Articles Of The Week March 11, 2018

Is yoga effective for managing chronic pain? Maybe, but then again maybe we just need to look at safe, non-threatening movement as a way to cure or manage chronic pain.

“Yoga, Mice, Pain and Your Brain” – Sarah Haag

There are some great points in this article about doing aggressive psoas work on patients, but there’s some things I don’t like about the article. To say that only those trained in visceral work should be doing this kind of work (because there’s not much evidence to say visceral manipulation is effective), is a bit of a stretch. However, I like the overall gist, that only trained professionals should be doing the work, and to be careful, there’s no need to do “aggressive” work.

“Serious Warning – If You Do Any Releases To Your Psoas or Abs, You Must Read This” – Antony Lo

Load management in athletes is an important factor in making athletes available for, and being in the best shape possible for competition. This post reviews three factors related to load management to help your athletes.

“Load Management Is Not About Decreasing Minutes” – Tim Gabbett

I love sleep, so I hate this part of the year where I lose an hour of it putting the clocks forward (why are we still doing this!?). A lack of sleep can lead to a host of health conditions and can affect brain health. Fortunately, massage therapy helps with sleep, so this could be a good article to share with your patients as another reason to get a massage!

“Why Are We So Sleep Deprived And Why Does It Matter?” – The Conversation

I’ve been asked many times if I would ever open up a practice at home and while it’s not for me, I know plenty of therapists who do. This post lays out several things to consider if you are wanting to open a home-based practice.

“Opening A Home Based Massage Business” – Allissa Haines

Articles Of The Week February 18, 2018

I may be partial, but I gotta say I love this post. It might be because I think this has happened to all of us. We have a patient come in who has been told by another practitioner that they will never get better, or they’ve been given some false information. Well, this is an open letter to everyone in our industry to do better.

“An Open Letter To My Patients Previous Therapists” – Sarah Haag

We all treat patients with low back pain. But, what are the appropriate guidelines for treatment? Well, some pretty reliable practitioners teamed up to look at the evidence, and explain the difference in guidelines, implementation, and controversies.

“Low Back Pain, A Ride Through The Guidelines” – Body In Mind

I don’t know about you, but I LOVE sleep. But how much do we really need? Well, that may vary, but it’s important to pay attention to our own individual needs, as well as looking at how to make sleep a priority.

“How Much Sleep Do We Really Need?” – National Sleep Foundation

One of the great things about massage therapy is the many ways we can focus on certain conditions or populations. If you’d like to focus on cancer treatment, this site has some good info. They present different recommendations as far as altering your treatment when someone is going through chemotherapy, and their reasoning seems pretty sound.

“Cold Caps, Frozen Feet, And Massage During Chemotherapy” – Tracy Walton & Associates

Our communication with patients is so important. So how do you present new ideas or research to them when you learn it? How about when it comes to your pain education? It doesn’t have to be complicated (in fact it’s probably a lot better if it isn’t), just explaining that certain areas of their body may be a bit more sensitive, is probably a lot better than a complicated description.

“Pain Science Education” – Lynita White

 

Articles Of The Week February 11, 2018

Like so many things in our industry, there is lots of confusion around youth strength training. Does it improve health? effect bone growth? is it even appropriate? Some great information in this article covering those questions and many others.

“Youth Strength Training”  – Mario Chavez

Chronic disease is a massive expense on our healthcare system, and yet there doesn’t seem to be much done to prevent it. So how can we start to change things to start making prevention a regular part of our healthcare systems?

“An Ounce Of Prevention Is Worth A Pound Of Cure” – Jarod Hall

Quite often I have patients and colleagues ask where to get good information on pain. Well, Lissanthea Taylor is stepping up with this great resource she is developing. There will be lots of information on pain so that we can give accurate information to others.

“Where’s The Good Information About Pain?” – Lissanthea Taylor

Do you know the difference between Varus and Valgus? This post will help to give you a better understanding of the differences between the two and what can contribute to it. One of the things I like about the article is how the author points out that someone may have this kind of condition, but not experience any pain, so it may not even need treatment.

“Valgus, Varus, Vargus…What Is It?”  – Whitney Lowe

Being in business for yourself is hard work! It seems there is a never-ending list of things that have to get done and we’re constantly hustling to accomplish more. But could we be more successful if we hustled less? Here are four tips on how to do just that.

