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
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
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
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
It takes many weeks for tissue to form adhesions and become tight. And when it is indeed tight, it does NOT vary day to day or week to week. I understand that the sensation patients report is one of “tightness,” but if there is variability, then the source of this tight feeling is not the tissue itself.
When I say tissue, what do I mean? I subdivide it into two main categories: contractile tissue (muscles and tendons) and non-contractile tissue. In the second group, most of the time we’re talking about joint capsular tissue, but there could also be problems with skin, fascia, etc.
Tissue can become tight for many reasons. Think of a simple cut on your skin. If you don’t move the affected tissue, over time the tissue will become tight as scar tissue lays down haphazardly, restricting normal, fluid motion. (This is a good thing - you want scar tissue to be strong! But consistent movement in the right direction will make it flexible.) Surgery is like a simple cut writ large. Many tissues are cut and repaired and, without proper re-integration of movement, often are tight months or years later. Some tissues get tight because they don’t get moved properly. That could be from life habits, patterns after a prior injury, or from 8 weeks in a cast, for instance. A frozen shoulder is another example of tight tissue - which, in the absence of an instigating trauma, usually comes on insidiously.
In these examples, it’s clear that tissue can certainly get tight - and that it can restore to normal length (with informal or formal therapy). It’s also obvious from these scenarios that this process doesn’t allow for a patient to report, “Well, some days it feels really tight, but then some days I’m fine.” Tissue does not behave like that. But joints do ... and they refer that tight feeling to nearby tissue. When I take a patient’s history, I ask very specific questions that narrow my possible diagnoses. If the patient describes variability, local tissue tightness is not the cause. --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.
Regularly sitting for prolonged periods, especially slouched, can lead to orthopedic problems. But the problems arise almost always from joints, not muscles. I continually hear people (health professionals, notably) declare that sitting’s “shortened” position of the hip flexors can cause painful, tight hip flexors. Granted this doesn’t affect all sitters (nothing does), but if large amounts of time in shortened states can lead to painfully tight muscles, then where is the observable pattern? Why aren’t more biceps affected secondary to prolonged elbow bending? Where’s the complaint of painful anterior neck muscles as our heads are so often forward?
Though I make my case verbally, people won’t budge. It’s likely the only way to prove my point would be to demonstrate an evaluation and treatment of someone with this given “diagnosis.” In the absence of that, I put forth that, one, we have ways of clinically determining if this is occurring, which, importantly, involves ruling out joints and nerves. Two, if we consider joint mechanics, deranged upper-mid lumbar segments and hip joints can send referred/radicular pain to the hip flexor area. Deranged elbows usually refer pain to the medial, lateral, or posterior elbow. And neck derangements typically send pain posteriorly and laterally – rarely anteriorly. The deranged joint pattern is observable. --Laura
If you lie propped up on your elbow for some time, it’s likely when you go to first move it, it’s stiff. Same with sitting on a crossed hip or ankle. As you start to move, the joint rapidly loosens and there’s no lasting impact. Do this enough, though, and it can become harder for a joint to consistently rebound to its correct alignment. And as the joint further deforms, this stiffness may become pain.
While this applies to extremity joints, these days it seems more prevalent in the spine. If your day entails primarily kneeling, it can become increasingly stiff and painful to straighten your knee(s). More commonly, though, if your day is spent protruding your neck looking at a computer or rounding your back driving in a car’s bucket seat, your spine may enter the stiffness-pain paradigm.
For many joints, it can be hard to notice stiffness/motion loss. Detecting stiffness, however, is often important in the prevention of pain, especially with previously painful joints. I therefore teach my patients how to self-test their affected joint each day. If stiffness is spotted, their corrective exercise should be performed to restore full joint motion and prevent unwanted escalation into pain. --Laura
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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