My biceps is usually in quite a shortened position due to shoulder flexion and elbow flexion. Ditto for my neck flexors and hip flexors. But they’re not actually shortened (or tighter than normal). I have full flexibility in each of those muscle groups. Muscles can indeed become shortened, but it’s not a given they will get short if they spend most of their day like that.
Again, there are ways to test muscle length/flexibility. I don’t rely on muscle length/flexibility tests alone because they are not very specific. That is, when you test the flexibility of a muscle, you are also testing other structures. What I do if I suspect muscle shortening is perform the muscle length test and note the findings. Then I will do dynamic movement testing and assess the effect on the muscle length test when re-tested. If we rule out everything else, and the muscle stays tight, then we can diagnose muscle tightness.
But my distinct point here is that we can’t make an assumption based on daily positions or activities. If you think “hip flexors get tight” because they’re shortened all day, well then what about all the other muscles that are shortened all day? Isn’t it more likely that something else is going on in the hip area? Things can be figured out with competent testing - not assumptions. -- Laura
Joint mobility is an extremely important piece of data when diagnosing and treating orthopedic disorders. Even though testing a joint’s mobility is easy, it is rarely done well. While the length of a muscle may matter, the strength very rarely does. A tight muscle (which is rare) may reduce a joint’s range of motion in a specific direction (the direction in which the tight muscle is put on stretch), but weakness is rarely a factor.
A muscle would have to be significantly inhibited and/or significantly weak for the patient not to be able to achieve full active range of motion, especially with gravity eliminated or gravity assisted procedures. (Remember: muscle inhibition usually comes from a nearby joint or spinal joints.) Muscle weakness does not impact passive range of motion, which is when the joint is moved by something external (not internal muscle strength). If a joint doesn’t move well - passively and/or actively - my investigation starts with joints themselves (local and spinal). If that proves fruitless, only then will I consider that muscles are causing reduced joint range of motion. -- Laura
If the diagnosis is a structural problem, then the location of pain is almost always where the structural lesion is. Structural lesions with bones, muscles, tendons, ligaments, discs, cartilage, and menisci create local symptoms. The main exception is when structural lesions occur with nerves, in which case symptoms can travel along the nerve. So if what you suppose is a problem in a structure changes location, it’s more likely that instead of there being a problem with the structure, there’s a problem with how things are functioning - which is the majority of problems. With functional problems (that is, something is not working well instead of a structure actually being broken), it's common for pain to change location. Muscle strain, tear, pull pain doesn't move. It's where the strain, tear, pull is. -- Laura
It’s not uncommon that sleeping makes problems worse. That is, symptoms become exacerbated and/or movement becomes limited. Morning stiffness to a small extent is allowable when it comes to spinal flexion, but, otherwise, after being up and about for a few minutes, you should have the same amount of mobility you went to bed with.
During sleep, we often spend considerable time in one position without moving - whether we want to or not. It is my opinion that most orthopedic problems are related to movements and postures, so it makes sense that, just like with sitting or walking, sleeping postures can easily make people worse (or better).
If the thought process is that people need muscular strength to “hold” or “stabilize” joints in the right position, then there must be profound weakness if the simple act of sleeping causes joints to destabilize. Similarly, sleeping should not be aggressive enough to strain/pull muscles.
My thought process is this: I agree healthy joints should be able to withstand prolonged positions while sleeping, but I don’t think the answer is muscle-driven stability. And I don’t think muscles get pulled in our sleep. Benign positions like sitting or lying can indeed move joints - regardless of how much muscle is nearby. And these subtle changes can commonly cause symptoms. On the whole, strength is wonderful, but I believe we need to get the joint better first by moving the joint itself.
It’s true that spinal discs enlarge when we lie down to sleep, and that may be the sole factor why someone has more pain and/or less motion upon waking (vs related to any certain position). But even if that is the causative factor, then, again, I want to primarily address the disc (part of the joint) versus address the musculature around it. It’s also true that not all orthopedic problems are joint problems. Sleeping on a painful tendon can worsen symptoms, too. But most problems do have to do with joints - and addressing them effectively is important. -- Laura
There are muscles encasing our heads and faces. I think people actually understand the concept of referred pain (or non-local pain) when it comes to headaches - they just don’t know they do. Put another way, I don’t hear much about people massaging their head (cranial) muscles, rolling them, stretching them, or otherwise treating those various muscles.
Of course muscles in general can be the producers of symptoms, but it’s rare. I write about this extensively. Everyone loves to name and treat muscles, but, while important, they’re rarely the problem when it comes to orthopedic disorders.
People seem to intuitively comprehend that head pain or headaches can come about for a lot of reasons. Stress, dehydration, allergies, hunger, concussions, and illness to name a few. There are indeed musculoskeletal causes as well - just rarely the muscles. The joints in the neck and mid-back can refer pain (or any symptom) to the head. In rarer cases, the jaw joint can create local symptoms.
