“Is that tight?” Muscles and Tone
“Is that tight?” Very often as we are working with our hands, feeling how our patient’s joints, muscles, tendons, and skin/fascia move, we may come across an area that elicits discomfort. Sometimes this might be an area of a muscle that rolls/snaps under our fingers, feels hard, or creates a pain response. Inevitably, the patient on the table will ask, “Is that tight?”
My response: “No.” Usually.
There are many normal and abnormal states one may find in a muscle. Outside of being consciously contracted or relaxed, you may often find a difference in what we describe as ‘tone’ – the resting state of a muscle. Diminished in tone may feel floppy or soft, elevated in tone will feel harder, elevated in tone – or “hypertonic”.
Hyertonicity is the best word to describe increased firmness in the resting state of a muscle. A bodybuilder will generally have firmer muscles than a couch potato – the bodybuilder having higher resting tone, the couch potato having lower tone. That, however, doesn’t mean it’s bad or wrong.
When a muscle has abnormal elevated tone, often in the clinic the patient can feel when we touch a specific part of a muscle that creates pain when touched or sends pain elsewhere. We call that “referred pain”, and that area of muscle hypertonicity can be called a “trigger point.” That is abnormal and may need to be addressed because outside of just hurting, it can limit range of motion or cause local joints to move improperly, altering function.
So what is tightness? Tightness simply refers to length. How long is the muscle at rest or how far can it stretch? It likely that I personally cannot kick myself in the head or do the splits, not because my hip joint lacks the range, but because my hamstring behind my thigh and knee is too short to allow my foot to reach my head. Tightness doesn’t hurt – it just stops. When stretched, you may feel a comfortable but intense stretching in the muscle, but it shouldn’t hurt. Tightness simply doesn’t go. If something is tight and you want it to be longer, stretch it. That’s the solution. 3 rounds of 30 seconds of stretching is good
Let’s address a more specific and common case of hypertonicity. Let’s say you feel a “knot” between your shoulder blades. Again, let’s call that knot an area of hypertonicity. I would be hard pressed to find someone who didn’t get an area like this after using a computer, trying to sleep on a plane, after playing sports, or simply from having not-so-perfect posture. It’s likely that the hypertonic area isn’t an entire muscle but a number of muscle fibers – a band of muscle cells within that muscle.
What is the cause? I can’t say – there are hundreds of reasons why it could happen. Often the cause is improper use of that specific muscle. In the back, postural issues are a major cause. Muscles don’t like to be used the wrong way and they’ll often times let you know by gripping on and becoming hypertonic.
What do you do about it? The muscle needs to be released – a change needs to happen to get that muscle to get it to relax and return to its normal resting tone. Sometimes the muscle won’t relax because nerves are telling the muscle to contract and won’t let it go. Trigger point release is one great way. Manual release of the muscle via hands-on care or dry needing (using an acupuncture needle) can be extremely effective.
Don’t like massage? A simple home remedy is using a tennis ball against a wall. Find the spot, and to your tolerance, press yourself into the ball. It may be uncomfortable but after a couple minutes it should feel better. Other great tools depending on the body part include foam rolls, thera-canes, golf balls, la crosse balls, etc. Your PT can give you specific instructions for your body. Lastly, the joy of self-trigger point release is that you are in control! If it hurts – back off on your pressure. Don’t push so hard. It should be intense but tolerable. “Hurts good” if a nice way to think about it.
Of course your physical therapist can instruct you specifically on your body, pain, or functional issues. Ask them! They are more than willing to help.