“How Not To Hustle Your Way To Success: 4 Tips For Aspiring Entrepreneurs” – MeiMei Fox

 

Three Reasons It Matters Why A Treatment Works

Why exactly does someone feel better after a massage? Or acupuncture? Or foam rolling? Or a chiropractic adjustment, or wearing K-tape, or doing mobility drills, or a hamstring stretch?

There are some good answers to these questions, and the interesting thing I’d like to point out in this post is that quite often, the therapist doesn’t know them. Or even care about them! Or maybe the therapist has heard the good answers, but prefers alternative bad answers that are far less plausible given the current state of relevant science.

Speaking of bad explanations: Foam rolling probably doesn’t work by breaking adhesions or melting fascia. Chiropractic manipulation doesn’t put joints that are “out” back “in.” Deep tissue massage doesn’t get rid of toxins or “muscle knots.” Acupuncture doesn’t access special points or meridians – putting the needles in random places works just as well. Some sham surgeries work just as well the real thing. Motor control exercises often work to reduce pain even though motor control hasn’t changed.

None of this means that the above treatments can’t work to make someone feel better. It just means they don’t work in the manner advertised. And no this doesn’t mean that everything is just placebo (that’s a confusing word without a clear meaning.)

In general, it seems that therapists have a strong bias towards the idea they are fixing “issues in the tissues.”  And they tend to ignore issues in the more complex systems in the body – nervous, immune, autonomic – which are very sensitive to even minor inputs and have a great influence over how we move and feel. Maybe this is because these systems are less visible, or tangible, or just not what practitioners learned about when they were in school.

I was trained as a Rolfer and taught that Rolfing works by changing fascia. So when people got up from the table and said they felt taller, or looser, or had less pain, this was because their fascia had somehow changed for the better.

After doing some research about the deformability of fascia in response to manual pressure, I decided this was not a good explanation for our observations. A better explanation would involve the nervous system, which is constantly adjusting muscle tension, movement patterns, perception, and pain sensitivity in response to new sensory information, including the highly novel sensory information caused by bodywork.

Of course, it’s kind of a bummer to learn that a central premise of your education is incorrect. But the good news is that this doesn’t mean people can’t be helped with your treatment. That is a completely separate issue. So my attitude was – OK, it’s not about the fascia, but that doesn’t mean I can’t help people.

But for many Rolfers, it just has to be about the fascia. And for chiros, it has to be about the subluxation, and for Reiki practitioners, it has to be about energy, and for others, it needs to be about posture, or core strength, or muscle imbalances, or movement patterns.

And of course, many others will say: “I don’t care how the treatment works, I just know that it works does so who cares why?”

Here’s three reasons why it’s important to know why your treatment works.

1. If You Know How Something Works, You Can Make It Work Better

This should be obvious. If you know where the target is, it’s easier to hit the bullseye.

Let’s assume that stretching or massage works to create better range of motion by getting the muscles to relax. (Reasonable enough, right? And supported by research!)

But if you think that it works by forcefully breaking adhesions or physically lengthening tissues you might lose focus on whether your clients are staying relaxed.

When I work on someone I always ask “how does that feel?” Here’s a common response from clients who think it’s all about the fascia: “Don’t worry about me, I have a very high pain tolerance, just do what you have to do.”

And I will think to myself: “Well, I need to know how you feel because that is one of the main targets for this work.” But if my target was breaking up fascia or muscle knots then indeed I wouldn’t care how they felt. And I wouldn’t do as good of a job.

2. Unintended Consequences

Imagine someone with neck pain goes to the chiropractor, is told their neck is “out”, gets cracked to put it back “in”, and then immediately feels much better. What’s the harm if they think that pain relief came from some form of realignment?

Maybe in the short term, there is no harm, but false beliefs have a mischievous way of eventually causing problems in the long term.

Let’s say the neck pain comes back. The client thinks her neck must be “out” again so she needs another crack. So she overlooks other potential solutions like exercise, rest, or gentle movement. If the neck pain continues, she might eventually develop the pathological belief that her neck is fragile and unstable. This can have a nocebo effect – creating further pain and avoidance of healthy movement.

I have seen many clients with similar misconceptions, and this has cost them significant time, money, anxiety, and confusion.

And I’m not just talking about the clients of chiropractors.

I have seen yoga people who are always stretching; Pilates people always stabilizing; corrective exercisers looking for microscopic muscle imbalances; joint mobility fans perpetually mobilizing, as if their joints need a constant bath in synovial fluid, or will start knitting themselves together with some sort of fascial “fuzz” after just a few minutes of stasis. Rust never sleeps!

