advice on home management and will advise if and when the next appointment will be required.

Do you have to get undressed for a chiropractic appointment?

Generally not.  Most of the therapies applied by the chiro are actually best done through one layer of light clothing.  On examination the chiropractor may require some disrobing, for example to better visualise a spinal curve (scoliosis) or to check a joint for swelling or inflammation.  Some of the modalities used do require the skin to be exposed, for example dry needling.  Where disrobing is required it is usually only the involved area that needs to be exposed.  Patient gowns are provided where necessary and patient modesty is respected at all times.

What should I wear to the chiropractor?

Whatever is comfortable.  Be aware that you will have to lie on a treatment table and roll into different positions so tight restrictive clothing should be avoided.  If you wear a long dangling  necklace or ear rings to the chiro, they will have to be taken off before treatment.

What is sports chiropractic?

Sports chiropractic is a branch of chiropractic with a focus on providing care in the conservative management, rehabilitation and prevention of sports injuries for people involved in physical pursuits ranging from elite athletes to occasional recreational participants.  This is achieved through the application of multiple treatment approaches that include the following.

  • Manipulation
  • Mobilisation
  • Soft Tissue Therapies (Massage, PNF Stretching etc.)
  • Prescription of specific rehabilitation exercises
  • Nutritional advice
  • Strapping (especially kinesio-taping)
  • Dry needling
  • Physiological therapies (such as ultrasound)

Sports chiropractors apply these approaches for both ‘rehab’ and ‘prehab’.  Rehab refers to injury management and the facilitation of return to sporting activity.  Prehab, also known as pre-event conditioning, involves the pursuit of improved neuromusculoskeletal functioning to prevent injuries and optimise athletic performance.

As with general chiropractic, sports chiropractors have special expertise in working with spinal conditions, but are trained and experienced in working with the entire musculoskeletal system.

Do chiropractors put bones back into place?

No.  In a nut shell, chiropractors free up stiff joints.  Although the phrase “I put my back out” is in frequent use and when you go to the chiropractor it feels as if the adjustment is putting a bone back into place, it is actually improving the function (movement) of a joint that is not functioning (moving) as well as it could.  If a bone was literally out of place it would be a dislocation and therefore a medical emergency.

Do chiropractors align spines?

No.  This is a common misconception.  It is quite common for patients to present with a wry neck or a postural lean to one side due to muscle spasm and pain.  As the chiropractor works with the patient, improving joint function, relieving pain and muscle spasm the patient will straighten up but it is not because the chiropractor has aligned their vertebrae back into the correct position.

What is an adjustment chiropractic joint manipulation) and how does it work?

There are many different ways to adjust a joint but what they all have in common are that they use a mechanical thrust to improve the function (movement) of a joint that is not functioning (moving) as well as it could.  As well as improving the function of the joint, an adjustment also produces a reflex muscle relaxation around the joint.  The most commonly used type of adjustment is the manual spinal adjustment where the chiropractor uses his or her hands to deliver a quick but relatively gentle thrust to a vertebra to improve the function of joints between the vertebrae.  Manual adjustments can also be used for joints other than spinal joints.  Manual adjusting usually results in an audible popping noise (see explanation of this in a FAQ below).  Other adjusting techniques use specialised chiropractic equipment (mechanically assisted adjusting).  These techniques do not result in a popping sound.  Drop piece is a commonly used example of mechanically assisted adjusting.  Drop piece uses a section of the chiropractic table that pops up about 5cm and then drops away again when a force is applied.  Other examples of mechanically assisted adjusting techniques are Impulse and Activator adjusting.  Both of these techniques use a small hand held mechanical instrument to deliver a very fast but low force thrust to the vertebra or other bone.  Impulse and Activator adjusting are good alternatives to manual adjusting when very gentle treatment is required.

What is the popping / cracking noise often heard with a manual chiropractic adjustment?

