Using the word “tight” to describe an injury means almost nothing and doesn’t allow us to know what is going on. But that doesn’t stop all types of practitioners from labeling their clients with a tight x, y, or z.

“Stretching” and “mobility” have become the universal prescription for anything that feels “tight.” So we default into this mode of feeling guilty for not stretching enough and blame the persistent tightness on our negligence. I watch people subject themselves to this torture all the time, trying to attain the elusive flexibility in their hamstrings as they grimace in agony.

A better approach is to answer the question of why the muscle is tight in the first place. To do so, I use the concepts I learned through my training in the Integrative Diagnosis system that was created by Dr. William Brady.

So what are the real causes of your “tight” hamstrings?

Stretching a tight hamstring can be the exact wrong thing to do.

Nerve Entrapment

Have you experienced any of the following? 

• Numbness
• Aching
• Burning
• Tension

If so, then you most likely have had a nerve entrapment. Nerves need to pass through or floss their way between muscles to get to where they need to go. They are usually built with a little extra slack, similar to a rubber band, around 15 percent to allow them to stretch a bit.

Nerves can get entrapped in 156 places in the body. When you have a bunch of adhesion, it can cause the nerve to literally get glued to the surrounding muscle. Then when you try to move the area, it creates a ton of tension and leads to an increase in a stretch feeling because all the slack gets used up quickly.

So what does this have to do with your hamstrings being tight? If your nerve is being compromised and squeezed on by an adhesion, it will cause your hamstring to engage in what is called protective tension. When this happens, your hamstring will feel very “tight” and will not respond well to stretching mechanisms.

How do you know if you have this issue?

• Stand with your feet about shoulder-width apart and knees relatively straight.
• Bend down and touch the ground (if you can.) You should be able to easily touch the ground. If you can’t, there is an increased chance that you have nerve entrapment.
• If you feel the stretch primarily behind the knees or especially in the calf muscle, then you are a slam-dunk candidate for this entrapment.

When you are bending down you are not changing the angle of the ankle, so no “stretch” should be felt in the calf. What you are actually feeling is the nerve being tugged, and the weakest branch of the nerve (tibial portion) is being stretched.

The next time you are stretching your hamstrings and feel a sharp “pull,” please stop immediately. All you are doing is causing more damage to the nerve. Get to a soft tissue specialist who can focus on removing the adhesion gradually with their hands. The treatment shouldn’t be excruciating. And please stop jamming lacrosse balls into nerves. Nerves are sensitive and they don’t appreciate being crushed by a hard ball.

Lumbar Disc Injury

If you frequently experience pain in your hamstrings, ask yourself these questions:

• Is the hamstring pain worse in the morning when you get out of bed?
• Does it hurt worse with sitting?
• Do you have any numbness or tingling down the leg?
• Is your back extra beat up after squatting or deadlifting?
• Do you ever feel sharp or stabbing pain in your low back?
• After sitting for a long time do you experience increased pain when trying to stand up?

If any of these are positive, there is a good chance that you have some type of injury to the lumbar disc. When you have damage to your disc, the hamstrings respond with what was mentioned above, a protective tightness. This is the body’s way of keeping the disc from getting any further damaged, sort of like hitting the brakes. All the surrounding muscles sacrifice their normal functions to unload the lumbar disc, which leads to a feeling of chronic “tightness” in the hamstrings.

Diagnostic imaging alone isn’t enough to diagnose a disc injury. A full examination is also required.

So how do you know you have a disc injury? One simple way is to obtain an MRI, but even that isn’t foolproof. In many cases, radiologists will downplay what they see or in some cases flat out miss some things. They are always looking for big, bad, scary stuff that could lead to a consult with a surgeon, so they often disregard minor bulging. 

So don’t solely rely on the MRI. Proper diagnosis involves a thorough history, exam, and imaging. If someone tries to tell you that you have a disc injury solely on an X-ray, that person is delusional. X-rays do not show soft tissue, just bone.

