Stretching — and being stretched — feels good. Why? And is it actually therapeutic?
Stretching for Trigger Points
Is muscle knot release a good reason to stretch?
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
EXCERPT This article is an excerpt from SaveYourself.ca’s ridiculously detailed tutorial about trigger point (muscle knot) self-treatment, which contains more detail about the bath trick, as well as hundreds of other basic and advanced tips and tricks.
In Muscle Pain, Simons and Mense are pretty bullish on stretching for trigger points.
They propose that “essentially any technique that elongates the muscle out to its full stretch length” constitutes effective treatment for trigger points therein. “A newly activated, single-muscle [my emphasis] myofascial trigger point is usually remarkably responsive to simple stretch therapy,” they write. Stretching “by almost any means is beneficial … At least five ways can be used to augment simple muscle stretch.”
Of course, they also mention a few pages later that it has “not been firmly established” that stretching trigger points is helpful, emphasizing that they are making educated guesses. But when experts this credible say that stretching may be effective, we have to sit up and take notice!
There are several ways that self-stretching might reduce the pain and stiffness caused by trigger points. The hazards and limitations discussed above certainly vary from case to case: worse in some physiological circumstances, better in others.
The hazards of stretching muscles with trigger points are probably worse in some physiological circumstances, better in others.
As mentioned earlier, I suspect that milder trigger points are probably in much less danger from stretching, and may therefore yield more readily. Simons and Mense clearly agree when they write that stretching works primarily for “newly activated, single-muscle” trigger points. The less extreme physiological circumstances of the muscle mean that a defensive contraction is relatively unlikely, and that the trigger point is not so tough that it can’t be pulled apart.
And stretching trigger points in long muscles — even serious knots in muscles like the rectus femoris, say, or the hamstrings — seems to be quite safe. It may or may not work, but it’s probably not going to irritate anything either.
How stretching works if if works
If stretching ever works for trigger points, this is probably how it works:
Quick review: as we know, a trigger point is a sick, poisoned patch of spasming muscle. It is experiencing a metabolic bad day, a situation known as an “energy crisis.” It is consuming lots of fuel and excreting lots of junk molecules at exactly the same time that it is choking off its own blood supply. Waste accumulates, irritates nerve endings, and everything goes downhill. It’s a vicious cycle.
A trigger point is experiencing a metabolic bad day, a situation known as an “energy crisis.”
As long as a trigger point can be fully elongated — which it definitely cannot be in some circumstances, but certainly could be in others — it cannot burn fuel. It can only burn fuel when the working molecules inside the muscle fibre are overlapping. When stretched out and disengaged, they cannot work, like a hamster without a wheel to run in. According to Simons and Mense, every moment the stretch is sustained presumably allows the energy crisis to abate, the vicious cycle increasingly derailed.
This is state-of-the-art of trigger point science. It is the single most-educated guess available, from the most credible sources in the world. This is as close as we’re going to get to a really good reason for stretching … and it sounds pretty good.
But there are still more concerns …
- Exactly how long this recovery from energy crisis takes, no one knows. Is a one minute stretch long enough? Five? Twenty?
- Exactly how you are supposed to pull apart a powerful contraction knot — muscle fibres in full spasm — with anything less than a pliers and a vice … no one knows.
- Whether or not the process needs to be repeated once, thrice, or nine times … no one knows.
- Whether or not it’s going to do any good to partially release the trigger points in one muscle while there are approximately seventy-two other trigger points in other muscles in the region … still, no one knows.
How are you supposed to pull apart an incredibly powerful contraction knot with anything less than a pliers and a vice?
Simons and Mense, on the same page I’ve already quoted extensively, emphasize in one place that a trigger point must be “fully” elongated in order — theoretically — to have any significant effect on the energy crisis. Then they caution that the stretch must be applied “slowly and only to the onset of discomfort.” Are they kidding? Is this a joke? Are we having a serious conversation here? There is no hope of “fully elongating” most muscles by applying stretch “slowly and only to the onset of discomfort.” The onset of discomfort is where you’ve only begun to tug on the fully contracted trigger point! Such a gentle stretch could probably only be useful in the case of the most minor trigger points, so clinically insignificant that it hardly seems worth bringing up. Stretching such trigger points might “feel good” to someone who feels a little stiff, but has no therapeutic importance to anyone serious about troubleshooting severe trigger points!
The trigger points people bring to me every day are so awful that they can’t bend over to tie up their shoes without disabling pain. They can’t fully elongate a Slinky without an onset of discomfort, let alone their trigger-point-riddled muscles.
Most of my clients are in so much pain they couldn’t fully elongate a Slinky without an onset of discomfort, let alone their trigger-point-riddled muscles.
It is these persistent and severe ambiguities that keep me from getting too excited about the theoretical potential of stretch to resolve trigger point pain … despite the fact that it “sounds good on paper.”
More information about stretching for trigger points
Stretching is just one kind of self-treatment for myofascial trigger points, and arguably one of the least effective. What else can you do for muscle knots?
In the full version of the trigger points tutorial, you’ll learn about the surprisingly practical problems with using stretching as a therapy, how muscles with trigger points may already be overstretched, and why the anecdotal evidence — even though it’s very strong — just isn’t good enough to get excited about it, as well as additional details left out of the sections above.
And stretching is the tip of the iceberg — there’s much more to know about self-treatment of trigger points. I’ve written a lot about stretching because it’s an interesting subject, and because a lot of people place a lot of their hopes on stretching. But there are better ways to treat trigger points! The tutorial explores them all. It’s is book-length and required reading if you’re serious about tackling trigger point pain. Buy it now ($19.95) or read the first few sections for free.
Further Reading
- SY Save Yourself from Trigger Points & Myofascial Pain Syndrome! — Trigger points (also known as muscle knots) & myofascial pain syndrome, explained and discussed in great detail, including every imaginable self-treatment and therapy option for difficult cases
- SY Quite a Stretch — Stretching research clearly shows that a stretching habit isn’t good for warmup, injury prevention, preventing or treating muscle soreness, enhancing athletic performance … or even flexibility!
- SY Dance of the Sarcomeres — A mental picture of muscle knot physiology explains four familiar features of muscle pain
- SY The Unstretchables — Ten major muscles you can’t stretch, no matter how hard you try