Let’s talk about tightness and pain

Why does that muscle feel tight? Is that what is causing my pain?

In the field of Registered Massage Therapy these question get asked a lot.

While tightness may sometimes be a response to a very specific problem, such as acute injury in muscle strains or ligament sprains, the answer is often not so clear. It would be fantastic to have a clean cut answer so that we could treat the problem and be done with it.

Indeed, definitive promises that your problem is caused by one thing and can be fixed by another one thing is often the calling card of a predatory practice.

Here’s a few examples…

• Your back hurts because heavy lifting is bad for you.

• Fix your back pain with one treatment!

• This trick will get rid of runner’s knee!

Sound familiar?

Back to the topic at hand: In the absence of specific injuries or medical conditions, why do some muscles always feel tight and restricted?

Well, the answer is one we hate to hear: it depends. Tightness, and its ugly twin, pain, are multifactorial monsters. We often have to step back from the specifics of the tight area and think about the bigger picture.

Some of the factors we may look at as therapists are:

1. Throughout the course of one person’s day, what kind of demands is their body under?
2. Do they exhibit faulty movement patterns in the gym or in sport?
3. Is there repeated stress coupled with inappropriate recovery?
4. Is this individual stuck in one position for hours on end?
5. Have there been previous injuries to this area? Is this a compensatory issue?
6. What preconceived notions of tightness does the individual have?
7. How long has this been an issue?

Now, these are only a few questions that help analyze the bigger picture, but they all draw attention away from the specific tight area and onto the person as a whole.

So since tightness and pain are multifactorial. What does this mean for you?

With the problem being multifactorial, the path of corrective action will need to be as well.

In the case of back tightness and pain, addressing the individual’s posture is often a key stepping stone on the way to recovery. Glutes will be strengthened, abdominals will be engaged, shoulders will be retracted, pectorals will be stretched, pain-free range of motion restored, and so on. With the help of well-managed exercise and rehabilitation, these goals are usually met.

So why then do certain clients still get feelings of tightness and pain despite having improved posture and mechanics? How does massage fit into all this?

While RMTs might have a decent repertoire of exercise rehab in their bags, clients expect that massage appointments will be just that – massages. RMTs typically help with a person’s tightness and pain through directed, intentional manual therapy of the problematic muscles and compensatory areas. This can help mitigate feelings of tightness by desensitizing the nervous system. Keeping the previously mentioned bigger-picture questions in mind, areas of the body can become sensitized to pain and tightness due to unnatural sustained postures, faulty movement patterns, previous injuries, injury misinformation, and so much more.

Going back to our previous example of a back pain sufferer, we need to think about how long the individual has dealt with this issue. Even with upright posture, the nervous system has been sensitized over countless hours and days of immobility, awkward postures, and expectation of pain so that the body is still primed to feel tight.  By working through tight and painful spots, and the surrounding tissues, RMTs help turn the dial down on these sensitized areas. Hands-on work helps decrease the sheer volume of neural input to the tight, painful area through a process called descending inhibition.

In short, massage provides a positive stimulus to the body, and this positive stimulus actually helps block some of the pain that the nervous system, and therefore the individual, is experiencing.

This sounds like a complicated way of saying something we knew from the start – massages feel good. Now, however, but now we can begin to understand why.

The discussion on tightness and pain perception is unending and is still actively being researched and updated. There are many resources out there for people interested in learning more about persistent pain.

Hopefully this discussion has given you some food for thought…or at least more questions to ask you RMT!

For now, here are some takeaways:

1. Tightness and pain are multi-factorial, therefore…
2. Fixing tightness and pain will also be multi-factorial
3. Our nervous system can become sensitized into feeling persistent tightness

Michael Uy, Registered Massage Therapist