There are many doctors out there who will say that some minor bulging isn’t a big deal and everyone has it. I humbly disagree. Any damage to a disc is a big deal in my clinic. The spinal cord and nervous system are the most important parts of your body. If they get damaged and don’t work correctly, then you don’t either.

If you discover you do have a disc issue, I’ll tell you what not to do: any of the corrective mechanisms that try to fix the inhibition by getting your hamstrings to relax. The hamstrings are tightening up for a reason. If you allow them to relax for a window of time, it can actually cause even more damage to a disc injury.

Find the Root Cause Before Attempting a Fix

There is a lot of confusion on the causes of tight hamstrings. People often engage in an obligatory stretch routine to eliminate the issue, without knowing what the true problem is.

Your body is a complex and intricate system that deserves to feel and function at its optimal level. If you are trying to work through “tight” hamstrings simply by stretching them, chances are they’ll only get tighter. You owe it to your body to get properly assessed, diagnosed, and treated.

More Tips for Tight Hams:

• Can’t Touch Your Toes? Find and Fix the Root of the Problem
• Will Static Stretching Make You a Better Runner?
• Foam Roller vs. PNF Purgatory: Which One Will Save You?
• New on Breaking Muscle Today

Photo 1courtesy of Wikimedia Commons.

Photo 2 courtesy of Shutterstock.

The post 2 Overlooked Reasons Your Hamstrings Are Tight appeared first on Breaking Muscle.

I found myself asking the same question, so I recently took a continuing education course about kinesio taping methods and how they could be incorporated into my daily practice. After taking the class, I had a feeling something wasn’t right, so I took it upon myself to do some in-depth research.

Kinesio Tape Research Is Flawed

The research on kinesio tape is completely flawed, and trying to determine its efficacy can make your head spin. I did a basic search for the effects of taping on various injuries on Pub Med and most of the results suggested the positive findings can be attributed to placebo effect, with no true increase in strength.

The companies that sell kinesio tape have gone to great lengths to do their own research and “prove” how this stuff really works. I don’t know about you, but when I hear of companies performing their own research, I’m a bit skeptical due to the obvious bias.

What is Your Body Saying?

Advocates of kinesio tape will say they are doing good work and providing people in pain with some relief. That doesn’t work for me. They don’t get a free pass for “trying” to do well. What they are doing is potentially disastrous.

If your coach or trainer is taping you up to get through a WOD or training session, they are doing you and your injury a huge disservice. However, trainers get a pass from me in this situation, as they don’t have as much training and may not understand the underlying causes of musculoskeletal dysfunction.

So here’s where I am going to be critical. If you go to a doctor and his or her first step to fixing your injury is to apply kinesio tape, I have a big problem with that.

“Contrary to popular belief, pain is not weakness leaving the body. It’s your body telling you something is going wrong and you better listen up.”

Let’s say you have been dealing with an injury for a while now that has continued to get worse. The pain is your body’s warning system telling you something bad is going on and you should stop doing whatever you are doing. Contrary to popular belief, pain is not weakness leaving the body. It’s your body telling you something is going wrong and you better listen up.

Kinesio tape does a pretty good job at reducing the symptom (pain). The problem is, it does nothing to improve the function. Any treatment that only focuses on a symptom and not function can be dangerous.

Kinesio Tape Masks Pain Signals

Maybe you have been dealing with low back pain from time to time, which seems to be getting a little worse each day. What if the back pain is actually caused by something more serious, such as a disc injury? The pain or tightness you’re feeling may be your body’s protective mechanism trying to keep you from beating the disc up any more.

“In any injury treatment, the goal should always be to improve tissue quality and function.”

If you or your practitioner decides to apply kinesio tape to the muscles of the low back, the pain and tension will subside. But the disc problem is still there, and now it’s even more exposed. Those muscles will no longer tighten up to protect the injury, as the tape is letting them relax.

Now you don’t have the pain or tightness telling you to stop, so you get back to training. The disc injury is exposed to even greater forces, which could cause a minor symptom to develop into a full-blown problem. Once the disc goes, you will never be the same again. The same idea applies to areas that have partial tears, weakness, or damage.

What Is Tape Good For?

