There is an engrained mentality in physiotherapy and the fitness industry that we need to help people stretch and strengthen the things that hurt in their bodies, but in my experience that is fundamentally not true.  I believe that everyone needs to find a meaningful amount of movement in their daily lives, and that a base level of functional strength is important to develop and maintain, but I do not believe that stiffness is that related to a lack of stretching, or that weakness is that related to pain.  Some people need to be encouraged to stretch more and most people would benefit from being moderately stronger, but sometimes these activities make people worse, or simply create busywork that isn’t actually addressing the root of their problems.

The experience of localized muscle weakness or tightness is more commonly the product of altered muscle tone than it is genuine weakness or stiffness.  Don’t get me wrong, sedentary people can get genuinely weak and stiff from inactivity, but moderately active people that develop localized dysfunction, pain, stiffness, or weakness in the absence of a structural injury, are most likely experiencing some sort of subtle nerve irritation that could relate to posture, stress and faulty movement patterns.  Trying to stretch a muscle that is tight because of dural tension, emotional holding patterns, or nerve irritations is starting a tug-of-war that you are really unlikely to win and might just make worse.  Overly stretching your chronically tight hamstrings may in fact just tug on your sciatic nerves and feed into your dural tension making your hamstrings react with even more tone.

Stretching is not inherently bad or dangerous, but body parts that feel tight and in need of stretching would probably do better by being moved and used more regularly, or more efficiently than simply being stretched more.  Try your best to understand that your body is a series of interconnected systems, so the sensations that you feel are likely generated somewhere else, making it important to not overly focus on the area that hurts or feels tight.  If one side of your body hurts, you are best to stretch and move both sides.  If your knee hurts, you are best to consider what is happening with your hip, knee, ankle, and back to try and address the problem.  We have a tendency to conceptualize ourselves as a collection of body parts and altered sensations can zoom our attention in to one area creating localized areas of sensitivity in our nervous system and conscious awareness.  If something hurts, your goal should be to put that area in a better environment, by paying attention to the areas around it and not giving the pain too much power. 

A client of mine named Jenny worked for our local health authority trying to help manage the knowledge translation and advocacy work related to the addiction and overdoes crisis in Vancouver’s downtown Eastside.  She was extremely dedicated to her work, but was in a relatively thankless job and just continued to see the death toll rise despite her best efforts.  She was extraordinarily stressed and knew it was taking a toll on her own health, but she just couldn’t bring herself to stop.  She developed endometriosis, a proliferation of cells from her uterus out into her abdomen, complained of pelvic pain, a feeling of being stuck in her upper right abdomen, constant headaches and persistent tension in her neck and shoulders.  Jenny’s nervous system had way too many amps running through it and as a result, most of her postural muscles rested in a strongly braced state, her liver and stomach were tensely mashed together, and her idea of a deep breath barely got passed her collar bones.

Jenny was referred to me by her pelvic floor physio to try some visceral manipulation to try and help with her abdominal pain, but I quickly realized that she needed more than a physical intervention.  She had already been told by friends and other health professionals that she should take some time off of work, and to try yoga and meditation, but she insisted that she couldn’t take time off, hated yoga and wasn’t sure how to meditate.  The one thing she did do for herself was work out with her personal trainer, it just seemed to resonate with her personality more than a yoga class, but it didn’t really make her feel better.  I explained to her that due to her stress, her muscles were already holding her body in a compressed, hypertonic state, so doing a lot of resistance training might just add more undue tension to her body.  I agreed that if she hated yoga and liked the gym, she should stick with her trainer, but shift their focus from resistance training to body weight movement and light cardio exercises.  Her goal was to feel better in her body, not to be an athlete, so I had to help her see the importance of meaningful movement as a stress outlet more than the importance of strength and fitness.

Jenny noticed some improvement with the shift in her approach to exercise combined with me trying to release some of her tension, but it was evident that she had a history of trauma that was fuelling her workaholism and regenerating any tension that I helped her let go of.  I slowly taught her more about how her body processes the stress that she was experiencing which eventually led into a discussion about the importance of altered states, the role of counselling and the idea of psychedelic integration to help her get more to the root of her problems.  Jenny worked in the area of harm reduction and was aware of some of the research in treating trauma, but had been entirely focused on helping others and not herself.  I helped her stop trying to outwork her problems in the gym and at the office and her counsellor helped her build more skills to create boundaries and be more present with the assistance of MDMA and psylocibin. 

My new book Why We Hurt: Understanding How To Be Comfortable In Your Own Body goes into much more detail on these topics and is full of stories of real people managing an imperfect world.