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"I ALWAYS FEEL SO TIGHT, THOUGH!" - WHY STRETCHING ISN'T ALWAYS THE ANSWER

Nov 22, 2020

Tight does not usually equal tension. Now, the exception here is when you’ve been stuck in a cast for 6 weeks or bedridden for months/years without changing position as much as needed. (Threw out arbitrary time frames, so don’t get too stuck on those) In those cases, enough time has past where the muscles are in a shortened position for long enough that collagen fibers have had the time to lie down and start to create true tightening. But that tight neck you woke up with after moving fine the day before? Or the tightness you feel in your legs and/or traps after sitting all day? That’s simply not enough time for collagen fibers to do a damn thing. That would take a very long time.

Generally, when we feel tight, it's often more a sign of weakness or poor activation of a muscle. Not true tension. And because true shortening is not the case, that’s part of why stretching/foam rolling/ lacrosse-balling hasn't made a lasting difference yet. 9 times out of ten (ok, fine, more like 99 out of 100 times) when I do a mobility test on the area that feels tight, it ends up being completely fine in that department. But then when I go to strength test it…different story. To note, I’m not necessarily saying there is true inherent weakness either. Sometimes there is pain or a motor control issue going on inhibiting muscle activation, thereby causing weakness. Let’s break it down a little more with some examples

MAYBE IT’S JUST IRRITATED

First, let’s actually take the neck example I gave above. In this case what likely happened is fluid through that area was static for longer than it wants to be. Our bodies are meant to move. So sometimes when it’s static like that, an area can get what we call chemically irritated as a little bit of inflammatory chemicals are just sitting there. Once you get moving however, fluid will get moving again and ”flush out” that area. (Yes, sometimes you need a little help in doing that from a practitioner - this is where getting a manipulation/adjustment from a good PT or chiro can really help hit the reset button) Moreover, any static fluid that’s chemically irritated will impair the signals to our muscles, causing poor activation and a feeling of tightness. This is actually pretty similar to what happens when you get that tension the 2nd morning after a hard workout, especially if you didn’t do much the day in between - inflammation built up, wasn’t flushed out with movement the day after, and then you slept in a relatively static position, allowing it to build up. Now, I could really deep dive into how that chemical irritation build up id the source for a lot of neck/back/joint pain that we feel as well, but that’s a long conversation and not entirely related to the message I’m trying to get across today. But it is another example of how the feeling of tightness isn’t what we think. At the end of the day, the message is this: We want to find a way to get the area moving and then load it to remind the area how it’s supposed to function.

MAYBE IT’S IMPAIRED MUSCLE ACTIVATION

Could be true weakness, could be impaired muscle activation. We have all experienced this. I know I personally have some neck/upper back tightness after hours of doing documentation and get tight upper traps if my hiking backpack isn’t sitting properly.

Some great common examples are

The tightness you feel in your upper back/neck after sitting at a computer all day
The feeling of chronic hamstring tightness …for a multitude of reasons… maybe you’re a runner with stronger quads vs hamstrings, maybe you overuse your stronger back with lifting and so your hammies are fighting to work, etc. But I promise you, I very rarely find true tightness with testing even when the person is convinced otherwise prior
Tight upper traps…maybe you carry a heavy purse or bag of some kind that causes it to fatigue out and then feel tight, or that’s where you carry your stress and you chest breathe, etc

…in these instances, there’s often a lack of full muscle activation…for some reason, the signal to them has been turned down. Whether it’s actual weakness or just shut off. Either way though, it needs to be addressed for that feeling of tightness to go away. And in both cases, getting some weight and loading it throughout it’s range of motion is the answer. See the exercises below for some great drills for tight hamstrings, hip flexors, and tight neck/upper back. Oh! And if you constantly find yourself doing the pigeon pose stretch, please stop and try more glute and hip flexor activation drill instead (see below for one) and see if that takes care of it

