Tension Part 1: Good and the Bad

Far too often, many patients and athletes are stretching and performing mobility work to alleviate the feeling of stiffness.   Almost to the point that aggressive techniques and excessive work are being performed that are either damaging tissue or provide transient/short term success.   The question you should ask yourself is “what is the reason for the stiffness in first place?”   Your follow-up question “what should I do to correct the issue?” The latter question is commonly answered without regard to the first question.   This results in performing endless hours of work attempting to alleviate tension only to succumb to lack luster results all in the name of futility.

A definition…

Tension – an internal state of tissue that is maintained continuously, also known as a state of a partial contraction. This exists at rest, in a relaxed state and increases with stretching. The loss of tension can be pathological (flaccid) due to nerve injury or excessive (spastic) due to nerve injury and or overstimulation. Each state can impair full physiological range of motion and or alter proper movement sequencing and control.

So my question(s) are and the scenarios that play out are:

Do you have full range of motion about a joint but experience tension?

Do you have less than full range of motion about a joint and experience tension? But can gain the remaining range with assistance.

Do you have less than full range of motion about a joint and experience an intolerance to gain in the remaining range regardless of the assistance?

The short answer to any and all of these questions is the proverbial “It Depends!”   It depends on the context of: a current injury, an unresolved but healed injury profile, fitness status, movement competency, motor development status, training stimulus, and the list can go on and on.

People need to recognize that flexibility-stretching related training, self-mobilization techniques (foam roller, lacrosse ball), soft tissue techniques (yes therapists you too!!), and other therapeutic interventions (electrophysiological modalities, thermal, and other manual techniques) in isolation without the understanding of what the underlying issue is can be done erroneously and in some cases unsuccessfully.

Tension or stiffness can actually have a protective effect depending on the tissues involved and the degree of impairment with function.   I see too many patients with adequate range of motion with insufficient joint control and subsequent movement incompetence.   In the clinical world this is formally known as dysfunction or sorts.   Exploring the tissues involved and understanding the context of when and why the tension or stiffness occurs is critical.   Just because you feel stiff DOES NOT MEAN YOU HAVE TO STRETCH OR ROLL OUT ON A ROLLER.   Where is the thought process? Moreover, condemn intuition. And just because it worked before does not mean it will work again. If you ascribe to the concept of movement variability and the principle of chaos theory you appreciate the notion that the state of the body is never in the same state across time, if ever for that matter.

Therapists you are not forgotten in this either. Many times therapists, match their mode of care to the findings of the examination – no issue there! However, if the examination is executed strictly based on an orthopaedic based approach (orthopaedic examination, neurological testing, and range of motion, general palpation, and general observation) and in the absence of any orthopaedic or neurological condition with a remaining issue (tension or stiffness) what are you treating?  More importantly what becomes of your intention for treatment?   There has been a shift in how we evaluate patients and athletes alike, when traditional examination is unsuccessful in identifying the mechanism of the presentation.   Assessing function of tissue and exploring the context of the demand on this tissue (movement) is a fundamental method to exploring the avenues that might explain or provide insight into the reasons why tension is occurring.

Therapists, the fundamental question you need to ask yourself is “What am I dealing with?”   If you can attempt, within the confines of science, to understand what is going on, only then you can truly therapeutically manage the presentation of the patient.

Enough of a rant. Here is a challenge for you.   The next time you experience or come across hamstring tension during a hamstring stretch I want you to consider the following: What happens if…

  1. You provide resistance in either adduction (groin) or abduction (glute) during the stretch of the hamstring?
  2. You perform isometric contraction of the hamstring (minimum of 10 seconds at 80% maximal effort for 5 repetitions) and reassess?
  3. You change your posture? For example if you assess the hamstring standing (i.e. toe touch), perform instead supine or lying on your back.
  4. You perform a core exercise of your choice and then reassess the hamstring?
  5. You perform a stretch or mobility exercise to the ankle?

When doing this challenge, or should I say experiment, pick your outcome measure of choice and be consistent! For example, a straight leg raise lying on the floor or table. It can be whatever you want based on the context of how you elicited the tension in the first place.

Record what happens with each scenario.   Next blog I am going to review what each scenario means in the context of tension and how you can better manage this tension.


5 Movement Assessment Considerations You Must Know

  1. Know who you are assessing

Far too often those that conduct movement assessments do so with a “One-approach fits all” approach. This can be misleading and inappropriate at times.   Remember that a youth under the age of 16 are still maturing and the motor development process is still occurring. Conversely, a 30 year old has fully matured physiologically and their motor development has been completed. Now on the other side of the spectrum, a 42 year old overweight, sedentary individual wanting to change their lifestyle habits is going to have a completely different need for movement.

What I am getting at here is that a young athlete will have strategies or deficits in their movements as they are still developing, whereas an adult should have their basic or fundamental movement patterns established. When you implement a squat, your intention for performing the protocol will be different on the basis of age, motor development, and demand for movement. For those working with <18 years of age athletes, the Long Term Athletic Development Process is a great review of the development process for motor development and physical skill acquisition.