All these pathological behaviours ultimately stem from false beliefs about why certain therapies have worked for them in the past. These beliefs cluster around the idea that they have corrected “issues in the tissues” as opposed to temporarily adjusting the sensitivity of the nervous system.

The bottom line is that false beliefs, no matter how small, are like viruses – they multiply, get passed to others, mutate to form superbugs, and can eventually cause disease. Don’t spread them, people!

3. The Truth Matters

The truth has inherent value, even when its practical application is not immediately obvious. Knowledge is always powerful – for you, your clients, and the whole community.

We don’t yet know exactly why people have chronic pain and the best ways to treat it.

Even though that knowledge hasn’t been created yet, that doesn’t mean it’s useless to learn more. Every step away from misinformation and confusion is a step in the direction of the truth.

Let’s face it. The truth is good and ignorance sucks. Here’s some quotes from smart people to prove it.

“All evils are caused by lack of knowledge.”

–David Deustch

“I think it’s much more interesting to live not knowing than to have answers which might be wrong.” 

— Richard Feynman

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

— Mark Twain

 “The truth will set you free, but first it will piss you off.” 

–Joe Klaas

Many thanks to my readers and members of my social media community who are thinkers, skeptics, and unafraid to follow where the evidence leads.

The Science Behind Why Assessing And Blaming Posture For Pain Is B.S.

If I had a £ for everybody that mentioned posture on social media or when they had a pain problem…… well lets just say I would be a pretty rich guy.

POSTURE has literally become engrained in peoples thoughts when talking about back, shoulder or neck pain even though we have a shit ton of studies that compare the postures of pain-free people with those with back, shoulder or neck pain and find no real differences, this information gets regularly IGNORED.

NEVER let science get in the way of a good story, especially if it’s on the interwebs!

In fact, I have written about posture a few times before:

The definitive guide to posture and pain 3 minutes flat

Do you really need your joints to be centred?

But just to kick off with a bit of science, this paper HERE from 2016 found NO significant difference in lumbar lordosis (spinal curve) between people with back pain and those without.

This is super important. HOW can we blame something that we see in people WITHOUT pain as a cause of pain for those that do?

I will just let that sink in…

What Are You Measuring?

In this blog, we are going to explore a few questions related to how we assess posture and if they are actually scientifically VALID, because if you don’t have a good measure, to begin with then it is pretty tough to blame something for the problem.

The first piece of ACTUAL EVIDENCE, something often missing in the posture debate, looks at the measurement of STANDING LUMBAR LORDOSIS (the curve in the back often blamed for back pain) and this assessment is something that is performed in treatment rooms and gyms the world over.

The idea is that an increase (and sometimes decrease) in lumbar curve increases back pain and is often coupled with the idea that the tilt of the pelvis has an influence on the size of the lumbar curve, even though lumbar curves do not seem to be much of a factor in lower back pain anyway (see the SCIENCE above : )

Way back in 1990 this was explored by Heino et al HERE and they found that the angle of someones pelvic tilt and their lumbar curve do not simply correlate! So looking at the position of the pelvis tells us very little about what is occurring at the lumbar spine, which is much harder to measure. A very similar study HERE from before this in 1987 also threw up the same result but this BS is still being taught today.

Anyway, back to the standing measurement paper HERE. The authors explored the variability in standing posture of 400 people, 332 without pain and 83 with low back pain, and they found that each time we stand we do it in a slightly different way.

The authors in their words state standing is highly individual and poorly reproducible”.

So why does this matter?

Well simply put, which posture are you ACTUALLY measuring with your postural assessment. One may show an increase in lordosis, another less so.

I have some questions related to how we interpret postural assessments in light of this information.

  • Which of these postures is related to the problem?
  • How many times do you measure and do you average?
  • What are you comparing against to determine if the curve is too much or not enough?

The authors highlight a good point that the lack of consistency in standing posture may actually lead to the “wrong diagnosis and possibly unnecessary treatment”.

If you focus on something that is not an issue you do not focus on something else that might be or be blinded to the fact that it is not working or only works transiently (potentially why so much back pain is persistent).

What people actually use in their everyday lives might also be different to what is measured in the clinic or gym. A clinic or gym measure could be described as a ‘snapshot’ and this study HERE compared this ‘snapshot’ to what was actually used on a daily basis by the study participants.

The authors found that on average whilst standing, as most postural assessments are, there was a 33.3° lumbar lordosis but the average used over a 24hr period was only 8°, a huge difference!