Kinesio tape could be used to alleviate some of the pain after a grueling workout or difficult event. It can be used to help reduce some inflammation and improve blood flow to the area.

As stated in my previous article, the majority of injuries are due to tissue dysfunction. The tape will do nothing to actually improve the tissue, but will encourage healing once the dysfunction is fixed.

Who Should Use It?

• If there is a lot at stake for an elite athlete, they must weigh the risk/reward of using kinesio tape to deal with pain.
• It may allow them to participate, but it does nothing to improve the tissue function.
• Always proceed with caution and listen to your body when you feel pain.

Who Shouldn’t Be Using It?

• People who are injured and trying to get back out there to train or participate should not use kinesio tape.
• As much as we hate pain, it serves as a kick in the butt to let us know to back off a bit.
• Simply ignoring discomfort could aggravate the issue to a point where you can’t do anything.

Let’s Actually Fix the Injury

The best soft tissue doctors in the world are trained in the Integrative Diagnosis system, which focuses on accurately diagnosing the injury and applying the correct treatment with the goal of improving overall function.

In any injury treatment, the goal should always be to improve tissue quality and function. Anything that deviates from that goal will produce temporary and sometimes disastrous results.

If you find you have to cover yourself in tape just to get through an everyday workout, please take the time to consider the potential danger and ramifications of what you are actually doing: hiding the pain.

More like this:

• Get the Diagnosis Right: It’s Not Tendonitis, It’s Tendonosis
• Kinesio Tape: What Is It? and What’s the Hype
• Kinesio Taping for Performance: How It Really Works
• New on Breaking Muscle Today

Photo courtesy of Jorge Huerta Photography.

The post Kinesiology Tape: Friend or Dangerous Foe? appeared first on Breaking Muscle.

The first start for many people with pain is to do a Google search, check WebMD, or ask their coach what is going on. In many cases, the overwhelming diagnosis is some type of tendonitis. But this default diagnosis is a mistake. There could be many causes for your pain. Assuming the injury is inflamed and must be tendonitis is flat out wrong.

Perhaps you have taken it a step further and actually sought out some type of medical doctor in hopes to find the root causes. But even medical doctors are guilty of making what I call a “junk box” diagnosis of tendonitis.

In many cases, this leads to bad advice. People get the standard answer of, “Lay off it for a few weeks, rest, use ice, and take some anti-inflammatory medication.” In the short term you do feel better because you aren’t using the damaged area. But as soon as you get back into activity, the pain returns.

A more common (and more serious) cause of that pain is what we call tendinosis.

What is Tendinosis?

Tendinosis is degenerated tissue. Consider the following analogy:

A healthy tendon looks like pre-cooked spaghetti. It is pretty strong and takes some force to break. Under a microscope all the cells look uniform and are stacked up neatly. A tendinosis is a degenerated portion of the tendon that ends up looking like cooked spaghetti. It receives lousy blood flow and is made of weaker and inferior tissue.

“97% of all soft tissue injuries and tears happen in degenerated tissue.”

Tendinosis comes about when the surrounding areas are overloaded. It is the body’s response to the increased demand. The problem here is that it isn’t good quality tissue. Often the cells are immature and lack many of the normal attributes of a healthy tendon.

Why did the Tendinosis Happen?

The tendinosis occurred because the diagnosis and treatment plan were both completely wrong. Degenerated tissue is often overlooked in the medical world. This oversight can end up being disastrous, since 97% of all soft tissue injuries and tears happen in degenerated tissue. And as we know, tendinosis equals degeneration.

Have you ever seen someone blow out their Achilles? It sounds like a shotgun went off and leaves the person in agonising pain. The sad part is that it could have been prevented if the pain had been properly diagnosed and treated.

So now we are clear. In the majority of cases it’s not an “-itis,” it’s an “-osis.”

How Do You Know if You Have Tendinosis?

• Does the pain feel worse in the morning when you first wake up?
• Does the area feel better after it is warmed up? (This can actually be dangerous, as people will often ignore the pain because they feel better as they warm up, but all the dysfunction is still there.)
• Does the area feel beat up after use or exercise, often a lot more than the other side of the body and with some swelling?
• Is the area sensitive to the touch? If someone were to press on it, would it send you jumping away?