Most joints of the body consist of two bones meeting each other in an enclosed space surrounded by a fibrous capsule synovial joints.  The friction that normally occurs when the joint moves is reduced by a small amount of lubricating fluid in the joint space synovial fluid.  Normally this fluid has some air dissolved within it.  When the two bones are pulled away from each other, the pressure within the joint capsule is reduced causing the dissolved air to come out of solution, forming a bubble.  The bubble formation allows the joint to pop open, often with an audible sound.  This is analogous to gas dissolved in a bottle of Champagne; when pressure in the bottle is reduced by loosening the cork, gas comes out of solution, forming bubbles and the cork pops open.  The formation of a bubble when a knuckle is being popped has been filmed on video MRI.  The bubble is that little black space that appears in the between the white bones at the end of the video.

 

In a spinal adjustment the joints that pop open are the little joints at the back of the spinal column known as the facet joints.  The bubble will re-dissolve back into the joint fluid in about half an hour, but the end result of the adjustment is that a stiff joint has been freed up and a reflex muscle relaxation of surrounding muscles is achieved.

Is it necessary to hear a pop / crack for a manual adjustment to be successful?

No.  Patients often do prefer to hear the crack as there is a certain degree of satisfaction of hearing the bone click back into place (even though bones going back into place is actually a myth – see above FAQ).  As chiropractors, we generally prefer to hear the sound as we then know that the joint has successfully popped open (cavitated) to free up the movement of a stiff joint.  However sometimes a joint is simply too stiff to cavitate but improved joint movement can be still achieved and it doesn’t mean the adjustment has failed.  Very good results can also be achieved by using mechanically assisted adjusting techniques or mobilisations that do not normally produce any joint sound.

Can I go to a chiropractor and not be cracked?

Yes.  Chiropractors use many interventions that do not involve any joint sounds.  Often it is not appropriate or necessary to use manual adjusting.  Sometimes it is simply the preference of the patient not to have this done.

Does joint cracking cause arthritis?

In a word, no. The aim of a chiropractic adjustment is to free up a stiff joint.  It is possible that people who habitually crack their own knuckles or self manipulate their neck or back could do some damage in the long term by over stretching ligaments around joints that are already moving perfectly well.  Similarly if a chiropractor was to manipulate the same joints several times a day for years on end it could end up doing damage, but when applied appropriately it does not.

Is chiropractic safe?

Yes, very.  Chiropractic has an excellent safety record.  However, no health treatment, including chiropractic is completely free of potential adverse effects. The vast majority of adverse events following chiropractic care are mild and transient. Many patients feel immediate relief following chiropractic treatment, but some may experience mild soreness, stiffness or aching (similar to the muscle ache experienced after strenuous or unaccustomed exercise) or develop a headache. Current research shows that the minor discomfort or soreness following spinal manipulation typically fades within 24 hours.

The risks of serious adverse events associated with chiropractic are very small.

Occasionally new patients express concerns that the chiropractic manipulation may inadvertently break a bone.  Normal healthy human vertebrae are far too strong for the forces involved in manipulation to come anywhere near breaking.  These concerns may be alleviated by understanding that the cracking noise associated with manual manipulation is simply due to a bubble forming within the joint (see the FAQ on this subject).  Essentially, the only circumstance where it is possible for a manual manipulation to break a vertebra is when a severe bone softening disease such as osteogenesis imperfecta is present. In practise this is extremely rare, with only a handful of cases ever reported.  A more common, though still rare adverse event due to manual manipulation is the fracture of a rib.  Again, the forces involved in manual manipulation are not high enough to fracture normal healthy ribs.  When it does occur it is usually in the presence of undiagnosed osteoporosis.  If a patient is known to have osteoporosis, the chiropractor will appropriately modify techniques used to eliminate this risk.

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well educated professional such as a chiropractor, is a remarkably safe procedure. Some reports have associated high velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection (tear). However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care with chiropractor, GP or physiotherapist —but that care provided is not the cause of the injury. The best evidence indicates that the incidence of arterial injuries associated with high-velocity upper neck manipulation is extremely rare—about one case in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.