So the ‘snapshot’ postural assessment would not really inform us very well about how much lordosis was REALLY being used and we could overestimate the extent of the imaginary problem.

We also have to remember these were radiological measurements and this is the clinical ‘gold standard’. Often a lordosis is measured in a much more rudimentary fashion by looking at the relationship of landmarks at the pelvis indicating a pelvic tilt and therefore change in the lumbar curve, which we have already discussed as not being well related to lumbar curve! This in itself is a problem as demonstrated by Preece in 2008 HERE as pelvic morphology is also VARIABLE leading to incorrect measures.

These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry”

 Here is the distribution of side to side difference of the ASIS-PSIS relationship (used to assess pelvic tilt), we can see it is skewed to the right side meaning it is more anteriorly tilted at a BONY level.

Jmmt0016 0113 F04

So it might be that we are really bad at measuring something that doesn’t matter that much. OUCH

Are You Biased?

Another important question for those that assess posture is…are you MORE inclined to see an ‘abnormality’ in posture when you know pain is present?

This paper HERE would suggest so. Here the authors looked at scapular dyskinesis or abnormal posture and movement of the shoulder blade, which is often proposed as a CAUSE of shoulder pain.

They compared 67 people with shoulder pain and 68 without and firstly found that there was no difference in shoulder posture or motion between those with pain and those without.

Fascinatingly though when the assessors were aware that they were assessing someone IN PAIN, they reported a greater prevalence of a postural or movement problem. This shows a bias towards finding an ‘abnormality’ to blame when there is pain, even though there was NO MORE ‘abnormality’ in those with pain than without.

The authors also suggest that scapular dyskinesis actually represents normal variability between humans! Perhaps if they assessed it multiple times it would throw up different measures each time?! It is important to remember we have no scientifically defined ‘good posture’ to base deviations from in the first place.

How Do Healthy People Sit?

Another question is how do people without back pain actually behave? They must have great daily posture, right? Well actually NO.

This paper HERE shows that asymptomatic folk, 50 of them, when seating actually SLUMP. In 10-min sitting, spinal angles flexed 24 deg at lumbar and 12 deg at thoracolumbar regions relative to a standing posture. But this slumping does not seem to cause them problems.

So changes in our spinal curves seem to be fairly unrelated to pain as we can see below.

 

PowerPoint Presentation

 

So If Posture Does Not Really Correlate With Pain, What Does It Correlate With?

Well, this paper HERE shows that cervical spine alignment changes actually correlate with age. This study split the participants into 4 groups determined by age. They found that the measures of the angles of the neck all correlated with the increasing age range of the 4 groups.

The key point to remember here is that all the participants, 120 of them, had no pain. In fact, the exclusion criteria here was pretty rigorous and the authors actually excluded 64 people, so 1/3 of the original sample, for having current or previous pain.

So simply put, as we get older our posture becomes ‘worse’ or perhaps better put our posture increases….BUT and a this a big BUT, this does not seem to cause MORE pain.

To sum up it does not seem as simple as ‘bad’ posture = pain whatever you read or are told in a bar, gym or clinic room.

Key Take Homes

  • People IN pain DON’T have different postures to those that don’t have pain
  • Posture displays variability just like movement
  • This means your assessment may not tell you what you think it does
  • Your assessment could be biased to finding a postural ‘problem’
  • Postures used throughout the day are probably different to those being assessed
  • As we get older our posture change and this happens to people NOT in pain too

Why Do Muscles Feel Tight?

*This was originally published on Todd Hargrove’s blog Oct 12, 2016

Why do muscles feel tight? Does that mean they are short? That they can’t relax? And what can you do about it?

Here are some of my thoughts about why muscles feel tight and what to do about it.

(Update – See bottom of the post for recent research confirming some of the speculations in this post.)

Tightness Is A Feeling, Not Just A Mechanical Condition

When someone says they feel tight in a particular area, they might be referring to several different complaints. So I try to find out:

  • Are they talking about poor range of motion?
  • Or maybe range of motion is fine, but a movement to the end range feels uncomfortable or takes excess effort.
  • Or maybe the problem isn’t really with movement, but just that the area never reels feels relaxed.
  • Or maybe the area feels basically relaxed, but has some vague sense of discomfort – a feeling that is unpleasant but too mild to be called pain.

This ambiguity means that the feeling of tightness is just that – a feeling – which is not the same thing as the physical or mechanical property of excess tension, or stiffness, or shortness. You can have one without the other.