If people can understand that their head can hurt not as a result of the muscles in the area and that their chests and arms can hurt due to a heart problem, then hopefully people can start to grasp that arm pain or leg pain is not necessarily due to arm or leg muscles. -- Laura
People end up replacing and fusing their joints, not their muscles. We must focus on keeping joints healthy, not just muscles. Yes, having muscle strength helps support joints, and training muscles for endurance and strength inevitably moves joints. But focusing on joints is different than simply getting the byproducts of working out muscles. The best way to monitor joint health is monitoring range of motion. The great news is that maintaining range of motion only takes minutes a day. It’s easy to preserve full motion with self-mobilizations once you have it and once you understand the factors that decrease it. For example, you can check your shoulder mobility in one minute. Want to strip it down to the bare minimum? I’d say make sure you can reach all the way up your back and that you can elevate your arm all the way up, out to the side.
Please keep working out those muscles - they're important for musculoskeletal as well as overall health. It’s easy to see, though, that joints more often fail, not muscles. In addition to controlling lifestyle factors, we can also very easily “exercise” our joints. The most important thing is to get joints all the way to end range (especially your spine!) and make sure you can continue to do so. This is what I teach my patients how to do. --Laura
Depending on where a muscle originates and where it inserts, it can move the bones of your body in a specific way. It’s rare that a muscle even works in isolation. A certain muscle or muscle group may need to be a focus of rehab in the case of a problem, but there’s no hierarchy of prestige in the human body. (I’m not talking about the heart, diaphragm, etc.) Your psoas is not the key, nor is your core (a group of several muscles). No one muscle will ensure health or prevent injury.
The relative importance of a muscle is circumstantial, based on what a particular individual’s needs are. For example, a shot putter, to improve performance, will focus on different muscles than a cyclist. Someone whose goal is to be able to get up easily from a low couch will have different needs as well. -- Laura
Most of orthopedics is getting joints moving better, getting nerves conducting electricity and moving better, and getting tendons functioning at full capacity. Rare is the case that true strength needs to be built in a muscle or muscles to resolve a problem. Those scenarios include when atrophy is creating problems (secondary to a number of possible factors) and when there has been injury to a specific muscle. While I often use general “strengthening” exercises as an adjunct to the primary intervention, the intent there is to get the musculoskeletal system moving and working again, not strengthening. Of course, muscular strength, which takes significant time to build, has myriad positive effects on the body, and I wholeheartedly support strength training in general. However, when problems arise, specific distinct solutions are typically called for. -- Laura
Structures other than muscles can be tight. For example, nerves can get tight. Clinically we say they have lost extensibility, are compressed, or are entrapped. However, they do effectively get “tight” in many cases. Joint capsules can also get tight, as can the joints themselves. I usually use the word obstructed when referring to joints, but, to most patients, they in essence feel tight.
Tightness is also a common referred sensation. With referred symptoms, people tend to name the muscle where they feel the symptom. For instance, if the joints in the low back are referring symptoms to the front of the thigh, people usually say (and assume) they have a quadriceps problem. Understanding the concept of referred symptoms is crucial ... but it’s also very important to recognize that it’s not just pain, numbness, and tingling that can be referred. It’s also common to have referred sensations that feel tight, achy, or even hot or cold. -- Laura
Part of effective diagnosing is understanding the basics of how joints, muscles, and nerves work. People with low back pain commonly think they “pulled” a muscle. They may have. I will allow that it is possible. However, in ten years of work, not once have I diagnosed someone with a pulled or strained muscle (or tendon) in his low back. (It’s almost always a joint-driven problem - and joints can refer pain to muscles.)
A symptomatic pulled (also known as strained or torn) muscle - anywhere in the body - will hurt when contracted. Each personal case is different, but at some angle and with some type of resistance, when that disrupted muscle is asked to contract, it will provoke pain. The second finding with pulled muscles is that they often hurt when put on tension (stretch). This may or may not create a minimal range of motion loss in the plane in which the muscle is on tension. Third, when the affected muscle is on slack (at rest) and not contracting, nothing should happen and range of motion should be full.
An extensor muscle performs extension. If it is pulled you’ll usually find painful resisted extension, pain at end range of flexion with minimal to no motion loss, and full pain-free passive extension. This applies to extensor muscles everywhere, including in the low back. Therefore, if passive low back extension (prone, using the arms or a machine) is limited or painful, I’m not likely dealing with a muscle problem. If standing extension is pain-free but limited, I’m also likely not dealing with a muscle problem.
Again, knowing the foundations of biomechanics is essential. Just that simple piece of information can allow me to rule out a muscle. Unfortunately, many people (including clinicians) don’t apply these fundamental rules to diagnosing problems. Muscles can hurt due to referred pain, so just because pain is felt in a muscle doesn’t mean the muscle is the problem. A competent diagnostic process will provide the answer. -- Laura
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