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
This topic has been coming up a lot with my patients recently. Many patients report that they don’t feel pain exactly - they feel tight, or, more usually, really tight. This can apply to the neck, low back, and extremities. Determining the reason a patient feels tight (the diagnosis) and helping fix it is, of course, my job.
True muscle tightness certainly exists. What do I mean by “true muscle tightness?” I mean that the reason you feel tight in a muscle, say the hamstring muscle, is because the hamstring muscle is actually tight. This is most typically a result of an increased or altered load on a muscle – like a workout - and sets in 1-2 days after the change in demand. This tightness may be called soreness, and is a result of normal breakdown in the muscle itself and/or inflammation in the muscle. While people might choose to intervene to reduce this tightness (such as going for a walk, stretching, getting a massage, etc.), it is imperative to note that this tightness is normal, and will pass within a few days on its own. People don’t usually seek medical care for this.
True muscle tightness can come from less strenuous events too. For example, if you wear a new pair of shoes while walking around a city for hours, you might experience tightness in a muscle or two the next day since your muscles experienced a new load due to the different position of your feet. Alternatively, if you were in a cast for 8 weeks, your muscles may also feel tight while they are immobilized. And, of course, if you tear a muscle, if will feel tight as inflammation and then immature scar tissue replaces the torn muscle tissue. In all of these scenarios, the cause of the tightness is normal, obvious, and reversible.
Again, patients usually don’t come to me reporting tightness of the normal variety (since normal muscle tightness will pass on its own). So what makes patients feel tight if it’s not normal true muscle tightness? There are two possibilities:
1. The abnormal sensation of tightness is referred from a joint, either nearby or distant.
A common situation here is a spine joint being out of place and referring a feeling of tightness to a separate area. It can be nearby, like the neck joints sending tightness signals to the upper shoulders. Or it can be more distant, like the low back joints sending tightness signals to the calf. Extremity joints can also send tightness signals. With extremity joints, the signal usually stays close to the problematic joint. The hip joint may send a feeling of tightness down the thigh a bit, for instance. This tightness can be constant or it can come and go.
2. The abnormal sensation of tightness is nerve tension/tightness.
Nerves run throughout our body, passing through and next to muscles. If a nerve is compressed somewhere along its path, it will lose the ability to lengthen, making it indeed tight. The most frequent example of this is the sciatic nerve. When compressed in the low back, it can create a feeling of tightness in the back of the thigh, calf, or foot. Most people, however, just blame the muscle in the area of tightness, not understanding that a nerve is also in that area! This tightness, also, can be constant or it can come and go.
There are movements and simple tests I use in the clinic to determine what is causing the tightness. A simple slump test is used to help differentiate if a hamstring muscle or a sciatic nerve is tight, for instance. The take home message is this: true muscle tightness is usually normal, but persistent or recurring (chronic) tightness is not normal, and is almost always arising from a location away from the site where the tightness is felt. You shouldn’t be stretching, foam rolling, or massaging your arm, back, or leg muscles all the time. Find the joint or nerve causing the feeling of tightness and fix that to get relief for good. -- Laura
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