Why you don’t need to worry about muscle tightness: Part 1

This is going to be a three part blog.  The first two parts will explore the reasoning why stiffness/tightness is often irrelevant for pain.  The last blog will discuss times where stiffness and mobility might be relevant for pain and injury.

Part 1: Why you can stop worrying about stiffness

Muscle and joint tightness can be viewed as two things:

1.  Actual or perceived joint and muscle stiffness.  Stiffness is a mechanical concept that describes how much force it takes to move a joint or structure.  Stiffer materials or joints require more force to lengthen or move.

2. Mobility refers to your entire range of motion. Some people call having a decreased range of motion being stiff. We shouldn’t use the term stiffness this way. View a lack of range of motion as limitation in your mobility. This would show up whether you can touch your toes, reach your hand behind your back or do a backbend.

As an aside, “tightness” is a pretty meaningless term. It often gets used to mean you both feel stiff and you feel like your mobility is restricted. I’m using it pretty generically to mean either stiffness or to denote a restriction in joint mobility. When its important I will try to be more specific.

Traditional physiotherapy has often blamed “tight” muscles as a cause of pain.  Let’s look at some of those theories and then see how they are probably irrelevant when it comes to pain. Again, we are doing this in two parts. Part 1 focuses on the sensory aspects of this stiffness and mobility and part 2 focuses on the mechanical aspects of stiffness and mobility. But both parts pretty much tell us to not worry about it too much. Stiffness and mobility restrictions get way too much blame in the pain world.

Reason #1: You can’t trust what you feel. Aka: you aren’t really “tight”

You might see me put “tight” into quotes.  This is because a muscle can feel tight or stiff but it isn’t truly lacking mobility nor is it objectively stiff.  Very simply, we can’t always trust what we feel.  Especially when we have pain.  Pain corrupts how we perceive our body. I’ve written about this almost a decade ago (blog here) That’s why people in pain at many joints (spine, knee, neck) will report greater perceptions of stiffness but this does NOT line up with their actual measured stiffness (a great paper here explores this).  We see that people with neck pain report stiffness but they aren’t objectively tighter than those who aren’t in pain (reference here).

This is pretty common - we can’t always trust what we feel when we have pain. People with knee pain will report a feeling of instability but their objective measures of instability/laxity don’t correlate with their perceptions (reference here). And this is also true for the perception of swelling. Where actual swelling doesn’t correlate with perceived swelling in those with knee pain (reference - I can’t find it damn it, I just read the paper. If you know this one please email me:) - Great, I got it. Thanks to the many who emailed - Reference here)

It almost like we don’t have means of communicating when something is kind of sore or bothersome and so we just feel it as “tight”.  Again, this isn’t weird. Our perceptions aren’t always a good indication of what is really going on. When people undergo a long term stretching regime their mobility or range or motion will increase but we won’t see a change in how stiff the joint is (reference here and blog here).  But!!! The person will feel less stiff (reference here) even though there is no objective change in actual stiffness.  The body is both cool and stupid sometimes.

What many suggest is that the perception of feeling stiff is really just one way that a sense of unease, discomfort, fatigue, pain or sensitivity show up. Or when you are in pain some well meaning therapist tells you something is tight (e.g you poked in traps and the therapist says “these are the tightest traps I’ve ever felt”) and that’s causing your pain. You then fall down this rabbit hole of spending a lot of time trying to “fix” an assumed tightness/stiffness problem that was never really a problem in the first place. We might be pathologizing a normal sensation and this can set you up to fail because all of your “fixes” (e.g stretching, foam rolling, massage, manipulation) are chasing the wrong target.

Reason #2: The feeling of stiffness or real stiffness is an epiphenomenon or a side effect of pain 

What the hell is an epiphenomenon? An epiphenomenon (plural: epiphenomena) is a secondary phenomenon that occurs alongside or in parallel to a primary phenomenon.  So stiffness occurs with pain but isn’t actually the cause of pain (e.g we see greater spine stiffness in those with pain, reference here). Meaning something else both causes the pain and the perception of stiffness. Related to this would be the idea that pain itself causes the stiffness. This is seen in some of the experimentally induced pain research where in those people who tend to catastrophize the will have greater muscle stiffness and stability (reference here)

A simple example is knee osteoarthritis. When someone has knee osteoarthritis they will have stiffness in the morning.  This is part of the condition.  They might also have pain.  Both pain and stiffness are caused by the process of knee osteoarthritis.  They are just correlated.  It’s not the stiffness causing the pain.