When discussing the risks of any health care procedure, it is important to look at that risk in comparison to other treatments available for the same condition. In this regard, the risks of serious complications from spinal manipulation for conditions such as neck pain and headache compare very favourably with even the most conservative of other treatment options. For example, the risks associated with some of the most common treatments for musculoskeletal pain—over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin, Voltaren or Nurofen, as well as prescription painkillers (opioids) such as codeine, Endone or  Tramadol —are arguably significantly greater than those of chiropractic manipulation. According to the American Journal of Gastroenterology, people taking NSAIDS are three times more likely than those who do not to develop potentially fatal, adverse gastrointestinal problems such as haemorrhage (bleeding) and perforation. That risk rises to more than five times among people over the age of sixty. Further, it has been reported that overdose of commonly prescribed opioid painkillers is among the leading causes of accidental death in many western nations.

What qualifications do chiropractors hold?

Australian chiropractors are well trained, government registered health care professionals.  At least five years’ university study is required in Australia.  There are four Australian universities that provide chiropractic education, RMIT University in Melbourne, Macquarie University  in Sydney, Murdoch University  in Perth and Central Queensland University in Mackay, Brisbane & Sydney.  The chiropractic degrees conferred by these universities differ slightly and have varied over the years but currently are usually a three year under graduate bachelors degree followed by a three year masters degree.

Are chiropractors doctors?

Chiropractors are not medical practitioners.  The courtesy title doctor (eg Dr Jones, Chiropractor) is commonly used by chiropractors and is approved by AHPRA  (the government body that regulates health care in Australia).  This is similar to the use of the courtesy title Dr by dentists, veterinarians and osteopaths.  The use of this title stems from the fact that chiropractors (and the other professions that use it) have always been primary care health providers; in that they are qualified to diagnose and treat patients without referral from, or supervision by, another health profession.  This ability to practise autonomously essentially defines the difference between a doctor and therapist or technician.  The term ‘doctor of chiropractic’ is sometimes used, and is entirely interchangeable for the word ‘chiropractor’.

Is chiropractic covered by private health insurance?

Yes, most private insurance policies with extras will cover chiropractic.

At Southside Health Care we have HICAPS on the spot health care claims so that, in most cases, we will be able to swipe your card and you will only need to pay the gap.  We are a Bupa Members First Provider, meaning that if you have Bupa health insurance you will get a higher rebate with us than with most chiropractors.

Can chiropractors bulk bill to Medicare?

Under the Medicare system, allied health providers (including chiropractors) are only able to bill to Medicare if the patient has been referred by their GP under a Medicare EPC health plan (sometimes also called a CDM plan).  Such a referral will cover up to five appointments per year. To be eligible for an EPC referral, you need to have a chronic health condition. For more information contact us or see the Medicare website .

At Southside Health Care, our chiros are fully registered with Medicare and we are happy to bulk bill patients who have a Medicare EPC health plan which has chiropractic referral.

Can you see a chiropractor when pregnant?

Yes, absolutely.  There is all the more reason to see a chiropractor during pregnancy.  The additional weight and forward shift of the body’s centre of gravity make lower back pain more common during pregnancy.   In the latter stages of pregnancy a hormone called relaxin is released.  Amongst other effects, this hormone softens the cartilage of the sacroiliac joints  which form part of the birth canal in preparation for delivery.  This can lead to pelvic instability and lower back pain which can be addressed by your chiro.

 At Southside Health Care we have specialised treatment tables that have drop away abdominal sections, allowing pregnant patients to lay face down right up to full term.

What is kinesio-tape (kinesiology tape)?

