Stretching

Do You Have "Tight" or "Stiff" Shoulders?

Often times I am told by a client that “things just feel stiff or tight.”  These reports tend to be most common in the hips, shoulders, and neck.

I usually will proceed to tell the patient that stiffness or tightness may actually be a good thing. As it could be the body’s response to a perception of threat in the area, and its protective mechanism is to tense up or hold on tight for security purposes.

I will also inform them that things may not actually be as “stiff” or “tight” as they believe.

Usually at this point I get a blank stare from the patient or a barrage of questions because nobody has ever explained these concept to them. So that will be my goal in this article. For simplicity sake, we will just be discussing the shoulder.

Stiffness is a sensation the body will produce, it is not an actual state of being. Three things that tend to impact the sensation of being “Tight” are: 1) Position 2) Nervous System 3) and Muscles. Usually in that order.

Position

Let’s use the analogy of a door frame here. A crooked door frame will not allow for a door to shut, obviously one of the corners will catch. The answer is not to stretch or force the door into a position it cannot achieve. The solution is to create a better door frame position so that the door will fit. Taking this back to the body, the shoulder and hips are really no different. Both are ball and socket joints. And if the ball (meaning your arm or leg) does not go through a full range. It could be because the position of your frame (or socket) is not optimal. 

When considering the position of the shoulder, the socket would be the scapula or shoulder blade. Fortunately for our mobile arms, the scapula has a great deal of movement. The tricky part is that because the shoulder blade is so mobile, its foundation is more dependent on the ribcage than anything. The ribcage is the foundation the shoulder blade sits on and thus will ultimately dictate position of the shoulder.

Below is an example of a patient of mine who needed to have more approximation of his left ribcage and expansion of his right ribcage. By putting him in a position that would allow for this, and then having him establish proper breathing patterns in this position, you can see the change in range of motion after. Mind you this picture was taken right after the exercise which lasted at most 2 minutes. No stretching, massage, or dry needling was performed. Just positional breathing. Which is great, because now the patient can perform this activity at home and not rely on a medical professional to always make a change. 

(patient is lying on opposite ends of the table, which is why picture looks reversed). 

How is that big of a change possible? Just as we discussed. If a joint is in a poorly managed position, it can directly affect the length/tension relationship of the muscles that cross the joint. In this case, due to shoulder position, the muscles that crossed the joint were already on “prestretch”. Meaning these muscle were more than likely already on stretch to achieve a neutral position. So to establish full range of motion, the muscle would have to elongate further than what would typically be expected. By establishing a true neutral position of the joints we can take that “prestretch” off and allow the arm to access its full range of motion.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Does Gaining Range of Motion Really have to Hurt?

Not all physical therapists are created equal. Nor does gaining range of motion have to be extremely painful! Unfortunately there is this idea among the public that physical therapy has to hurt to be effective. In most cases, nothing could be further from the truth. Sadly enough there are plenty of physical therapists out there who also believe "no pain, no gain" to be true.

Before we go any further, I need to clarify that pain is very different then a "stretch", "pull", "pressure" or "fatigue/workout soreness". Just because I don't believe in "no pain, no gain" doesn't mean I'll vouch for laziness or sub-par effort.

So here is why gaining range of motion does not have to hurt:

–  When the brain starts feeling ‘stress’ it goes into protection mode.  A pain response results in signals sent to muscles, fascia, and joint capsule to literally tighten down to protect the painful structure.  So the entire time your PT is cranking on your new rotator cuff repair, knee replacement, or you are cranking on it at home per their instructions. Your brain is busy fighting back.  The result is lots of pain and minimal progress.

– Pain fires up your sympathetic nervous system, the part of the system that handles ‘fight or flight’ situations.  To complicate matters, research has found that a lot of people are already in this sympathetic state even at rest. These individuals tend to exhibit increased stress hormone levels that result in poor sleep patterns and poor recovery from workouts and games (If you are coming off of surgery, I would argue that you are already in this state to some capacity anyway).  This elevated level of stress over the long term can have some serious effects and implications on rehabilitation.

Balance is good!

The moral of the story here is that increased pain levels correlate with increased stress levels which can delay healing and recovery.  Some pain is going to be present when you’re dealing with an injury or surgery, but your therapy should not be making you consistently feel worse! Increased pain is not an ideal situation for someone trying to gain range of motion, strength, and returning to work or athletics.

So how do we avoid the "no pain, no gain" philosophy! For starters, you still need to put forth maximal effort. Laziness will not get you out of pain. If you are post surgery then you should expect some type of "stretching" or "pulling". It is very important to distinguish between this and actual pain. The surgical limb has to move (when appropriate) and move frequently in order to start improving and building back up normal tissue resiliency. However, you want to avoid jamming your limb through further ranges of motion putting yourself into a further stressful (sympathetic) state then you already are post surgery.

Taking this a step further, in both surgical and non surgical folk we want to consider other areas which could be contributing to your overall dysfunction and pain on movement. This means looking at the joints above and below the injured area to make sure they are functioning optimally. Assessing the difference between active and passive movements also plays a role on distinguishing between actual soft tissue restriction or just lack of motor control or coordination in those end ranges of motion.  Muscle strength, endurance, work capacity, and timing are all important factors as well.

Next time you go through a physical therapy treatment, or any treatment for that matter, ask yourself if all these things are being assessed? If your program feels like a cookie cutter program then it probably is! Find a provider that understands pain and will take the time to assess/reassess movement. In most cases, there are better ways to gain range of motion and strength than trying to push through restrictions and pain.