Flexibility Isn't Always (Or Often) The Solution

You may have read last week's post about how flexibility is a mechanism that is driven by our nervous system, rather than being a structural issue like how we typically visualize it.

To further debunk the myths, let me also tell you about how flexibility work may not (or rather, is probably not) the end-all-be-all solution to pain or discomfort, contrary to what we often assume.

This assumption is made constantly! Back hurts? I need to stretch more. Recurring muscle strains? Stretch more. Knee pain? Stretch more!

However, I know plenty of regular yoga enthusiasts that still experience pain. If stretching was all that it took to keep joints and muscles healthy and happy, why would this happen?

Unfortunately, there isn't a lot of merit in flexibility, by itself, as a solution to pain or dysfunction. For instance, while there is a correlation between individuals who have poor flexibility and workplace back pain, the flexibility of non-symptomatic individuals can also be very low as well, suggesting that inflexibility is not the pain culprit, at least on its own.

A lack of flexibility is almost more like a symptom of a broader problem, not the problem itself!

So which direction do we go in, instead? Well, I can relate this back to a past post about the use(lessness) of static stretching. As I found when writing that one, it seemed that eccentric training of the hamstrings resulted in greater and longer-term range of motion increases than stretching did. As we know, a lot of muscular tension can be related back to a lack of joint strength or stability.This all suggests that, while a lack of flexibility may be associated with pain, that flexibility was only lost because of a need for more strength in the first place.

That all being said, when someone tells me that they're in pain and that they "just need to stretch more", I try to impart on them that it's not usually as simple as that. Inflexibility seems to, most often, be secondary to another underlying condition, and so we need to address that whole picture rather than just trying to stretch it out.

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Flexibility Is Driven By The Nervous System

Flexibility is a common concern for the health-conscious population. Right or wrong, stretching a tight muscle is often a main focus. However, what causes a lack of flexibility? How does that lengthening and shortening of muscular tissue work?

Well, you may be surprised to know that a lack of flexibility is not a structural issue. Often, we think of tissue like an elastic band. It seems like a good metaphor, as we'd like to stretch out that band enough to a point that it remains lengthened.

How we visualize muscle on stretch.

HOWEVER, the reality is that flexibility is, in fact, a neural mechanism, not a structural one. Just like the shortening of fibers occurs when you contract a muscle, the nervous system initiates similar contractions in response to stretch. (It's this response that we condition or decondition by lifestyle, rehab, or training.)

In other words, when you try to reach for your toes, your hamstrings experience a reflex that cause a contraction against the stretch.

You can't think of muscle shortening or lengthening like an elastic band. You have to think of it like a second person pulling back on a rope when you try to pull it in another direction.

What's really happening.

If you think about it, it makes a lot of sense. If you've ever pulled a muscle in your back or slept funny and have a kink in your neck, you can feel the sudden lack of flexibility in the area. Your muscle tissue didn't just magically and suddenly decrease in length (which would mean decreasing in size) in that time. Rather, the muscle is contracted and guarded.

This being said, getting muscle to lengthen and remain like that is not as easy as simple as performing prolonged stretching. If inflexibility is a nervous system reflex in response to stretch, that reflex needs to be trained out. Whether that be teaching the muscle to relax under tension, addressing a reason for excessive muscle guarding, or some other type of conditioning, it always comes back to making the nervous system happy and willing to let go.

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The Potential Rebound Effect Of Painkillers

I have a small discussion to have about some of the negative effects of pain-management drugs. Before I begin, however, let me set the record clear: Painkillers, including opioids, have a necessary and vital role in our society and healthcare heavily relies on them in numerous circumstances. I'm not allowing this to go down one of those anti-pharmaceutical, all-natural arguments made by fanatics who buy detox cleanses and don't vaccinate their children.

I banged my head against my keyboard just from Googling this image.

