Contractions - the most underestimated aspect in musculoskeletal pain

Friday, August 7, 2020

7:19 AM

Contractions are easily the most under-evaluated and under-estimated condition when it comes to soreness, tightness and pain. In this post we are going to talk about what contractions are, what they do and also what I do to treat them.

Contractions are the beginning point to all manner of soreness, tightness and pain. They lead into the other 3 main causes of pain which are slackening, adhesions and nerve impingement.

Our medical system defines contractions as; a shortening or tightening, as of a muscle, a shrinking or a reduction in size. A drawing together. (Taber’s Medical Dictionary)

Too often, in my opinion, people are treated for contractions and soreness, tightness and pain with pharmaceutical drugs and surgery. Many pharmaceuticals are known to cause tissues to tighten. Surgery is stressful and traumatic no matter how routine. Both contribute to further inflammation, dehydration and contractions.

Contractions are probably responsible for more surgeries than any other single reason with the possible exception of traumatic injury.

At first it is difficult to wrap one's mind around what contractions actually are and what they do. This is soft tissue both fascia and muscle tissue that is hardening and pulling together. It becomes a destabilizing influence as it acts like a muscle that is locked in a firing (or engaged) position. Contractions destabilize the system by creating torsion on and around joints. The musculoskeletal system is an elaborate system of levers and pulleys; when one spot tightens or shortens something else is necessarily going to lengthen. Over time tissue under constant duress will dehydrate and tear.

There are two ways in which contractions begin. The first is through a traumatic injury such as a sprain, deep impact compression, bone fracture, whiplash, and a number of other possibilities.

Most people have experienced a sprain at one time or another. Unless these are properly treated sprains will not heal completely (see my post here for more about that). Some tightness remains even after the pain is long gone. This tightness is a source for future soreness and pain because as we return to normal daily activity the contraction can deepen and strengthen over time. The remaining tightness is putting torsion (twist) on joints as it restricts full motion which can create more problems down the road.

The second way contractions form is through the accumulation of stress over time. Life is stressful. Whether we realize it or not, I believe we all have experienced some childhood or life trauma physical, emotional or both. These traumas can live on in our tissues and manifest in adulthood as soreness, tightness and pain.

Many people are familiar with the term 'trigger point'. A trigger point is a contraction on a small scale which occurs when a few fibers of a muscle get so hyper tight they become a red hot ball of sensitivity and inflammation.

Think of painful contractions like what happens when you squeeze the water out of a sponge. As the tissue tightens more life blood is squeezed out and dehydration grows. This creates swelling. That swelling is liquid that would otherwise be in healthy tissue but has been squeezed out. This also creates inflammation and as the area becomes more contracted/dehydrated bulging veins and varicose veins can become present. It is my experiences these are further evidence that the area is starving for blood, but cannot receive it due to advanced stages of soft tissue contractions.

Earlier we talked about a trigger point and how it is a small scale contraction. Here is a case example of a traumatic injury severe level contraction. A client came in severely limping and said "I tore my hamstring water skiing". The back of his leg was a dark black and blue all over. What he believed to be a tear was actually a severe contraction. This was determined with certainty during our 4th session. We were continuing treatment on the upper middle hamstring near the attachment point on the ischial tuberosity. This part of the muscle was like a steel rod it was so incredibly tight and contracted. After thoroughly stretching the area I was doing specific deep tissue work. Suddenly the hamstring released and his entire body convulsed with the recoil. When the initial shock of the recoil wore off he was able to say he felt much better. A few days later when I saw him again the black and blue was 95% gone. I determined that the reason the bruising was gone related directly to the hamstring release experienced during the last session. The released contraction allowed the blood that had been pooling around and protecting his injury to release and be reabsorbed by his body. Once the contraction was released the muscle regained normal use because blood was able to move around and through the traumatized tissue. He was back in the gym doing squats 2 weeks after the initial injury.

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How are contractions healed? The first key step is getting blood into tight contracted tissue. This starts by applying the appropriate stretch on the contracted fascia and muscle tissue. I have found what works best is a PNF stretch or Proprioceptive Neuromuscular Facilitation. A PNF stretch is when the client provides counter-force to my pressure. This stretch does a key thing that other stretches do not - it gently pulls the muscle away from the attachment points to the bone. This is key because it gets more blood into the area.

When the area has been sufficiently stretched with several repetitions of different stretches then we move into deep tissue work. What I do is different then what many people have experienced in deep tissue work. Many people have told me they are accustomed to very deep broad pressure into sensitive dehydrated tissue. This hurts and is largely ineffective because the tissue has not been properly prepared for deep access. If I were to go straight into deep tissue work and not stretch it out improving blood flow first - I would not be able to access the deeper layers necessary to get release. It would be too restricted and too painful.

If the deep tissue is so painful that the client is mentally and/or physically bracing against it - I believe we are no longer accessing the brain to help with healing. Therefore, I insist pain levels remain at very manageable levels. Getting results does not mean it has to be excruciatingly painful. Clients often say it feels like a 'good' pain or a productive pain. This way the brain is accepting the treatment and real change can occur.

All contracted tissue has a point that when deep specific pressure is applied at the correct location the tight tissue begins to release its grip.

Now you may be able to see why soreness, tightness and pain is so exhausting to our energy. Contractions are soft tissue that is working extremely hard all the time. I have seen people make the mistake believing an area or muscle(s) is weak and needs to be trained. In actuality the area is in a state of contraction, it is not weak it is tired from over working and being dehydrated. Training it just makes the contractions deeper and stronger. Release the contractions (and possibly adhesions and nerve impingement) get blood and circulation through the area and the tissue will regain strength quite naturally.

The good news is contractions are not that difficult to treat. However, making a full life long recovery from soreness, tightness and pain takes persistence and setting a priority in life.

Key Takeaways:

1. Commitment to manual therapy that re-hydrates contracted tissue

2. Build awareness back into the body - become aware of holding patterns

3. Create new musculoskeletal habits - break old habits that hold dysfunction in place.

In my next post we will go into more detail about numbers 2 and 3. These are easier said than done and essential in the process of bringing vitality, flexibility, strength and endurance back into the body.