When does joint and tissue stiffness matter? Part 3 of all things stiffness
Let’s jump into a few areas where joint stiffness, tissue stiffness and joint mobility might matter. Please don’t consider this exhaustive.
1. When it matters to you
Easy-peasy eh? If you are concerned about the feelings of stiffness and think it is contributing to your pain then its something we need to discuss. We need to figure out if it is really contributing to your pain or function or if your feelings of stiffness are just “victims” from whatever else is driving your pain. The thought here is that sometimes we might be trying to “fix something” (perceived tightness) that actually isn’t a problem. And focusing on something that doesn’t need to change or that can’t change can make our problem worse.
2. When stiffness is driven by some other negative and unhelpful habit or belief
This is best seen in the work of the Cognitive Functional Therapy group (review here and please note that I am not a spokesperson for this group and below is my interpretation from their published works and discussions) where one small part of their intervention involves “behavioural experiments” where people in pain are guided into movements which they have been avoiding or they may be fearful of. Often people will be naturally hesitant and guarding when doing these activities. In my opinion, that muscle guarding/bracing is not inherently wrong for everyone (e.g it might help some people for a short period of time) but in a subset of people that guarding (e.g more muscle tension than you actually need to function) is not helpful and is essentially the physical manifestation of their belief that their back is frail, damaged and in need of protection (these are my words, not CFT group).
In the “exposure” world these would be called “safety behaviours” and these safety behaviours perpetuate the problem rather than being part of the solution. In this case trying to bend or move with less tension is one possible way that people can learn to control their symptoms (i.e exposure with control and removing these safety behaviours). Again, muscle tension isn’t inherently wrong. It’s not putting too much stress on a joint and causing “wear and tear” but in this case it’s no longer helpful because it’s one thing that keeps sensitizing the person. Tension, bracing and guarding is a maladaptive movement pattern that might be helping the pain persist thus it might be worth changing how they move and getting confidence in a formerly feared and avoided activity.
3. You need mobility for movement options and performance
Let’s say you love squatting but your back starts to hurt. And it turns out when you goblet squat you have less low back pain. It then seems like you have less low back pain when your trunk is more upright. Well, how can we get you to squat more upright which will allow you to continue to squat with less pain? You could get a safety bar (I did - but that was for a Frozen Shoulder), you could get lifting shoes (I did) or you could increase your ankle dorsiflexion (I should, but I’m too lazy). Having increased ankle dorsiflexion will allow you to squat more upright because it shifts you centre of mass forward to balance out your ass-weight.
Another area where mobility is important is again for symptom modification, stress shifting or performance. In the video below where I land on my head during a back handspring one of my many limitations is my ankle dorsiflexion (there are others, no need to start a list and email me). I’m not quick enough to generate the force to go backwards and up and when my ankles reach their end ROM and want to start pushing off my body is not in the right spot. So, I kind of go up to early and fizzle out in the air :)
Very simply, ROM might matter if you think it’s reasonable for someone to move differently and a requirement of moving differently is having that new ROM.
Related to back handsprings another area where mobility matters is if I wanted to be in a better position to push off the ground with my hands. Ideally, I should work on having more thoracic and lumbar extension. This would allow my shoulders to not “receive” the ground at their end ROM which they often do.
4. Performance
Building tissue stiffness (tendons have the most research) might be inherently beneficial for many sports. Interestingly, we don’t see a lot interventions that can decrease tendon or connective stiffness (outside of injury or immobilization) but we know that strength training that induces high tendon strains (>4.5% strain) which is probably around 70% of maximal lifts seems to induce increased tendon stiffness. Surprisingly, plyometric training doesn’t have consistent effect. Neat-o.
5. When stiffness means there is something else going on.
Sometimes stiffness (particularly morning stiffness lasting longer than 45 minutes) or stiffness that spreads across multiple joints could be indicative of a more systemic condition like Rheumatoid Arthritis or the family of conditions found in Spondyloarthritis. Part of taking a conservative approach to dealing with pain and injuries is also recognizing that sometimes there are some more rare conditions that can benefit from medical help. Always check your biases here. A nice tool for screening this is here (http://www.spadetool.co.uk/)