However, I was reading some interesting points made concerning the opioid crisis. As it turns out, chronic use of the medications may actually work to prime the nervous system and increase pain sensitivity! Obviously, this begins a problematic cycle of continued use due to heightened pain levels which are now going to be more resistant to further treatment.

This isn't necessarily a phenomenon exclusive to opioids, either. Acetaminophen has shown to have a similar rebound effect when it comes to headaches.

This creates important considerations when it comes to long-term recovery from pain, whether it's the severe pain following a spinal surgery or the headaches resulting from stress and neck tension. We need to recall the responses that the body will have to these pharmaceutical pain-management methods and be mindful when transitioning away from one management technique into the more conservative methods that I, as a therapist, employ.

In short, we can't always expect a cold-turkey cessation of pharmaceutical use. At the same time, that  use requires an off-ramp.

Disclaimer: Athletic Therapists do not provide prescriptions nor instructions regarding the use of any medication. Addressing these issues is done with the advice of medical doctors with the therapist providing the guidance for the rehab process.

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How Getting Past Pain Relapses Is Like Quitting Smoking

We made it to February!

How are those New Year's resolutions coming....?

Mmmhmmm!

Stepping aside from New Year's-specific goals (as you already know my opinion on them), let's discuss the realistic situation of regression.

Across the board, regressions and relapses occur in every type of behaviour or lifestyle change, whether it's recovery from pain, smoking, or weight loss. While the ideal is that we persevere through the road block or speed bump and continue on through the recovery process, often, hitting a point where pain returns, a cigarette is lit, or a few pounds are gained back are enough to shatter motivation and derail progress altogether.

One research group categorized pain relapse responses into four possibilities, some less ideal than others.

1) An unpleasant mystery that leaves negative feelings towards oneself and the situation.
2) A fact of life that should just be ignored.
3) A reminder to keep within physical limitations in order to avoid a future relapse.
4) An indication to change your behaviour to avoid another relapse.

You can probably assume that the first option is the least constructive, likely resulting in an ever-increasing level of negativity regarding the pain and loss of motivation to pursue further recovery.

The second option, ignoring the pain, is dangerous, as it may result in the individual becoming too content with their pain to the point of identifying with it.

The third possibility is good to a point. During a more acute phase of healing, learning to stay within limitations is vital, and sometimes the reminder is necessary. However, avoiding behaviours for too long can end up in a person simply using avoidance as a long-term coping mechanism.

Lastly, the fourth option is the most ideal in the long term. Understanding triggers or becoming aware of an increased need for self-work for your health is the most productive response to have if reexperiencing pain. However, sometimes coaching (whether it be self-coaching or help from a therapist) is necessary to reevaluate a relapse in order to maintain a positive foreseen outcome on the situation.

As it turns out, you can closely relate behaviour change relapses between health behaviours fairly well across the board! For instance, these tips of quitting smoking are amazingly applicable to this very process!

1) Focus on the next 24 hours:
Manage the acute phase of the relapse. Modify the environment so that further aggravation doesn't occur. Understand that this was an acute occurrence only and that you shouldn't become down on yourself and treat all the work up until this point as a failure.

2) Talk to someone:
Seek advice or support as needed. Seek your therapist or even consult a doctor if it puts your mind at ease that this wasn't a complete reset to square-one.

3) Analyze what happened:
Did you decide to get too aggressive with the weight you were squatting? Did you take a week off of your rehab exercises in too-early of a stage? Try and ask yourself exactly what may have caused this relapse to happen so that you can use that knowledge for future recovery.

4) Build a new plan:
This one is built straight into the basic rehab process. We're always modifying and changing pain-management and prevention strategies as needed, and having this relapse happen is a bit of a blessing in disguise, as it can help you and your therapist to further progress your long-term plan.

I try my best to ensure that my clients are ready for the possibility of their pain returning at some point, whether it's simply next week or a sudden reoccurrence in five years. Yes, it may happen. No, it is not the many steps back that you may think it is. And yes, there are steps that you can take to get right back on the train and continue to always get better.

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