Kinesio-tape also known as kinesiology tape is a modern elastic (usually brightly coloured) form of strapping tape.  Being elastic, it does not provide the same level support that is provided by traditional rigid strapping tape but is much more comfortable to wear, doesn’t limit range of motion and can be left on for days at a time.  Kinesio-tape is used in applications where a strong support is not required.  For example, rigid tape is generally better for supporting a sprained joint, while kinesio-tape is generally better for rehabilitating an inflamed muscle.  Kinesio-tape has been shown to improve proprioception (joint & muscle position sense) which can aid with injury rehabilitation and possibly improve sporting performance.  Its elastic properties can also be used to aid lymphatic drainage.   Kinesio-tape is often seen in sporting applications but is also used for general patients from paediatrics to geriatrics.

Do chiropractors ever break necks, backs or other bones?

Occasionally new patients express concerns that the chiropractic manipulation may inadvertently break a bone.  Normal healthy human vertebrae are far too strong for the forces involved in manipulation to come anywhere near breaking.  These concerns may be alleviated by understanding that the cracking noise associated with manual manipulation is simply due to a bubble forming within the joint (see the FAQ on this subject).  Essentially, the only circumstance where it is possible for a manual manipulation to break a vertebra is when a severe bone softening disease such as osteogenesis imperfecta is present.  In practise this is extremely rare, with only a handful of cases ever reported.  A more common, though still rare adverse event due to manual manipulation is the fracture of a rib.  Again, the forces involved in manual manipulation are not high enough to fracture normal healthy ribs.  When it does occur it is usually in the presence of undiagnosed osteoporosis . If a patient is known to have osteoporosis, the chiropractor will appropriately modify techniques used to eliminate this risk.

Do chiropractors cause strokes?

Neck pain and some types of headaches are treated through precise cervical manipulation. Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck manipulation, when performed by a skilled and well educated professional such as a chiropractor, is a remarkably safe procedure. Some reports have associated high velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection (tear). However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease. These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon. Patients with this condition may experience neck pain and headache that leads them to seek professional care with chiropractor, GP or physiotherapist —but that care provided is not the cause of the injury. The best evidence indicates that the incidence of arterial injuries associated with high-velocity upper neck manipulation is extremely rare—about one case in 100,000 patients who get treated with a course of care. This is similar to the incidence of this type of stroke among the general population.

Dry Needling Q&A

What is dry needling?

Dry needling involves the insertion of very fine, solid needles (acupuncture needles) into tight points in muscles (trigger points) or other soft tissues with the aim of providing pain relief through decreasing muscular tension and improving musculoskeletal function.  In many ways, dry needling is similar to trigger point massage except that needles are used to treat the trigger points, rather than digging in thumbs or fingers.  Dry needling usually involves very little or no pain, with generally less discomfort than trigger point massage.

What is the difference between dry needling and acupuncture?

Acupuncture and dry needling use the same needles, but the theory and clinical reasoning behind the needle placement is very different.  Dry needling is practised mainly by physiotherapists and chiropractors, according to modern scientific principles in contrast to acupuncture which is usually practiced by practitioners of Traditional Chinese Medicine according to ancient oriental theories on health.  The aim of dry needling is to decrease muscular tension and improve musculoskeletal function, as opposed to acupuncture which seeks to remove theorised blockages to the flow of chi (life force) energy along the meridian lines.  With the different aims of acupuncture and dry needling, comes different scope of practice (ie. conditions treated). Dry needling is strictly musculoskeletal, while acupuncture seeks to address the full range of human ailments, and even smoking cessation.   In practice, dry needling needles are only placed in the affected body part, in acupuncture, the needles may be placed in distant locations (along the involved meridian).  So, for example, an acupuncturist may place a needle in the earlobe whilst treating tennis elbow.

Does dry needling hurt?
Dry needling usually involves very little or no pain, with generally less discomfort than trigger point massage.  Many people actually find the experience very relaxing.  Once the needles are inserted the patient is left with meditation music playing for about 15 minutes.  It is actually quite common for people to drift off to sleep in this time.
Why is dry needling called dry needling and is there such thing as wet needling?

