Most people blame age, or an injury (old or new), then too much activity or too little activity. They all could play a part, however there’s more than one type of stiffness so let’s run through how I classify and categorize tightness and stiffness and some options on managing each category.
This refers to medical conditions that result in body regions becoming extremely stiff such as a frozen shoulder, excessive scar tissue in soft tissues after an injury or surgery (fibrosis), or muscle contractures associated with some neurological conditions or muscular dystrophy.
Most of us have experienced protective spasm at some point in our lives. The classic is a wry-neck, where muscles on one side of the neck spasm usually after one of the facet joints in the neck are irritated or injured.
This type of spasm is a clever way for the body to ‘splint’ a region to help protect it. However, rarely is it comfortable! This type of spasm is often only short term.
Pathological stiffness and protective spasm are more so related to clinical conditions that require a health professional to manage. I included them in this blog for completeness, however it’s not the reason most people feel tight and stiff on an ongoing basis. For that read on…
Kinesiophobia, or the fear of movement, can affect people in various ways. Typically we see people avoiding certain movements after an injury or episode of pain. A good example is people with (or who have had) lower back pain who are reluctant to use their full range of motion in their lower back in fear of re-aggravating or worsening the pain. I’m sure you’ve seen people like this – and how would you describe how they look? Stiff!
A small 2013 study (3) investigated 14 people with lower back pain who had pain related fear. The researchers found that fear of movement was associated with trunk stiffness, as measured by the movement in the lower back in response to a sudden perturbation.
Now I could do a PhD on the topic, but in the case of this fear of movement with people with lower back pain, where does it come from? Is it instinctive? Or does a lifetime of being told “don’t bend your back when lifting” groom a psychological response to pain and injury in the region?
We also see similar patterns of kinesiophobia in people after an ACL (knee) reconstruction. Half the people who don’t return to sport after the injury/surgery cite a fear of re-injury as a reason (4). We also see people with reduced shock absorption through their knees when doing jump and land tasks (5). How would you describe how they land? Stiff!
Fear of Movement = Stiffness
When you assess people in the clinic with non-acute lower back pain, or in later stages of ACL rehab, most of time their range of motion is normal, so it’s not structural. It’s psychological, but people “feel” and move stiff.
I have a cliché that I use most days I treat people;
Weak Muscles Get Tight
I’ve used the saying for years and I must admit that for a long time I didn’t have any evidence to back up my confident one-liner. There’s been plenty of work done on muscular weakness and it’s link to injury, especially in problem muscles like the hamstrings. However, I couldn’t pull out a reference supporting my direct claim that weakness caused tightness, or that strength work improved flexibility.
Anecdotally though, I noticed time and time again with my patients that if a muscle was weak and tight – the stronger it got, the better the range/stiffness became both objectively and perceptually.
Thankfully (for me) a paper came along in 2011 which supported my hunch (6). Researchers from the University of North Dakota recruited 25 volunteers who were randomized to either a static stretching group or a resistance training group. Various flexibility and strength measures were taken before and after the intervention – either 5 weeks of stretching, or 5 weeks of resistance training.
If you’re interested in the particulars of the exercises and outcome measures you can read the full version of the study here, however it’s important to note that for the resistance training group there was an emphasis on full range of motion for the exercises.
Flexibility improved equally in both the stretching and resistance training groups, compared with a group of controls. It’s only a small study, but the take home message is that you can improve both flexibility and strength with resistance training. Remember, this was all on a group of ‘normals’. My feeling is that this is accentuated further in people with significant weaknesses post injury, surgery, or just neglect.
Some people can experience an ongoing sensation of stiffness and tightness, similar to a chronic pain experience. When assessed, they exhibit ‘normal’ range, muscle tone etc, however the feeling of tightness and soreness, often in the neck and back (but it can be anywhere) is real.
Early in my career as a physiotherapist I loved people with these type of symptoms, as most often I would do a solid session of massage, mobilization, and a good chat and they left the clinic feeling amazing.
What I provided was in one form or another a session of therapy, but probably not manual therapy. Frequently, you find that their tightness and restriction correlates with stress and anxiety with work, family, or sport.
A sensation of tightness and restriction can develop for psychological, rather than physical reasons.
The last point I would like to make is that sitting down all day isn’t making you stiff. In a study conducted on mice (7), researchers immobilized the rear ankle in full plantar flexion (toes down) in a plaster cast. They found that only 30 minutes a day of stretching maintained dorsiflexion range (the opposite movement) and prevented sarcomere loss (the contractile unit of a muscle fibre).
So what’s causing your stiffness? Stretching it out isn’t the long term solution.
Originally published on Premax by Randall Cooper. Randall is a physiotherapist and founder of Premax premium massage creams.
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