Pain With Stiffness, Pain With Looseness
Would you rather be mobile or stable?
There is a simple guiding principle to the philosophy physical therapists have when approaching a dysfunction in the body. Is it stiff, or is it lose? Or in our terms, hypomobile (stiff) or hypermobile (lose). Both of these conditions can cause dysfunction and pain. This is an oversimplification but it can provide a good starting point when trying to assess an area of the body that has unexplained pain.
As you peel away layers of the body, you realise that most of the structures are capable of becoming stiff or loose. We are all familiar with a tight muscle and the general recommendation is to lengthen the tissue, i.e. stretch. However, there is much more to it. Every joint has a leathery capsule around it that is prone to stiffness. Nerves can be restricted in the tunnels of muscle that they travel through. Joints can become arthritic and limited in range of motion. Ligaments can become lax due to hormones, repetitive trauma, or a lifetime of poor positioning. So when we have assessed an area of the body, we chose our treatment based on these principles.
The general idea is to stabilize what is loose, and mobilize what is stiff. This is where people tend to get confused. Very few people are loose or stiff throughout their whole body. There are certainly conditions such as Ehlers Danlos syndrome that create a laxity in the connective tissue of the body, but this is rare. This is where you have to become tissue specific. So in other words, most people will have areas of the body that are stiff and areas that are loose. Let’s take the spine for example. It is very common to have a vertebra that is hypomobile. The vertebrae above and below will tend to become hypermobile since we have to do things like bend and twist. If one vertebra doesn’t move much, the neighboring ones have to pick up the slack. This in turn can cause problems. If the vertebra is too mobile, it can shear on things like the spinal cord or peripheral nerves causing pain into the legs. These same relationship can exist with muscles as well. There is such a thing as too much flexibility in muscles. In fact, that is what “double-jointed” is. It is not some sort of extra joint you are born with, it’s just laxity in muscle/tendon and ligament on one side of a joint.
I get questions such as “should I do yoga?” all the time. This is a difficult one to answer. If the person is just stiff everywhere, then yes. What if they have loose vertebrae or a hamstring that is so lax on one side that the knee bends backwards. Certainly there are certain positions in yoga that may exacerbate pain.
A better approach is to know your “sticking points”. Maybe your hamstrings and hip flexors are tight from your desk job. Maybe your thoracic spine is stiff from sitting in front of your computer for 40 hours a week. Find corrective exercises to mobilize these areas. Do a search for Kelly Starrett and the involved body part on youtube. He has thousands of hours of great content to sift through to address these issues. Also know your weaknesses. Weak core? Everyone is weak in the core. What about your hip abductors? These are infamously weak in most of my patients and create all kinds of havoc. Put a plan into place to fix these issues and think of it as supplemental to your work out plan. It takes persistence. I would recommend at least 5-10 minutes of mobility work a day if you really want to see change. Just have purpose to your exercise. It is too easy to just go through the motions and do the same tired old stretches.