Dry needling is dry because nothing is injected.  The term wet needling does exist, referring to a rarely used procedure where cortisone and/or local anaesthetic are injected into trigger points.

Remedial Massage Therapy Q&A

What is remedial massage therapy?

Remedial massage is the assessment and manual treatment of the muscles, tendons, ligaments and other connective tissues of the body to assist in rehabilitation, pain reduction and injury management.
Remedial massage aims to reduce or eliminate pain, and restore normal function of muscles and other soft tissues by relaxing areas of excessive tension. It can also help increase flexibility, stimulate the lymphatic system and promote blood flow, particularly to injured areas.

What conditions can be treated by remedial massage?

The most common aim of remedial massage therapy is to reduce pain and dysfunction by releasing tension in tight muscles and other soft tissues. Other aims include emotional stress / anxiety relief and improved circulation / lymphatic drainage.

Specific conditions that are amenable to remedial massage include:

 

  • Sports Injuries
  • Neck Pain
  • Headaches
  • Migraines
  • Calf Pain
  • Muscular Pain
  • Muscular Tension / Cramps
  • Pelvic Girdle Pain (Sacroiliac Syndrome)
  • Emotional stress / anxiety
  • Elbow Pain (Tennis Elbow & Golfers Elbow)
  • Muscle Strain
  • Heel Spur (Plantar fasciitis)
  • Pregnancy Back Pain
  • Back Pain
  • Shoulder Pain
  • Hip Pain
  • Foot Pain
  • Knee Pain
What is sports massage?

Sports massage is a form of deep tissue massage therapy specifically tailored to rehabilitation and prevention of sports injuries for people involved in physical pursuits ranging from elite athletes to occasional recreational participants. It is not necessarily a relaxing form of massage and can often be quite strenuous. It works by releasing tension and trigger points from tight muscles, managing overuse muscular injuries, and stimulating circulation / lymphatic drainage to remove by-products of the increased muscular metabolic activity such as lactic acid.

Sports massage is of benefit in both ‘rehab’ and ‘prehab’. Rehab refers to injury management, where massage can be beneficial in healing and speeding return to sporting activity. In prehab (also known as pre-event conditioning) sports massage may improve muscular function and endurance to help prevent injuries and optimise athletic performance.

At Southside Health care we have a special emphasis on sports massage.

What remedial massage modalities do you use?

At Southside Health Care we offer many different massage modalities. In practice, treatments usually consist of an amalgamation of at least two modalities on the following list, according to the individual needs of the client:

 

  • Sports Massage
  • Trigger Point Therapy
  • Therapeutic massage/relaxation massage
  • Children’s Massage
  • Myofascial Release
  • Lymphatic Drainage
  • Chinese Massage
  • Japanese Massage
  • Swedish Massage
  • Thermotherapy
  • Pregnancy Massage
  • Craniofascial Release
  • Cross Friction
  • Petrissage
  • Tapotement
  • Effleurage
How is remedial massage therapy different to other forms of massage?

Remedial massage therapy has the aim of treating a specific health condition or injury, and is therefore a form of health care.  This differentiates it from other forms of massage (eg spa massage or hot stone massage) that are intended to simply be enjoying or relaxing, and are therefore forms of health care, being better classified as entertainment.

Is remedial massage therapy covered by private health insurance?

 Yes, private insurance policies with extras will cover remedial massage, on the condition that the therapist holds an appropriate provider number.   To be eligible for private health provider number, a therapist must be suitably qualified, have professional insurance, be a member of an approved association and take appropriate clinical notes on all appointments.  As remedial massage therapy is not a government registered profession, not all people practising in the industry meet these requirements.

 At Southside Health Care all of our massage therapists are well qualified, experienced and hold provider numbers.  We have HICAPS on the spot health care claims so that, in most cases, we will be able to swipe your card and you will only need to pay the gap.