Many of the above symptoms are classic signs of tendinosis. An example would be in the Achilles tendon. Are your first few steps out of bed painful? This happens because the area gets a poor blood flow overnight and causes waste products to build up in the area. The longer it takes to move around and not have pain, the more severe the tendinosis may be.

See the picture for the most common places to have a tendinosis:

What Do You Do If You Have Tendinosis?

The first step is to get the problem accurately diagnosed. Once the right diagnosis is made, the resolution of the tendinosis has a high success rate with the following steps:

• Stop beating the hell out of the area. If you experience a ton of pain or dysfunction in the area and suspect it is tendinosis, the last thing you want to do is to beat up the area any more. This degeneration can be a ticking time bomb that can tear before you know it. Then the only option is surgery and the tendon never being the same again.
• Get the surrounding area treated. As I mentioned in a previous article, addressing the adhesion around the tendon will go a long way in taking the load off the tendon so it doesn’t get worse.
• Start some eccentric exercises. This will help the tendon start to regenerate and improve the overall blood flow to the area. Unfortunately just resting it won’t improve the tissue quality at all.
• Brace the area if you need to. This is a cautionary step and should only be used if absolutely necessary. The brace shouldn’t be used to help get you through your training or to allow you to do more activity.

Summary

Too many people end up getting full-blown tears because the true causes were overlooked. If you have pain and it seems like it is tendinosis, act quickly before your only option is surgery.

Further Reading:

• Why Ultrasound Is a Waste of Time When Treating Injuries
• ASimple 4-Step Mobility System for Every Lifter
• Hurt or Injured? A 3-Step Assessment and Action Plan
• New on Breaking Muscle UK Today

Photos courtesy of Shutterstock.

The post Tendinosis Versus Tendonitis: The Critical Difference appeared first on Breaking Muscle.

The first start for many people with pain is to do a Google search, check WebMD, or ask their coach what is going on. In many cases, the overwhelming diagnosis is some type of tendonitis. But this default diagnosis is a mistake. There could be many causes for your pain. Assuming the injury is inflamed and must be tendonitis is flat out wrong.

Perhaps you have taken it a step further and actually sought out some type of medical doctor in hopes to find the root causes. But even medical doctors are guilty of making what I call a “junk box” diagnosis of tendonitis.

In many cases, this leads to bad advice. People get the standard answer of, “Lay off it for a few weeks, rest, use ice, and take some anti-inflammatory medication.” In the short term you do feel better because you aren’t using the damaged area. But as soon as you get back into activity, the pain returns.

A more common (and more serious) cause of that pain is what we call tendinosis.

What is Tendinosis?

Tendinosis is degenerated tissue. Consider the following analogy:

A healthy tendon looks like pre-cooked spaghetti. It is pretty strong and takes some force to break. Under a microscope all the cells look uniform and are stacked up neatly. A tendinosis is a degenerated portion of the tendon that ends up looking like cooked spaghetti. It receives lousy blood flow and is made of weaker and inferior tissue.

“97% of all soft tissue injuries and tears happen in degenerated tissue.”

Tendinosis comes about when the surrounding areas are overloaded. It is the body’s response to the increased demand. The problem here is that it isn’t good quality tissue. Often the cells are immature and lack many of the normal attributes of a healthy tendon.

Why did the Tendinosis Happen?

The tendinosis occurred because the diagnosis and treatment plan were both completely wrong. Degenerated tissue is often overlooked in the medical world. This oversight can end up being disastrous, since 97% of all soft tissue injuries and tears happen in degenerated tissue. And as we know, tendinosis equals degeneration.

Have you ever seen someone blow out their Achilles? It sounds like a shotgun went off and leaves the person in agonizing pain. The sad part is that it could have been prevented if the pain had been properly diagnosed and treated.

So now we are clear. In the majority of cases it’s not an “-itis,” it’s an “-osis.”

How Do You Know if You Have Tendinosis?

