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