Is remedial massage covered by Medicare?

No.  Unfortunately not even with an EPC / CDM plan.

What can I expect at a massage appointment?

New patients will be asked to fill in a new patient form which will be reviewed by the massage therapist before you go in.  Upon entering the massage room, the therapist will take a history and discuss what you would like from your massage and what areas you would like addressed, allowing you and the therapist to plan an appropriate treatment for you.  The therapist will then start some relaxation music and leave the room while you disrobe.  Only clothing covering areas that will be massaged need to be removed and underwear always remains on.  You will then lie on the table and cover yourself with the towels provided.  The therapist will use this time to take clinical notes before knocking and returning to the room to commence the treatment.  During the treatment you are encouraged to provide feedback for the therapist to assess that massage (level of firmness etc) is appropriate for you.  Our therapists are very skilled in draping (using towels to cover the client’s body) and are very conscious of client modesty.

Does remedial massage hurt?

Only if you want it to!  Some forms of remedial massage are very gentle and relaxing (eg. myofasial release, Swedish massage and relaxation massage) others are firm and can produce a certain amount of ‘good pain’ when working the tension and knots out of the muscles and other soft tissues  (eg. sports massage, trigger point therapy and deep tissue massage).  The choice of technique and level of firmness is entirely up to you and you will be encouraged to provide feedback during the treatment.

How long are massage appointment times?

We usually book either 30 minute or full hour massages.  If you have one specific area that you would like treated then 30 minutes is usually enough.  If you have two or more areas requiring attention, or would like an all over massage then you’ll probably require a full hour.  Ninety minute massages can also be arranged.

Can you have a remedial massage when pregnant?

Yes, absolutely.  There is all the more reason to have a massage during pregnancy.  The additional weight and forward shift of the body’s centre of gravity make back pain more common during pregnancy.   The increased fluid build up during pregnancy can also be addressed by massage.

 At Southside Health Care, our massage therapists are very skilled in using pillows to make expecting mums comfortable, and modifying techniques appropriately.  Pregnancy massage is often done in a side-lying position.

Remedial Massage Therapy Q&A

What is remedial massage therapy?

Remedial massage is the assessment and manual treatment of the muscles, tendons, ligaments and other connective tissues of the body to assist in rehabilitation, pain reduction and injury management.
Remedial massage aims to reduce or eliminate pain, and restore normal function of muscles and other soft tissues by relaxing areas of excessive tension. It can also help increase flexibility, stimulate the lymphatic system and promote blood flow, particularly to injured areas.

What conditions can be treated by remedial massage?

The most common aim of remedial massage therapy is to reduce pain and dysfunction by releasing tension in tight muscles and other soft tissues. Other aims include emotional stress / anxiety relief and improved circulation / lymphatic drainage.

Specific conditions that are amenable to remedial massage include:

 

  • Sports Injuries
  • Neck Pain
  • Headaches
  • Migraines
  • Back Pain
  • Shoulder Pain
  • Hip Pain
  • Foot Pain
  • Knee Pain
  • Calf Pain
  • Muscular Pain
  • Muscular Tension / Cramps
  • Pelvic Girdle Pain (Sacroiliac Syndrome)
  • Emotional stress / anxiety
  • Elbow Pain (Tennis Elbow & Golfers Elbow)
  • Muscle Strain
  • Heel Spur (Plantar fasciitis)
  • Pregnancy Back Pain
What is sports massage?

Sports massage is a form of deep tissue massage therapy specifically tailored to rehabilitation and prevention of sports injuries for people involved in physical pursuits ranging from elite athletes to occasional recreational participants. It is not necessarily a relaxing form of massage and can often be quite strenuous. It works by releasing tension and trigger points from tight muscles, managing overuse muscular injuries, and stimulating circulation / lymphatic drainage to remove by-products of the increased muscular metabolic activity such as lactic acid.