• Does the pain feel worse in the morning when you first wake up?
• Does the area feel better after it is warmed up? (This can actually be dangerous, as people will often ignore the pain because they feel better as they warm up, but all the dysfunction is still there.)
• Does the area feel beat up after use or exercise, often a lot more than the other side of the body and with some swelling?
• Is the area sensitive to the touch? If someone were to press on it, would it send you jumping away?

Many of the above symptoms are classic signs of tendinosis. An example would be in the Achilles tendon. Are your first few steps out of bed painful? This happens because the area gets a poor blood flow overnight and causes waste products to build up in the area. The longer it takes to move around and not have pain, the more severe the tendinosis may be.

See the picture for the most common places to have a tendinosis:

What Do You Do If You Have Tendinosis?

The first step is to get the problem accurately diagnosed. Once the right diagnosis is made, the resolution of the tendinosis has a high success rate with the following steps:

• Stop beating the hell out of the area. If you experience a ton of pain or dysfunction in the area and suspect it is tendinosis, the last thing you want to do is to beat up the area any more. This degeneration can be a ticking time bomb that can tear before you know it. Then the only option is surgery and the tendon never being the same again.
• Get the surrounding area treated. As I mentioned in a previous article, addressing the adhesion around the tendon will go a long way in taking the load off the tendon so it doesn’t get worse.
• Start some eccentric exercises. This will help the tendon start to regenerate and improve the overall blood flow to the area. Unfortunately just resting it won’t improve the tissue quality at all.
• Brace the area if you need to. This is a cautionary step and should only be used if absolutely necessary. The brace shouldn’t be used to help get you through your training or to allow you to do more activity.

Summary

Too many people end up getting full-blown tears because the true causes were overlooked. If you have pain and it seems like it is tendinosis, act quickly before your only option is surgery.

Further Reading:

• How to Self-Diagnose Your Shoulder Pain
• The Real Way to Train Your Stabilizers (NOT 3 Sets of 10)
• 3 Bang-for-Your-Buck Mobility Exercises for Bigger Lifts
• New on Breaking Muscle Today

Photos courtesy of Shutterstock.

The post Get the Diagnosis Right: It’s Not Tendonitis, It’s Tendinosis appeared first on Breaking Muscle.

We all like to think that when we go to a doctor, we are going to get good treatment and hopefully a resolution to our injury. Unfortunately, that resolution doesn’t happen as often as it should, leaving patients fed up and frustrated with their injuries. Doctors end up trying to mold the diagnosis into what they happen to be trained in, instead of what the problem truly needs.

What if I were to tell you the most common musculoskeletal problem could be what’s causing a majority of your pain? What if I told you it is completely reversible with the right treatment?

How Do I Know If I Have Adhesions?

Do you have any of the following?

• Pain
• Decreased Range of Motion
• Weakness

If so, chances are you have adhesion, which is a technical name for scar tissue. There are three common pathologies in the human body when it comes to injuries:

1. Adhesion
2. Weakness
3. Degeneration

It is almost completely impossible to have either weakness or degeneration without the presence of adhesion as well. People who try to argue that adhesion isn’t present or that it cannot cause pain, weakness, or decreased range of motion are wrong. In many surgical reports, surgeons note a high amount of adhesion present when trying to fix degenerated tissue. It is one of the most under-diagnosed problems. In many cases it doesn’t show up on MRI or X-ray and is usually completely missed during the diagnostic process.

What Is Adhesion?

The technical definition of adhesion is as follows:

It is a focal area of dense immature collagen fibers. The fibers are laid down by fibroblasts in response to either a hypoxic (lack of oxygen) environment from a crush/tear or sustained contraction (sitting all day at a desk).

The less technical definition goes like this:

It’s like someone poured glue inside the muscle. The only jobs muscles have to do are to contract and relax, but when adhesion is present it causes the need for more force to be applied to contract the muscle. This increased force leads to more tension and a higher production of inflammation in the area.

Adhesion isn’t the same as a trigger point. If we put a cell of a trigger point under a microscope, it would look pretty similar to a healthy muscle. Adhesion has a different look and feel to it. The tissue looks disorganized and the cells are not uniform. This can happen in a muscle, tendon, ligament, or even inside a joint.

