SaveYourself.ca • Sensible advice for aches, pains & injuries
Stretching — and being stretched — feels good. Why? And is it actually therapeutic?
updated 7/13/11
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.
If stretching ever works for trigger points, this is might be how it works:
Quick review: a trigger point may be a sick, poisoned patch of spasming muscle 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.
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 …
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 that a joke? Are we having a serious conversation here?
There is absolutely 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.
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.”
The energy crisis theory of trigger points may be the best-educated guess available today, but it could still be wrong. What if trigger points are merely a symptom or an illusion of a neurological cause of pain?
We know that a diligent stretching habit increases flexibility, but not by actually changing the muscle. Fascinatingly, it is actually our tolerance for stretch that changes with exposure (see Weppler et al). Muscle elongation is normally strictly limited by the brain and spinal cord, and only with repeated exposure to strong stretch can we “get used to” the discomfort and gradually push the limit back.
Trigger points might be a symptom or side effect of the nervous system imposing excessive limits on muscle extensibility. If so, they might — sometimes, when the planets align — fade away as we train ourselves with stretching to tolerate greater muscle extensibility.
Not a bad theory, eh? It has some attractive qualities. I am only emphasizing the complexity of the problem, and the many reasons why it’s not clear that stretching can actually help trigger points — but might be able to.
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 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.