Sports massage is of benefit in both ‘rehab’ and ‘prehab’. Rehab refers to injury management, where massage can be beneficial in healing and speeding return to sporting activity. In prehab (also known as pre-event conditioning) sports massage may improve muscular function and endurance to help prevent injuries and optimise athletic performance.

At Southside Health care we have a special emphasis on sports massage.

What remedial massage modalities do you use?

At Southside Health Care we offer many different massage modalities. In practice, treatments usually consist of an amalgamation of at least two modalities on the following list, according to the individual needs of the client:

 

  • Sports Massage
  • Trigger Point Therapy
  • Therapeutic massage/relaxation massage
  • Children’s Massage
  • Pregnancy Massage
  • Myofascial Release
  • Lymphatic Drainage
  • Chinese Massage
  • Japanese Massage
  • Swedish Massage
  • Thermotherapy
  • Craniofascial Release
  • Cross Friction
  • Petrissage
  • Tapotement
  • Effleurage
How is remedial massage therapy different to other forms of massage?

Remedial massage therapy has the aim of treating a specific health condition or injury, and is therefore a form of health care.  This differentiates it from other forms of massage (eg spa massage or hot stone massage) that are intended to simply be enjoying or relaxing, and are therefore forms of health care, being better classified as entertainment.

Is remedial massage therapy covered by private health insurance?

 Yes, private insurance policies with extras will cover remedial massage, on the condition that the therapist holds an appropriate provider number.   To be eligible for private health provider number, a therapist must be suitably qualified, have professional insurance, be a member of an approved association and take appropriate clinical notes on all appointments.  As remedial massage therapy is not a government registered profession, not all people practising in the industry meet these requirements.

 At Southside Health Care all of our massage therapists are well qualified, experienced and hold provider numbers.  We have HICAPS on the spot health care claims so that, in most cases, we will be able to swipe your card and you will only need to pay the gap.

Is remedial massage covered by Medicare?

No.  Unfortunately not even with an EPC / CDM plan.

What can I expect at a massage appointment?

New patients will be asked to fill in a new patient form which will be reviewed by the massage therapist before you go in.  Upon entering the massage room, the therapist will take a history and discuss what you would like from your massage and what areas you would like addressed, allowing you and the therapist to plan an appropriate treatment for you.  The therapist will then start some relaxation music and leave the room while you disrobe.  Only clothing covering areas that will be massaged need to be removed and underwear always remains on.  You will then lie on the table and cover yourself with the towels provided.  The therapist will use this time to take clinical notes before knocking and returning to the room to commence the treatment.  During the treatment you are encouraged to provide feedback for the therapist to assess that massage (level of firmness etc) is appropriate for you.  Our therapists are very skilled in draping (using towels to cover the client’s body) and are very conscious of client modesty.

Does remedial massage hurt?

Only if you want it to!  Some forms of remedial massage are very gentle and relaxing (eg. myofasial release, Swedish massage and relaxation massage) others are firm and can produce a certain amount of ‘good pain’ when working the tension and knots out of the muscles and other soft tissues  (eg. sports massage, trigger point therapy and deep tissue massage).  The choice of technique and level of firmness is entirely up to you and you will be encouraged to provide feedback during the treatment.

How long are massage appointment times?

We usually book either 30 minute or full hour massages.  If you have one specific area that you would like treated then 30 minutes is usually enough.  If you have two or more areas requiring attention, or would like an all over massage then you’ll probably require a full hour.  Ninety minute massages can also be arranged.

Can you have a remedial massage when pregnant?

Yes, absolutely.  There is all the more reason to have a massage during pregnancy.  The additional weight and forward shift of the body’s centre of gravity make back pain more common during pregnancy.   The increased fluid build up during pregnancy can also be addressed by massage.

 At Southside Health Care, our massage therapists are very skilled in using pillows to make expecting mums comfortable, and modifying techniques appropriately.  Pregnancy massage is often done in a side-lying position.