This second example is where an epiphenomenon evolves into a side effect and then morphs into a pain contributor. You might have low back pain, be sensitive to spine flexion and be fearful of spine flexion.  Maybe you have been told some nonsense like your discs wear out when you bend your spine or you need to brace your spine and avoid flexion to protect it (BTW, discs can adapt and stress is good - references here and here).  For the most part this is pretty horrible advice (there are some exceptions where we want to avoid flexion temporarily) and its this type of advice that has messed up a lot of people.  So now you will either subconsciously or consciously brace your core, restrict your movement and “tighten” up your trunk muscles.  You will naturally feel stiff and in pain.  You might be rigid and guarded and lack fluidity in your spine motions AND you still have low back pain with suffering.  So what is the true cause of the pain?  I’d suggest the stiffness was an initial victim just like the pain and now its involved in perpetuating the problem.

Perhaps its the fear, worry and belief that your spine needs a lot of protection that lead to you bracing and not moving your spine that caused the muscle and joint stiffness and lead to the perpetuation of pain.  The lack of movement is now helping to perpetuate pain because the spine loves to move and you are denying the spine healthy activity. And your bracing and guarding is feeding into the negative beliefs about your back which is in turn sensitizing you. The primary problem for the ongoing maintenance of pain was the shitty advice you have been given.  The beliefs, fears and worries you have about your back have caused you to stop doing healthy things like moving your back thoughtlessly, fearlessly and confidently.  So the muscle and joint stiffness was initially a side effect of pain and the beliefs you had but now it is helping to promote the pain problem.  

The solution here isn’t foam rolling your spine, getting your back cracked or a massage to “loosen” something. No, the solution would be to develop a healthy view of your spine, your pain problem and start to feel confident again in what you are capable of.

Reason #3: Its the worrying about the stiffness and not the actual stiffness that is the issue

Because pain and stiffness perception are often linked when you are in pain you might start to think that the perception of stiffness is the important problem.  If you are like me you might be a ruminator and a catastrophizer (see my blog on my stomach pain here).  As humans we have the ability to take innocuous sensations and really turn them into something bothersome that can lead to suffering and disability.  And I’m afraid that we can do this with the perception of stiffness.  If you are a human you will feel stiffness.  And you will feel pain.  These things are unavoidable.  And if you have been told that they are problematic then you might think that you always need to fix these things.  You then get on this hyper vigilance train where you are foam rolling, rubbing stuff, stretching and looking for some release.  If you get your back manipulated you might be a “crack” junkie.  (Good one, eh?). 

Unfortunately, my professions have pathologized normal body sensations and for a subset of us this can really create suffering. It’s like hearing something drip at night. You want to go to sleep but you just start worrying and thinking about the dripping sound. It’s just water dripping. Its going down the drain. Its nothing. But if you keep thinking about then that is all you hear and you can not sleep. Related, it’s like trying to sleep. The more you try to sleep and the more you think about your need to sleep the harder it is to sleep.

Or you might have been told your IT Band tight and needs to be released or stretched. Or some tendon is tight or your TFL is tight and is tugging on your ITB and causing you knee pain. These things don’t really exist and aren’t problems. But if you start to poke your IT Band it might feel tender and it might feel stiff. But it should feel that way. You can’t stretch out connective tissue. That’s not how we work (See this decade old blog that goes through that). Again, the problem here is that we are taking a normal sensation and turning it into a problem. Don’t do that.

So what is the solution here?  Is it OK to stretch, mobilize, foam roll and get a massage?  If you have tried these approaches and they are successful for you then great.  Keep doing them.  But, if you’ve tried them and you are still suffering or if you need to foam roll 20 minutes before and after you do anything then maybe its time to wean off that self care.  Re-evaluate what that stiffness really means?  Is it really a problem that is causing you suffering?  Did someone just tell you it was a problem and now you spend half your life trying “release” something. Can you view the sensation of stiffness non-judgmentally and just say “hey, this movement feels stiff. Interesting. But that isn’t inherently problematic or pathological.  It is what it is and it’s not something that needs fixing”.

This isn’t always easy.  You are just accepting these sensations and trying not to amplify them.  And then the interesting thing is that sometimes when we do this they actually become less bothersome and we might not even notice them.  You give up on trying to “fix something” that actually doesn’t need fixing and then you get comfortable with yourself.

Part 2 of this series will look dispel the myths behind stiff joints causing altered postures and proposed negative mechanical loading.  Part 3 will look at when stiffness and mobility might be relevant for pain.