• To Stretch or Not To Stretch?

    To Stretch or Not To Stretch?

    At Fast Track Physical Therapy and Sports Medicine we treat patients who experience back and neck pain due to many different causes.  As a physical therapist, one of the questions I most often get asked from my patients or from friends and family is how to stretch the back when it feels stiff or tight.  They will often say something like this, “I was helping a friend move a heavy couch a few days ago and tweaked something in my back. It feels stiff and I need some stretches to loosen it up.” Or they might say that they’ve been really stressed at work lately and now their neck is tight when they are working on the computer.

    Well, there are definitely some very effective stretches that a person can do for muscles and joints in the spine, but the real solution may not be as straightforward as stretching it out.  In fact, stretching something that feels “tight” might actually make it worse.

    Let me explain.

    One of the miracles of the human body is that when an area is injured, there are protective mechanisms that come into play to prevent additional tissue damage.  If you sprain your ankle bad enough, swelling will be present in the joint. The loss of joint mobility from swelling protects the injured ligament that would be strained with more movement.

    Another protective mechanism to prevent more tissue damage is pain.  Our brain interprets signals coming from the injured tissue (nociception) that something has happened to the area and we need to pay attention.  The resultant pain that we experience by continuing to walk or jump or play sports on that injured ankle will be enough to keep us on the sidelines.  

    The last protective mechanism, and most relevant to our discussion on stretching, is something called muscle guarding.  In response to pain and tissue irritation, our nervous system tells the muscles surrounding the area to contract a little more than normal to form a muscle brace or splint of sorts.  This limits our movement and stiffens the injured area to again prevent additional strain or damage.

    With that understanding, why would you want to stretch out and take away that muscle splint that is protecting the irritated tissue?  The muscle tightness and stiffness we feel after injury is often muscle guarding and not true muscle shortening.  Of course we can have a tight muscle to begin with but how can we tell the difference between muscle guarding and muscle shortening?  And once we can identify what is going on, what do we do about it?

    If an injury is acute, meaning it has happened very recently, and you feel stiffness setting in, most likely that stiffness is from muscle guarding and possibly swelling.  The more recent the injury the more likely the muscle guarding.  

    Another clue can be related to the repetitiveness of the tightness you feel. If you stretch out the stiff areas but the tightness keeps coming back, most likely there is an underlying problem that is not being addressed.  We see this often in patients who are flexible to begin with, like a dancer or gymnast.  The muscle guarding may be the attempt of their body to stabilize and protect an area that is already under a great deal of stress.  They don’t have the muscle strength or control to protect the already loose, injured area, so the nervous system kicks in and tells the muscles to remain at a higher level of contraction.

    Stretching a muscle out that is guarded may make it feel better temporarily but will often lead to an increase in soreness or tightness later on.   So how do you deal with muscle guarding?  

    1. Understand that tissues need time to heal.  There is no accelerated healing schedule for our body.  There are things we can do to get in the way and delay healing, and there are things we can do to provide the optimal healing environment, but we cannot make something heal more quickly than it is programmed to heal.  Healing takes time.
    2. Consider using external support.  Just like you would wear a brace for a badly sprained ankle, sometimes tissues in our body could use some type of external support to offload or reduce the amount of stress to the tissue.  If the spine is injured, one way to reduce stress is through our posture.  A firm pillow behind the lower back when sitting in a chair or couch can help reduce the stress to the tissue.  A physical therapist can help apply tape to the area to give support and temporarily take pressure away.  Once the injured area starts feeling better and we are able to move without increasing soreness, the support isn’t needed and we can set the brace or tape aside.
    3. Improve the muscle condition around the injured area.  Co-contraction, or the ability for muscles on all sides of the joint to contract simultaneously can be a great support.  Light exercises, which emphasize gentle contractions and pain free movements can help restore the normal tone of the muscle as the tissues heal.
    4. Gentle massage, heat, and easy pain free movements can also reduce muscle guarding as the body is ready to let go.  If they don’t seem to help at the start it may be that the injured tissue still needs some protection.  These are particularly helpful when the muscle guarding has gone on longer than normal and the underlying tissues have healed completely.

    If a muscle or an area is just tight, then there are a number of safe stretches or other techniques  you can do to improve mobility.  To be most effective, maintain the stretch for 30 seconds and repeat 2-3x.  The stretch should be pain free and the joints around the muscle should be in a safe position.

    So in summary:  Stop stretching out muscles that are trying to protect an injury.  If the injury is recent or the tightness keeps coming back most likely the muscles are guarded, not tight.  Follow the above steps to address the muscle guarding and get back on your feet.  And don’t hesitate to contact your physical therapist at Fast Track if the injury isn’t getting better or you have questions on how to treat your back.

     

    Matthew Randall, Doctor of Physical Therapy

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