MAYBE IT’S TAUGHT, NOT TIGHT

Another important thing to note is we will often feel tight when the tissues are being pulled taught. A good example of this that I have seen frequently is “IT Band tension” in someone who has a muscle imbalance between their glutes and their adductors (the muscles on the inside of your thigh). If your adductors are doing a lot of the work in squats, running, etc, they will be pulling the knee inward as they contract, causing the IT Band to be pulled taught. Part of the job of the glutes is to counterbalance that in order to keep our hips/pelvis level. If there’s an imbalance in strength or activation and this isn’t happening, the IT Band will feel tight from being pulled to it’s end range. So you can smash it on a foam roller all you want, and it may feel good for a bit, but it’ll keep coming back until you address (read: load) the glutes and/or adductors. (Glute example below. For the latter, check out the 1st 2 exercises in this blog. Both load the inner thigh into a lengthened position) But seriously, please stop foam rolling it. The fact that it does nothing other than maybe feel good for a few minutes after is incredibly well researched at this point. And it’s not like it feels good during, anyways.

THE ANSWER?

You may have guessed it…
Instead of stretching, try loading (ie strengthening), into a lengthened position. Works SO much better for a multitude of reasons.⁣
⁣
FEW EXAMPLES

(Thank you, Andris, for helping me out with videos)
❣Weighted hip thrusts for "tight hip flexors"⁣ or “tight IT Band” or “tight glutes”

Can bias it for hip flexors by taking 3-5” to come down from the top each rep - the hip flexor is what controls that descent. And for the ITB or glutes, you can add a band around the knees to help remind you to press them out and get a little more glute activation.

Either way, make this challenging with enough weight (Andris is taking it super light here). Try doing 4 sets of 8 at a weight that you could maybe do 10, but not 11 reps at, each time. If you have the slow negative (coming back down), this wont be nearly as heavy as it would otherwise. And it’ll take some time to figure out what a good weight is, and it’s so vastly different for everyone

❣Overhead press for "tight neck/ upper back"⁣

To note, this one is obviously not into a lengthened position, mostly because trying to add weight into a lengthened position for the traps is just awkward if you think about it. But this exercise works incredibly well!

Here, he is doing a Z Press, which is simply a strict press seated with your legs out straight. This makes it so you can’t use your low back or legs to help drive the weight up, therefore better targeting the upper areas. Make sure you don’t let your ribcage flare and you don’t lean back and end up doing some weird variation of a bench press. Use the same rep/weight scheme as in the hip thrusts to start.

❣Slow negative RDLs for "tight hamstrings"⁣
⁣For these, you can use just about anything. Kettlebell, dumbell, barbell, etc. Smaller weights will end up being held just in between the legs. Note that depending on your range of motion, if the weight is hitting the floor before you are at your end range, you’ll need to stand on a box or bench.

Start standing tall and keeping your back flat, push your hips back to the wall behind you (think like shutting the car door with your arms full of groceries). The weight should slide right down your thighs. Don’t let it drift out away from you! Take 5” to get all the way down as far as you can without letting the back round (you should feel this entirely in the back of your thighs). Hang out at your end range for 3” and then drive through the ground to return.

And in case anyone is still in a situation (yay COVID) where they don’t have access to actual gym equipment, get creative with household items! Try the hip thrusts with a 50lb bag of dog food or mulch. Do the overhead press with a bag full of books or your kid. Do the RDL negatives with a full laundry basket.

This is a short list and there are SO many other good ones. Please shoot me any and all questions you have either through the comments, contact form, or you can even email me at [email protected] or text me @ 480-751-2137

Have a “tight” area or anything else going on that you want individualized help with? Schedule now :)

"Your knees are shot and if you keep up all the activity you're doing, you won't walk at 30"- what I was told by medical professionals at age 18 after my 3rd knee surgery. Fast forward to today, and I'm 32 and not only do I Crossfit 4-5 days a week, but my off days are usually spent trail running and/or hiking. And the only time I have knee pain is when I take 4 or more days off from activity. You see, the stronger the muscles around a joint are, the more they can unload the joint - i.e. the ligaments, meniscus, and cartilage in the knee don’t have to absorb quite as much force as they would otherwise. And less pressure = less risk of damage or pain.

