What does "Stiffness" really mean?
Greg Lehman, a brilliant PT and educator, wrote a great three-part series on the concept of tissue stiffness, which is one of the primary complaints our Made 2 Move patients come in with.
What is stiffness? Why do we feel it? And what can we do about it? A 5 word answer: stiffness is simply a sensation. Okay that’s a quick answer, so it definitely needs some unpacking. Let’s jump in!
Why do we feel stiffness?
We won’t even try to pretend that we have a definite answer for why humans feel stiffness. The body’s sensations and signals it sends are incredibly complex. But below we outline a few potential contributing factors, NOT by any means an exhaustive list.
Stiffness/Tightness from working out:
You had a tough workout the day before and your central nervous system (CNS) is sensitized. Thus, the brain sends messages to your tissues and your tissues send messages to your brain that give you the feeling of “oof, that feels tight.” This is what is often referred to as DOMS, or delayed onset muscle soreness. Sometimes this soreness warrants a rest day- your body needs the recovery. Other days, if you get moving and start to desensitize your system, the soreness will decrease or subside.
Stiffness as a protective mechanism:
Stiffness could be a result of your body saying “ah that movement is painful,” so now I’m not going to move my joint through it’s whole range of motion or utilize the muscles in that region. Over time, your body adapts to only moving in partial ranges of motion and not using certain muscles, so they start to talk to you through the all too familiar feeling of tightness.
Similarly, stiffness could be a sensation your body generates when it feels it is not strong enough to perform the tasks demanded of it. This is often seen with inactivity, as the body trys to “protect” itself from doing activites it doesn’t feel fully prepared for.
Stiffness as a result of underuse:
Stiffness could be your body sending you a message of “hey I want you to move” as is the feeling that arises in those with osteoarthritis that report morning stiffness or after a 3 hour road trip. The body hasn’t moved for a while because it’s been asleep or strapped in your seat but once the body gets moving, the stiffness usually subsides.
At Made 2 Move, we will often ask you questions like: “What do YOU think is going on?” because we want to begin to understand your perceptions of your stiffness, pain, and injury.
We aren’t here to pathologize a normal feeling or part of your body, but in the world of PT the pathologization of normal is all too common. What we mean by this pathologization of normal is that often times clinicians take something like stiffness (feelings of tightness), postures (anterior pelvic tilt), and structures (flat feet) and label them as a problem that needs fixing when in all actuality, things like stiffness are just a part of the human experience and differences in bodies are just demonstrations of the variability between humans.
Greg Lehman notes, “We might be pathologizing a normal sensation and this can set you up to fail because all of your “fixes” (e.g stretching, foam rolling, massage, manipulation) are chasing the wrong target” (Lehman 2021).
What does the research say about tissue stiffness and pain? A 2020 study by Dieterich et al. looked at 20 women with chronic neck pain and 18 women without neck pain. Researchers utilized ultrasound shear wave elastography to objectively measure the stiffness of 5 muscles around the neck and found that, “all participants with neck pain confirmed sensations of neck stiffness, but higher muscle stiffness was not measured” (Dieterich et al. 2020). The same results were found in a 2017 study that looked at 15 people with back pain and stiffness and 15 matched subjects with no back pain or stiffness (Stanton et al. 2017). Their findings were the same: feelings of tissue tightness did not equal true tissue tightness upon imaging.
What do these studies this tell us? Essentially, the women who reported higher feelings of pain and stiffness did not present with more stiffness in the tissues upon objective measurement. Thus, we can’t always attribute what we feel (neck tightness) as the definitive source of our pain (tissue tightness), especially in chronic pain, as our bodies tend to send distorted signals and have heightened pain responses in times of chronic pain.
This also tells us that we can’t address stiffness by simply trying to stretch out the tissues. This won’t always work because maybe the tissues are not truly “tight.” If it feels good to stretch and it works for you then, keep on keeping on. But if stretching hasn’t been working, it’s time to switch gears. We have to uncover why our body is sending us this sensation of stiffness.
People can have “normal” ranges of motion, but still FEEL tightness. Our therapists at Made 2 Move test the mobility through your hamstrings and they are not lacking, yet you still feel “tight.” So what can this mean? Greg Lehman breaks this down beautifully: “What many suggest is that the perception of feeling stiff is really just one way that a sense of unease, discomfort, fatigue, pain or sensitivity show up” (Lehman 2021).
So stiffness doesn’t exist?
Okay so what we’re saying is that stiffness doesn’t exist? Of course not. Stiffness obviously exists (we have all felt it); we are just saying that stiffness might not mean what we think it means ie. because I’m stiff/tight, I need to stretch more. It has been drilled into our brains that stiffness means we need to stretch. But stiffness is a perceptual experience unique to each individual and we have to begin to start viewing it through this lens rather than the lens of true tissue tightness. We have to start attempting to uncover WHY we feel this stiffness.
Humans want a reason for their pain. And because of this, a common victim to blame for pain? Tissue tightness. My back hurts? It must be because my hamstrings are tight. (This is rarely the case). While tissue tightness can no doubt contribute to pain, it may not be the underlying cause. And a hard truth: we may not ever truly uncover the definite cause of your pain. But we will work with you to ameliorate your pain, get your body stronger, and begin to develop a greater understanding of the resiliency all humans uphold.
Interested in working with a PT that will do more than just send you off with a few stretches and a foam roller to address your feelings of tightness? At Made 2 Move, we work with you to get to the root cause of why you feel what you feel. Reach out to firstname.lastname@example.org today to set up an initial evaluation and stay tuned for Part 2 of this Stiffness as a Sensation Series: How to “fix” stiffness.