When to Seek Help

You’ve already tried self-care to help with your injury, such as:

• Stretching
• Foam rolling
• Mobility work
• Self-myofascial Release
• Medication
• Corrective exercises
• Exercise modifications
• Self-taping

But that hasn’t made much difference. You’ve also enlisted the help of multiple musculoskeletal professionals, such as:

• Chiropractor
• Physical therapist
• Massage therapist
• Corrective exercise specialist
• Acupuncturist
• Primary care physician
• Orthopedic surgeon

But none of those options have worked, either. So if you’ve failed with self-treatment and professional treatment, what’s left? The key to fixing this problem is finding a practitioner who focuses on getting a tissue-specific diagnosis, preferably soft tissue dysfunction. The good news about adhesion is that it is completely reversible with the correct treatment. The point of any treatment is to reverse the pathology.

Finding a Care Provider

This is where it can be a little tricky. Look for these must-haves in getting resolution for your injury.

• Tissue-specific diagnosis. This is a key component of ensuring the right treatment. No treatment can begin unless you know what the problem is in the first place. The diagnosis needs to be complete and accurate. Simply stating something is tendinitis/bursitis/tight is incomplete and lacks true substance. The practicioner should know exactly what tissue is involved so they can get in there and fix it.
• The goal of the treatment. This should always be to remove the dysfunction and return normal capacity back to the muscle, which in turn should allow the area to function at a higher level and relatively pain-free. Trying to work around the injury can often prove to be a bigger problem down the road.
• Progress should be measurable. Everything should have a measurement or benchmark goal to help define where the treatment is going. Relying solely on the patient’s pain level can often lead the doctor in the wrong direction. Having specific, measurable results lets the patient and doctor know they are on the right path to fixing the injury. An example would be taking a measurement of ankle dorsiflexion. A “healthy” ankle needs at least 5 to 6 inches of dorsiflexion to have an optimal range. Until that range of motion is reached, you can’t have a fully functioning ankle. Clean tests determine discharge, not level of pain. If you don’t have full function and capacity in the muscle, the chance for re-injury goes way up.
• 10 to 12 visits. This is usually the sweet spot for fixing the majority of problems that walk through the door. Avoid practitioners who want to see you for anything over 24 visits right out of the gate, because chances are they aren’t the one to fix your problem. It shouldn’t be a long, drawn-out process that takes months. If the practitioner accurately diagnosed the injury and removed the relevant adhesion, the process should take around 10 to 12 visits if there are no other issues. If it is going to take a lot longer, it’s more likely that you have an irreducible block (see below), which won’t respond well to manual therapy. Or the diagnosis could just be wrong.

What About Irreducible blocks?

Irreducible blocks include disc injuries, labrum degeneration, tears, and cartilage damage. If these blocks are present it will shift the focus of the treatment and make it more into a long -term maintenance care. This longer approach will prevent the degeneration from getting any worse and keep you functioning at sub-symptom threshold. In some cases the blocks can be so bad that no amount of conservative care will fix it. These are the prime surgical candidates, which ends up being roughly ten percent of the population.

Save Yourself From Pain

If you find yourself not responding to your current treatment methods, be it self-treatment or professional help, perhaps it is time to consider what you are overlooking. If you have been dealing with an injury for a long time, you owe it to your body to get the problem accurately diagnosed and fixed.

The best soft tissue practitioners in the world will take the time to accurately diagnose your injury. They have the skills to apply the correct treatment to your specific problem. Trying to fix it yourself with various self-treatment methods or whatever the practitioner happens to be trained in will only produce temporary results, if any at all, leaving you frustrated and in pain again. Good luck!

More Like This:

• 5 Effective Ways to Move and Feel Better Today
• What Is Graston Technique? New Tools for Healing
• Active Release Techniques: Putting Tension on Injuries
• New on Breaking Muscle Today

Photos courtesy of Shutterstock.

The post The Real Reason Your Pain Is Holding You Back appeared first on Breaking Muscle.