How do I increase a person's ankle dorsiflexion range of motion? There is no one way to fix a sign/symptom. I can name ten possible things I would do to increase a person's dorsiflexion depending on the source of the deficit. A sign or symptom is not a diagnosis. You diagnose the problem that causes the sign/symptom and provide the appropriate treatment for that diagnosis. It’s the same as with other medical problems. There’s not one way to relieve head pain nor one way to increase low blood pressure. You figure out the reason (the diagnosis) and address that.
I know I sound like a broken record, but people want to oversimplify orthopedics when it actually takes solid diagnostic skills to achieve effective care. If a patient of mine has decreased dorsiflexion, that is just one piece of data in isolation. Combined with the other data I obtain (verbally and physically) and combined with the response to repeated dynamic testing, that piece becomes more intelligible. If you think you simply need to stretch your Achilles to gain more dorsiflexion, by all means, go ahead. It will help sometimes, but it’s not high on my list of treatments I use to gain dorsiflexion. There are many treatments I use more commonly than simple muscle/tendon stetching. So the answer to how I increase dorsiflexion is: “It depends.” -- Laura
If you indeed have problematic scar tissue (it happens), it will be consistently tight or painful when it is put on tension. There won’t be normal days and tight days. Or good mornings and bad afternoons. Or pain-free months and painful months.
Scar tissue is normal, and only sometimes becomes a problem. When appropriately challenged with movement, it will normally become as elastic as the tissue it replaced (the previously injured tissue). Think of a cut on your skin. Scar tissue will replace the skin that’s been cut and, almost always simply through normal daily life, you will gain full mobility of that tissue. In the event the scar tissue hasn’t been moved well for years, it may not be possible to get it as elastic as the prior tissue was.
This premise applies to cut skin as well as tissue injuries inside the body. Tight tissue is tight tissue - and, though it can be lengthened with movement, it will not demonstrate variability when problematic. This is why I am sure to ask patients if their complaint is consistent (meaning each time) or variable; it’s an important part of differential diagnosing. Before we start to think scar tissue is your problem it has to at least fit this one basic criterion. -- 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
I realize that it often feels good to stretch forward when your back or neck hurts. People even do it when it does hurt because they feel as though they’re getting a “good stretch” that “hurts so good” that they “need.” While I sometimes use forward bending of the spine as the foundation of therapy, it’s rare - under 10%. It does make sense that it can feel good, though! If you temporarily increase space and take pressure off a problem area, it can feel nice. My job, however, is deciding what patients need to achieve real, long-term success. By the time patients see me, they have usually already figured out on their own if something gives them short-term relief (certain stretches, heat, ice, meds, etc.). -- Laura
A tight flexor muscle will be apparent with extension. End-range extension will be limited, painful, or both. Other motions are not commonly as affected, if at all. For certain, flexion won’t be limited because, with flexion, the tight flexor muscle is on slack.
As I’ve stated before, muscles are incorrectly incriminated as someone’s problem way too often. While I see tendinopathies (a contractile issue, not usually a length or tightness issue), I can’t remember the last time I diagnosed a “tight muscle” or had a patient stretch a muscle. What I typically find are joint derangements - joint problems which refer symptoms to muscles. Joint derangements are fixed (often very quickly) with directional preference exercises.
Tight muscles exist, but they are very rarely the source of someone’s complaints. The better we are at diagnosing a problem, the better we are at fixing it. -- Laura
When reaching hard enough, will you feel pulling in your hamstrings? It’s likely. Tendons and muscles (unlike other structures) will usually allow you to eek out another centimeter in pursuit of your toes, which you’ll feel. But “feeling it there” does NOT mean that is necessarily the limiting factor. To touch your toes you’ll need sufficient hip mobility, low back mobility, and sciatic nerve length for starters, not to mention mid back mobility and even arm length! Whereas so many (I want to say most) fitness professionals and medical clinicians alike make assumptions such as this, I critically assess why someone cannot do something. We move your body in various ways repeatedly to understand the source of a complaint or functional deficit. And by the way: it’s usually not your hamstrings.
Many, many bodily joints and tissues need to function well to be able to fully bend forward. Poor hamstrings, though … they always get blamed!
To regain forward bending ability, I hardly ever loosen patients’ hamstrings. However, say a patient did simply need looser hamstrings - then clinical care is hardly needed. (Stretching is not rocket science!) With consistent home stretching, hamstring length better consistently improve.
In almost all cases, forward bending is limited because lumbar structures are moving improperly. Usually it’s that the joints themselves are misaligned. In other cases, compressed/adhered/trapped nerves create nerve tension that limits this movement (with or without contemporary joint malalignment).
Forward bending (lumbar flexion) is usually restored once we get the patients’ lumbar structures moving properly again. Importantly, using forward bending to achieve this is beneficial in only a small group of patients. More commonly I utilize lumbar extension or sidegliding.
So why do people say they “feel it” in their hamstrings? It’s either that they’re actually feeling the sciatic nerve(s) pull or that, in attempting to bend further, their body eeeks out more motion in the only structures it can – muscles and tendons – so they “feel it” there. Expert mechanical clinicians know better. --Laura
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