For example, I have many clients tell me their hamstrings feel tight, but they can easily put their palms on the floor in a forward bend. I also have clients whose hamstrings don’t feel tight at all, and they can barely get their hands past their knees. So the feeling of tightness is not an accurate measurement of range of motion.

Nor is it an accurate reflection of the actual tension or hardness of a muscle, or the existence of “knots.” When I palpate an area that feels tight to a client (let’s say the upper traps), they often ask – can you feel how tight that is?! 

I often say something like:

Ummmmmm …… no. It feels just like the surrounding tissues.

But I completely understand that it FEELS tight in this area and you don’t like it.

I don’t like the feeling of tightness either so I want to help you get rid of it. But the feeling of being tight isn’t the same thing as that area actually being physically tight. Make sense?

This actually does make sense to most people, and they find it mildly interesting. I want people to understand this because it might help them reconsider a misconceived plan they may have already developed for curing their tightness – such as aggressive stretching, fascia smashing, or adhesion breaking. So now they are willing to consider an approach that is a bit more subtle than driving a lacrosse ball halfway through their ribcage.

Why Do Muscles Feel Tight If They Are Not Actually Tight?

So why would a muscle feel tight even if it physically loose?

I think we can use pain as an analogy. Pain can exist even in the absence of tissue damage, because pain results from the perception of threat, and perception does not always match reality. Pain is essentially an alarm, and alarms sometimes go off even when there is no real danger.

Perhaps a similar logic is involved in the feeling of tightness. The feeling happens when we unconsciously perceive (rightly or wrongly) that there is a threatening condition in the muscles that need a movement correction.

So what is the threatening condition that a feeling of tightness is trying to warn us about? Surely it is not just the presence of tension – muscles are made to create tension and we often feel tightness in muscles even when they are almost completely relaxed.

So the tension is not a threat, but the absence of adequate rest or blood flow is a threat, which could cause metabolic stress and activate chemical nociceptors. So the problem that a feeling of tightness is trying to warn us about is not the existence of tension, but the frequency of tension or the lack of blood flow (especially to nerves, which are very bloodthirsty.)

With this in mind, I think of the feeling of tightness as a variety of pain, perhaps a pain too mild to deserve being called pain. But it is definitely bothersome. And it has a certain flavour or character that motivates an interest in changing resting posture, or moving around or stretching. Which is different from certain pains, which often make you want to keep still. Maybe we could say that pain is warning us to not move a certain area, while tightness is warning us to get moving.

How Can You Cure Muscle Tightness?

I think we can probably treat the feeling of tightness in the same way we treat pain – by changing one of the many “inputs” that cause the nervous system to perceive a threat in the body, such as nociception, thoughts, emotions, memories, etc.

Some pains are very obviously related to movement or postural habits. We can know this if someone says something like: “It hurts when I do this, and it hurts even more when I do more of this, and it hurts less when I do less of this.” In this case, changing movement or posture is likely to help because it will reduce the main driver of the pain – mechanical nociception caused by movement.

On the other hand, there are many other cases of pain, particularly chronic pain, that are more complex – the pain doesn’t correlate very much with certain movements or postures, but instead with other variables like time of day, sleep duration, emotional state, stress level, diet, general exercise, or some random unknown factors. In this event, it is unlikely that mechanical nociception caused by movement is the main driver of the pain, and more likely that peripheral or central sensitization are playing more of a role.

I think we can look at the feeling of tightness in the same way.

In most simple cases of feeling tight, the cause is obvious – we have been stuck in the same posture or movement pattern for too long, and our muscles need a rest or change of position to reduce the ischemia or metabolic stress that is causing nociception in certain areas. For example, if we spend hours in a car, or an airplane, or behind a computer, we will instinctively feel compelled to stretch and move, and this will usually alleviate any feelings of stiffness or yuckiness.

 

Of course, most clients who complain of chronic tightness have already tried and failed at this simple strategy. The feeling of stiffness remains for hours and days at a time, comes and goes as it pleases, and is less related to posture and movement.

In these cases, the driver of the discomfort may have more to do with the nervous system becoming either peripherally or centrally sensitized to the need for more blood flow in certain areas. This could happen through local inflammation, adrenosensitivity, increased sensitivity at the dorsal horn, or maybe even learned associations between certain environments (say computers) and certain sensations (e.g feeling like crap).

So how do we reduce this sensitivity?

