Can Stiffness be Helpful?

Can Stiffness be Helpful? 

Welcome to the last newsletter in our series on the myths of stretching, mobility and stiffness. The previous newsletters are ‘‘You don’t have tight muscles!’ and ‘The Cult of ‘Tight’ Muscles and Pain….’ The observant reader will get the sense of continuity regarding this topic and our previous series on ‘Pain and the Brain’.

Thanks for all the feedback on this topic so far. We appreciate this undermines much of what is still being purported by many Personal Trainers, Yoga and Pilates Instructors. However, even in unregulated professions such as those, the hallmark of a skilled operator is someone who keeps abreast of scientific developments and is therefore deeply aware of this significant paradigm shift in thinking.

This is a nice simple newsletter. I’m giving you a reprieve before the educational journey we will be embarking on in the New Year. The topic ‘Insulin Resistance’ is probably the most profoundly far reaching health topic I have written about. I would encourage you to dig in for the ride and to get the best out of that experience, have a recap of the previous newsletters in our Cholesterol Series. 

For now let’s jump into a few areas where joint stiffness, tissue stiffness and joint mobility might matter. Please don’t consider this exhaustive.

1. When it matters to you

If you are concerned about the feelings of stiffness and think it is contributing to your pain then it is something that requires discussion with a health professional who you trust. In this instance it is vital to figure out if it is really contributing to your pain or function or if your feelings of stiffness are just ‘victims’ from whatever else is driving your pain. The thought here is that sometimes we might be trying to ‘fix something’ (perceived tightness) that actually isn’t a problem. As we discussed in the previous newsletter, focusing on something that doesn’t need to change or that can’t change can make our problem worse.

2. When stiffness is driven by some other negative and unhelpful habit or belief

This is best seen in the work of the Cognitive Functional Therapy group in the 2018 paper ‘An integrated Approach to Disabling Low Back Pain’. I have had significant success in clinic by using some of their ‘behavioural experiments’. This is where people in pain are guided into movements which they have been avoiding or they may be fearful of. Often people will be naturally hesitant and guarding when doing these activities. In my opinion, that muscle guarding/bracing is not inherently wrong for everyone (e.g. it might help some people for a short period of time) but in a subset of people that guarding (e.g. more muscle tension than you actually need to function) is not helpful and is essentially the physical manifestation of their belief that their back is frail, damaged and in need of protection.

In the ‘exposure’ world these would be called ‘safety behaviours’ and these safety behaviours perpetuate the problem rather than being part of the solution. In this case trying to bend or move with less tension is one possible way that people can learn to control their symptoms (i.e. exposure with control and removing these safety behaviours). Again, muscle tension isn’t inherently wrong. It’s not putting too much stress on a joint and causing ‘wear and tear’ but in this case it’s no longer helpful because it’s one thing that keeps sensitising the person. Tension, bracing and guarding is a maladaptive movement pattern that might be helping the pain persist thus it might be worth changing how they move and getting confidence in a formerly feared and avoided activity.

3. You need mobility for movement options and performance

Let’s say you love squatting but your back starts to hurt. It turns out when you squat with your feet further apart you have less low back pain. It then seems like you have less low back pain when your trunk is more upright. Well, how can we get you to squat more upright which will allow you to continue to squat with less pain? You could get a safety bar, you could get lifting shoes or you could increase your ankle dorsiflexion. Having increased your ankle dorsiflexion you will be able to squat more upright because it shifts your centre of mass forward.4. PerformanceBuilding tissue stiffness (tendons have the most research) might be inherently beneficial for many sports. Interestingly, there isn’t a huge amount of interventions that can increase or decrease tendon or connective tissue stiffness (genetics seem to play a huge role here). However, some studies support the concept that strength training that induces high tendon strains. The implication for tendon strains means remodelling and robustness. The literature suggests that around 70% of your maximal lift seems to induce increased tendon stiffness through this process. The papers ‘Maximal Strength Training improves Running Economy in Distance Runners’ and ‘Maximal Strength Training improves Running Efficiency in Distance Runners’ both support this assertion. Surprisingly, plyometric training doesn’t have this consistent effect probably due to the more natural dynamic nature of the activity and lack of maximal load you can actually achieve.

Your legs are like springs. When you run, you stretch those springs. Indeed areas like the Achilles tendon and the arch of the foot store huge amounts of kinetic energy that’s then released to power your next stride, as the spring snaps back to its original length. In fact, studies over the years have concluded that between 40% and 50% of the energy you need to run is recycled from stride to stride through this elastic energy storage-and-return mechanism.

