Acute musculoskeletal pain is often directly or indirectly related to tight soft tissues. We can further subdivide soft tissue types into muscle, tendons, ligaments, joint capsules, and the intervening fascia. In acute dysfunctions (lasting less than a few months), contractile tissues (muscles, fascia) are the most important tissue that should be addressed. After a few months of tight tissues/joints, we must address all of the aforementioned tissue types.
There are many different schools of thought related to why tissues become tight, and which tissues are responsible for the dysfunction. Inevitably all theories MUST converge to the influence of the nervous system on contractile tissues. I would argue that the most effective way to do so is by directly stimulating the nervous system in certain ways, however other indirect methods also exist. The most effective method that a given health practitioner chooses will depend on the patient’s history, diagnosis and clinical reasoning. The following is a list of ways to reduce resting and active muscle or fascia tone. Use it to guide your assessment and treatment.
1) Central Nervous System Approaches
Decrease / Manage Stress – A high level of stress increases levels of cortisol released by the adrenal gland. The result is an increased sympathetic (fight or flight) nervous system response. The result of chronically high stress levels therefore can result in greater awareness of their body’s status (including a greater focus on pain), poor sleep, slows down digestion (leading to weight gain), and are at risk for a number of different diseases/disorders. Additionally cortisol is an interesting hormone as it plays a large role in healing – it slows the formation of college growth necessary to heal properly. Therefore, tissue healing takes longer.
There are many different ways to reduce stress, and many different fantastic resources to help you learn how to manage and decrease your stress levels. In the interim period, you can temporarily manage some of the signs/symptoms by ensuring you employ some relaxation/meditation techniques with the purpose of calming the mind, and thus calming the nervous system.
Cessation of Painful Stimuli – Our brain goes into protection mode when it senses stimuli that it deems to harmful: It creates extra muscle tightness to prevent any potential pain. In acute pain, this is best mediated by experiencing no pain at all on a daily basis during healing. In chronic pain, other tactics may be used.
Spinal Mobilization or Manipulation - During mobilization or manipulation, the nervous system is directly stimulated. The brain becomes aware of the specific input to spinal nerves, and a 'reset' occurs. Essentially, the brain and the spinal cord are thought to provide better neural output to the distal nerves (and subsequently, the muscles), thus having the ability to reduce resting muscle tone.
Spinal Manipulation - In addition to the benefits described above, after a manipulation there is a releases endogenous opiods (pain killing hormones created by the nervous system). These hormones allow the brain to experience a window of time in which the pain levels are decreased. This window provides the body with a chance to resume normal muscle activation patterns, thus allowing a decrease in muscle tone.
2) Peripheral Nervous System Approaches
Massage / Soft Tissue Techniques - Another way to stimulate the parasympathetic nervous system and produce a calming sensation for the nervous system is via massage / soft tissue techniques. The result is a positive feedback loop that encourages the muscles to relax, which encourages the nervous system to relax, and again encourages the muscles to relax.
Neurodynamics – This technique implies that all nerves in the body must be able to move in relation to the surrounding tissue. Indeed, should a nerve become adhered (stuck) to another tissue because of injury, poor movement patterns, or disuse of certain movements, proper conduction of electrical impulses will be less likely. The result of decreased nervous system conduction equates to hypertonicity of muscles.
Intramuscular Stimulation / Dry needling – The use of acupuncture needles via trigger point stimulation has been proven to be a very effective tool used to decrease muscle tone in myofascial trigger points (1). Not only does it directly affect the muscle length, but it is thought that the input into the nervous system brings more conscious and subconscious attention to the area (2). Clinically, I speculate that this attention permits the brain to re-focus, evaluate the targeted area, and attempt to reset muscle tension as needed.
3) Biomechanical Approaches
Joint Mobility Dysfunction - If any joints are hypomobile/hypermobile, or there has been a joint trauma, these problem must be addressed before you can expect normal muscle activation to occur. As we all know and have experienced, pain can either inhibit or facilitate muscle contraction, and may additionally facilitate resting muscle tone. Fix the dysfunction first, then train movement patterns.
Tissue Extensibility – If any tissue is extremely short (e.g. overly strong, or contractures), or lengthened (e.g. too flexible, partial tear, or select disorders including Ehlers–Danlos syndrome), you will need to assist tissues in resuming their normal length. Options may include specific soft tissue techniques, stretching, braces, splints, strengthening, or adequate time to allow healing.
4) Global/Movement Based Approaches
Movement Patterns - The correct activation sequence of muscles has been shown clinically to be a primary driver for most musculoskeletal problems, and can properly assessed by the Functional Movement Screen and Selective Functional Movement Assessment (3, 4). If a therapist can educate and train a client to active muscles in a certain sequence, it can decrease existing muscle tone and pain. Over time, the exercises are progressed through developmental sequences from non-functional to functional and unloaded to loaded. These progressions allow the brain to once again become comfortable with normal movement patterns and moving without pain.
Compensations in Other Regions of the Body – There are very important relationships between different areas in the body. If we have poor movement patterns in one area of the body (e.g. the thoracic spine), it can affect how well many other areas move (e.g. the lumbar spine, the scapulothoracic articulation, the cervical spine). Each compensation affects the next tissue and joint in the body, and may eventually create a physical dysfunction and then a source of pain. This pain serves as an eventual realization of dysfunction should you not fix the issue sooner rather than later. Please refer to the “Concluding Remarks” of my previous blog post where I refer to Gray Cook’s Joint by Joint Approach from his book entitled ‘Movement’.
1) Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of musculoskeletal pain. The Journal of the American Board of Family Medicine, 23(5), 640-646.
2) Hui, K.K., Liu, J., Makris, N., Gollub, R.L., Chen, A.J., Moore, C.I., Kennedy, D.N., Rosen, B.R., & Kwong K.K. (2000). Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects. Human Brain Mapping, 9, 13-25
3) Chorba, R.S., Chorba, D.J., Bouillon, L.E., Overmyer, C.A., & Landis, J.A. (2010). Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North American Journal of Sports Physical Therapy, 5(2), 47.
4) Kiesel, K., Plisky, P.J., & Voight, M.L. (2007). Can serious injury in professional football be predicted by a preseason functional movement screen?. North American Journal of Sports Physical Therapy, 2(3), 147.
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Jacob Carter lives and works in Canmore, Alberta. He combines research evidence with clinical expertise to educate other healthcare professionals, athletes, and the general public on a variety of health topics.