There isn’t an easy answer to this question because if there was, it would solve the problem of chronic pain, and no one is figured out how to do that yet. But if I’m right that the feeling of tightness is a mild form of pain, then it should at least be easier to deal with.

Below is a list of several methods people often use to address a chronic feeling of tightness, along with some thoughts about each strategy from the above perspective. You’ll notice that some of the recommendations run exactly opposite to what people often do.

Stretching

We instinctively stretch muscles that have remained in a short position for a while, and this usually makes us feel immediately better.

But, as noted above, most people who suffer from chronic tightness have already tried and failed at this strategy, which suggests the issue is less about bad mechanics and more about increased sensitivity.

The problem is that many people, and indeed many therapists, will think that the failure of a few simple stretches indicates the need for a far more aggressive program.

Photo by: RachelScottYoga

This would, of course, make sense if the root of the problem was short or adhered tissues. But if the root problem is in fact increased sensitivity, then aggressive stretching might just make the problem worse. On the other hand, stretching can often have an analgesic and relaxing effect.

So is stretching a good way to cure tightness? Like with most things, I say if it feels good do it. If it doesn’t … don’t.

Soft tissue Work For Tightness

There are various soft tissue treatments (deep tissue massage, foam rolling, Graston, ART, IASTM) intended to lengthen short tissues, break adhesions, or melt fascia, etc. This is very likely impossible, as I and many others have pointed out.

But could these treatments decrease sensitivity and make someone feel less tight? For sure, by activating descending inhibition of nociception, which is a well-known effect of painful stimulation that is expected to bring health benefits.

But of course, these treatments also create nociception, which tends to increase sensitivity. It’s a fine balance that depends on the individual and many other variables. Again, if it feels good do it, but it’s an option, not a necessity, it’s only temporary, and you should keep in mind the reason for doing it.

Motor Control For Muscle Tightness

Many forms of movement therapy are essentially motor control approaches – they seek to change movement, postural and breathing habits so they are more efficient, eliminate parasitic tension, develop the skill of relaxation, etc.

 

Habits are hard to break, but this strategy is worth a shot, especially in cases where tightness seems related to certain postures or movements. Of course, where the situation is more complex, motor control shouldn’t be expected to fix the problem on its own.

Exercise And Resistance Training

People tend to associate strength training with becoming tighter. During exercise, muscle, of course, becomes very tense, and they may feel stiff the next day because of delayed onset muscle soreness. There is also the (false) idea that strength training makes muscles shorter and less flexible.

These concerns are unfounded. In fact, full range of motion strength training can increase flexibility, perhaps more than stretching. It creates local adaptations in muscle that may improve endurance and make them less likely to suffer metabolic distress. And exercise also has an analgesic effect and can lower levels of inflammation that cause nervous system sensitivity.

Here’s a personal anecdote. Back in the days when I did yoga, I had much more flexibility, but my hamstrings always felt tight. Then I quit yoga and started doing a lot of kettlebell swings. My forward bend decreased a bit, but the feeling of hamstring tightness was GONE, even though I was working the hamstrings HARD. In its place was a feeling of functional strength and capacity, which I imagine decreased any perception of threat related to lengthening my hamstrings.

Of course, if you overwork your muscles from strength training and don’t let them recover, they will get sensitive, stiff and sore. But if you work them the right amount – enough to create an adaptation and not too much to cause injury or prevent full recovery – then you will make them healthier, stronger, and yes – less stiff.

Conclusion

When you feel stiff, remember it is a feeling, and not necessarily a physical condition of shortness that needs an aggressive structural solution. Like other feelings, you feel it more when you are sensitive. And like other forms of sensitivity, it will go down if you improve your overall fitness, strength, awareness, motor control and health.

Update – August 30, 2017

This paper from Stanton, Moseley, et al. validates some of the speculations in this post. Here are some quotes from the abstract:

We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back. . . . Over three experiments, we challenge the prevailing view by showing that feeling stiff does not relate to objective spinal measures of stiffness and objective back stiffness does not differ between those who report feeling stiff and those who do not. Rather, those who report feeling stiff exhibit self-protective responses: they significantly overestimate force applied to their spine, yet are better at detecting changes in this force than those who do not report feeling stiff. This perceptual error can be manipulated: providing auditory input in synchrony to forces applied to the spine modulates prediction accuracy in both groups, without altering actual stiffness, demonstrating that feeling stiff is a multi-sensory perceptual inference consistent with protection. Together, this presents a compelling argument against the prevailing view that feeling stiff is an isomorphic marker of the biomechanical characteristics of the back.