In their 2017 paper, ‘The relationship between mechanical stiffness and athletic performance markers in sub-elite footballers’, the authors concluded ‘Higher stiffness appears to be beneficial to athletic performance for football players’. Supporting the benefits for stiffness in runners, in the paper, ‘Running economy: measurement, norms, and determining factors’, the authors note:

‘We estimated that VO₂ Max during running might have to be 30 to 40% higher without contributions from elastic storage and return of energy. At higher running speeds, elastic recovery of energy prevails over the contractile machinery and accounts for most of the work. The available evidence indicates that there may be substantial interindividual differences in ability to store and release elastic energy and it has been suggested that fiber composition, gender and maturity are likely contributors to these differences’.

It’s worth noting something in reflection of the research thus far – if you’re bendy or more concerningly diagnosed as hypermobile, High Intensity Interval Training (HIIT) training will be a significant challenge to perform safely and will probably end in tears. I am utterly convinced exercise is a great thing, it defines me as a person. It’s the reason I work the hours I work, the reason my business looks the way it does and even my house is designed to facilitate training! I have played rugby for North Wales youth, Swam for GB youth, had over 60 boxing matches, came first in Commando selection earning the ‘Kings Badge’, passed Special Forces selection and now, nearing 50 have an FTP for 400 watts (cyclists will understand that, but it’s quite good for an old bloke)…So I am in favour of well considered exercise choices. But, exercise will not help much with weight loss (should I repeat that?).

Personal Experience

For the past 15 years I have been riding my bike with structured HIIT workouts an average of 14 hours per week and therefore using an average of 8310 calories.  I also perform 2x gym sessions at a calorific cost of 1200 calories per week.I also do some short walks in the week I haven’t counted.I have an active job and therefore need 2800 calories per day to live (19,600 calories per week).I eat 3000 calories per day, making my weekly calorific intake 21,000 calories.That means that over the past 15 years I have been in a weekly calorific deficit of 8110 calories or 421,720 calories per year!

My weight has stayed a steady constant of 70-72kgs and I feel invigorated every day. If we really believe that exercise makes us thin and solutions to weight control reside in the antiquated nonsense of ‘calories vs calories out’ then I would no longer be on this earth! There are many, many more spinning plates between what you eat and what your physiology does with it. So a word to the wise, don’t rely on the simplistic and ineffective approaches of the unregulated for your answers here.

Convinced (wrongly by the way) that HIIT will help with quick fix weight loss, patients often come limping into the clinic unable to train again for months. Those early morning HIIT sessions and sudden drastic diet changes will most definitely achieve two things: an injury and bounce-back weight gain.

Supporting our long term observations the paper, ‘Slow and Steady, or Hard and Fast? A Systematic Review and Meta-Analysis of Studies Comparing Body Composition Changes between Interval Training and Moderate Intensity Continuous Training’, the authors conclude:

‘Our findings also indicate that structured exercise only has minor effects on fat loss regardless of intensity of effort and duration when performed at relatively modest doses; the amount of exercise required to achieve practically meaningful changes in this outcome seems to be unrealistic for most individuals. It is much easier and realistic to create weight loss from sensible dietary changes which, therefore, should be the focus of weight loss interventions’.

For more background and to understand weight control and nutrition, have a read of the following newsletters:Understanding Calories,What is the best diet for Humans?

5. When stiffness means there is something else going on

Sometimes stiffness (particularly morning stiffness lasting longer than 45 minutes) or stiffness that spreads across multiple joints could be indicative of a more systemic condition like Rheumatoid Arthritis or the family of conditions found in Spondyloarthritis. Part of taking a conservative approach to dealing with pain and injuries is also recognising that sometimes there are some more rare conditions that can benefit from medical help. This is an important place for clinicians like me to check our biases and clinical thinking with a new patient. Common things are common, but not every presentation is common…

A nice tool I use for screening this is here (http://www.spadetool.co.uk/)

6. Hormonal Changes

If you attend a gym, are female, have a personal trainer but have not discussed how your monthly cycle or menstrual changes should be factored into your training regime you are paying money to someone with a low skillset who desperately needs to update themselves.

To give this topic the scrutiny it deserves, have a read of the following newsletters:Vital Menstrual Cycle Tracking,Understanding Menopause