Traditionally in the therapy and fitness world it is accepted that joint movement is restricted due to muscle inflexibility. This is true, to a point, but there is much more to consider.
Therein lies the secret to success, or failure.
There is much more to restriction of range of moment than tight muscles. Certainly, muscle restriction often plays a part, but not always. And if this solely is the focus of therapy, the foremost tenet of treatment, “Do no harm”, may be compromised. Sometimes the joint will not move further simply because it is the end of the range (e.g. A straight knee when standing). In this instance further movement is clearly impossible.
I favour analogies to illustrate and simplify clinical situations. Let’s imagine a door that is unable to close. Could it be that someone is pulling the doorhandle from the other side, resisting your efforts to close the door? Might it be possible that the hinge is dysfunctional? It is also possible that there is simply a pillow lying in the doorjamb.
All of these will restrict the door and each of them require a different strategy to remedy the situation. If someone is holding the door from the opposite side, eliciting a pull in resistance, this is the equivalent of a “tight” muscle. I.e. Soft tissue that is simply not elongating enough to enable the movement. This tissue has to be stretched.
The dysfunctional hinge parallels the kinematics of the joint. By that I mean the actual relationship and movement between the joint surfaces. There is an inherent sliding between the joint surfaces that aids and abets the movement. In their absence joint movement is incomplete. This is something best demonstrated visually, but it’s a concept that has long standing acceptance and understanding among therapists. Unfortunately it is often forgotten.
Finally, the pillow in the doorjamb. This corresponds to swelling within the joint. Due to injury, irritation or even infection, the existence of fluid between the joint surfaces restricts movement just as a pillow would between the door and doorway.
The diligent therapist must ascertain which of these, or in some cases which combination of these factors is affecting movement. Therapy must address these. Pushing a joint beyond its limit when there is swelling is painful for the patient and futile. Range of movement will not change and the injured joint risks further injury. Various drainage techniques must precede stretching. Exploring these techniques is beyond the scope of this discussion, but they do exist and they are very gentle and effective.
If joint kinematics (the dysfunctional hinge) is compromised, this can easily be reestablished with mobilizations. The therapist must recognize that this is the case. This situation is probably the easiest to remedy since mobilizations are quick and effective. The therapist that forgets to explore this option is clearly focusing on soft tissue only and ignoring other aspects – anatomy 101 tells us that bones, joints and a host of other systems make up the body structure. Soft tissue is very important with rehabilitation, but unfortunately for some therapists it eclipses other considerations.
Stretching is common, popular, has few contraindications and easily done at home. It does take various forms, but most commonly it is done and is most effective after a warm up. In the same way as a rubber band left in the summer sun will stretch more easily than one left in the snow, so too muscles will respond to heat – generated by activity. A cycle, a run or even a brisk 15 minute walk will suffice.
If you suspect that you have restricted range of movement, consult your health care practitioner. There is no harm in reminding them to look at all the options! The educated client/patient is one that is assured the best treatment.