  1. What is the objective of the assessment

Again, just because you were taught to identify particular things (mobility, strategies, stability, etc…) does not mean that is where the assessment stops.   Keep in mind that many of the movement protocols you will have your athlete/client put through, are new, challenging, and unlearned.   One of the biggest mistakes with movement assessments is that it is assumed that the athlete knows exactly what it is that you expect of them in the protocol; it is also assumed that the instruction on how to perform the protocol is sufficient enough for the athlete to remember and then mimic what it is you want them to do.   The objective initially, should be to demonstrate the ability to apply the instruction of a protocol by the athlete and then assess the movement. This is called fast learning where changes or adaptations in an unfamiliar movement are produced to give a reasonable movement the athlete feels confident with for you to assess.   True learning of a movement, particularly a new or unfamiliar one, requires nearly 3 weeks before it becomes automatic. It can take longer for others.   Therefore, if you do not account for the stage of development and the familiarity of the movement, what are you assessing then?

  1. Consistency, consistency, consistency


For those health care practitioners, you understand from your medical or physical evaluations that in order for a response (positive or negative finding) to be relatively true or valid, the response should be evident on other tests of different variations. Many orthopaedic tests algorithms are now showing support for multiple tests to confirm pathology over a single isolated test. Movement assessments are no different. If you identify a problem (strategy, lack of mobility, lack of control, etc…) then it should be evident in other protocols that are assessing similar things. For example, if a 2 legged squat identifies knee valgus that may be attributed to lack of motor control of the medial hamstring complex in the first 30 degrees of descent, then a 1-legged squat should also elicit the same findings in order to conclude that the knee valgus in the first 30 degrees of a squat is in part attributed to the poor motor control of the medial hamstring complex.

Avoid using single protocols or tests to assess a region, use 2-3 if you can to ensure consistency of your findings, otherwise bias sets in and you could be correcting or neglecting an issue inappropriately.

  1. Stability 101

If you speak to a biomechanists and seek the definition of stability you will probably get something along the lines of “in the presence of a perturbation a characteristic behavioural response occurs”. Therefore, in order to assess the stability system, in this case the human body, it must be challenged either by gravity with body weight based protocols or through the application of an external load (barbell, resistance bands).   There is a spectrum of stability that needs to be discussed. First is structure stability – this is the ability of passive elements (ligament, joint capsule) to maintain the neutral zone of the joint through motion either during an orthopaedic examination or athletic movement.   Second, is static stability – this form of stability is requires an interplay between the nervous system, musculoskeletal system, and osseo-ligamentous system.   The expectation for static stability is that at the joint or anatomical region no movement occurs when challenged (gravity or external force).   The ability to hold a prone plank without moving for the duration of the test protocol.   The third type is called asymptotic stability. This form of stability indicates that when the system is challenged the change in position of the joint or anatomical region is imperceptible to the naked eye and looks stationary during a static or dynamic positioning. An example would be the patella remaining in line with the web of the first-second rays during a single legged squat.   This form of stability is typically what movement assessment protocols are attempting to identify. The last form of stability is the bounding or dynamic stability. This form of stability suggests that upon a challenge (movement) there is a change in the position and motor behaviour about the joint or anatomical region which permits movement (forward, change in direction, reverse, etc…).

Static stability, asymptotic, and dynamic stability all require control to produce stability.   This is highly contextual, meaning that it depends on the demand of the movement and competence of the athlete performing the movement.   To generally state a movement looks stable is an overgeneralization that qualitatively one cannot determine.   Biomechanical laboratories determine and quantify stability. The reason for this is that there is a paradox between mobility and stability.   The more mobility a joint or anatomical region needs to be, the less stability that said joint or anatomical region becomes.   Conversely, the more stabile a joint or anatomical region needs to be, the less mobile it has to be to produce a movement.   The contribution between how mobile and stabile a movement is not a qualitative process and requires highly sophisticated instrumentation to determine.

You can make inferences about stability all you want, but the true nature of what you can assess in the movement is control of the region or joint through the identification of postural deviations, joint misalignments, and a lack of control to execute the movement competently.

  1. Control

As I had mentioned above in the stability 101 section, control is the more relevant component of what you assess in movement. Control is a function of the efficient interplay between the nervous system and the rest of the body (muscle, joint, ligament, etc…).   There are two forms of control that need to be discussed here. The first is motor control. This control is the ability of the athlete to produce a contraction type: concentric, eccentric, and or isometric.   The contraction type is contextual, based on the demand of the movement.   Typically this where isolated examination of a joint or anatomical region is conducted.   The other form of control is movement control. This form of control entails the athlete’s ability to follow the instructions and the protocol to the specifications of the assessor.   These specifications include tempo of movement, depth or desired end point, and sequencing of joints to produce a movement.   This last form of control is influenced on the learning capability and the ability of the athlete to follow or mimic instructions.

Without control (motor and movement), stability is an irrelevant component of the movement assessment that does not have context for interpretation.   Stability requires a functioning motor system first before stability can be determined. Therefore, control of a movement provides greater context to the issues at hand than stability. Although stability becomes highly relevant in the biomechanical laboratory.