For years, I avoided squatting below parallel, catching heavy weight in a squat such as full cleans and snatches, and had a crazy wide squat stance. I also avoiding running and would get nervous hiking downhill. Why? Because I let the nocebo (negative thoughts) given to me medical professionals dictate my movement. You see, I've had three knee surgeries, with the 1st one being in 5th grade and the last being a cartilage graft during college. Most of my knee injuries have been due to Osteochondritis Dissecans (Rare condition. Lack of blood flow to bone causing cracks to form in the cartilage and underlying bone. Cause unknown). Though one surgery was an ACL reconstruction where they took out part of my patellar tendon and put it where the ACL should be.

With each of these instances (a few others didn't require surgery), I was told yet again that I should stop doing any high impact activity, never run on hard ground, that I should never do heavy squats, and definitely don't go below parallel even without weight. This is devastating news to a very active and athletic fifth grader. And let's be real, still devastating to an active college student. Thankfully, I'm stubborn. I agreed to quit all hard court sports like basketball (though to be fair, as soon as everyone else hit their growth spurt, I probably wouldn't have lasted) and gymnastics. But I refused to give up soccer. And with that came weight training once I got to high school.

I still lift and do Crossfit 4 days a week and trail run or hike in the off days. I honestly LOVE heavy squats and deadlifts, and I am constantly challenge myself! And you know what I realized once I left soccer but was still in the gym doing weightlifting? My knees only bothered me when I did one of 2 things: wayyyyy overdid it or skipped the gym and hiking several days in a row.

Two main takeaways from this bit:

1. Don't let a doctor's opinion dictate your own opinion or your life.

Every profession has it's bad and good apples. And a certain degree does not make one infallible.

2. Heavy squats fix everything (read: your body wants to be loaded. Strength training has countless benefits and should definitely be a part of your life)

So I bet you’re like “Sweet, so strength is important. Got it. But what are some ways to build up strength?” Here ya go:

First, I should explain that it’s not always as simple as “get stronger.” Mobility and technique also need to be considered when figuring out the cause of knee pain. And it’s almost never directly the knee. Typically, if a mobility issue is at play, it is either from the hips or ankles, though it could be from further up as well. This will be it’s own blog (or maybe Eboko!) soon

As far as technique goes, it really kind of depends on when you’re having pain. For example, if it’s just with running, maybe you’re not keeping enough bend in your knee throughout the gait cycle, causing increased stress on the knee. If it’s just at the transition point at the bottom of a squat, maybe you’re only going to parallel, which is actually the knee angle with the highest amount of pressure on the knees. Or maybe you’re letting your knees come inward even just slightly with squats or sumo deadlifts and causing undue stress. If you are having pain with a certain lift/movement and want it assessed, or just want to dial in technique, I do offer movement assessments. Ok, gonna get nerdy and dive a bit deeper to include some research on technique for the next few paragraphs...(if you don’t care about research and just want the takeaways…skip to the next bolded line)

Research by Bloomquist et al showed that deep squats improved strength throughout the range of motion while shallow squats did improve strength a little more at shallow depth, but minimal strength increase at deeper positions. In other words, if you constantly squat above parallel, you;ll get stronger in that position, but not really improve strength for things like getting up and down from the floor, squatting down to pick up heavy items off the ground, catching nd standing a clean or snatch at full depth. Squat jump strength also improved only with full depth squats, not quarter squats according to research by Hartmann et al.

Hartmann et al also found that the compressive forces in the knee are highest at 90 degrees and have little quad tendon support, yet when you squat deeper, there is actually a protective wrapping effect around the knees! My mom can attest to that. One of my biggest recent “wins” is finally getting my mother to listen to me (seriously, it’s like pay back for not listening as a child) about squats. She does not have ACLs in either knee and then retore an MCL about 10 years ago while waterskiing. She has at least listened to me for awhile that the best thing she can do for her knees is keep up strength to create the extra support needed in lieu of those ligaments. About a month ago, I finally got her to start doing a few exercises I wrote including some goblet squats with increased weight. However, she’s been scared to squat below parallel. So she called me up and told me her knees were achy. I explained the above research and told her to just give going below parallel a shot for a few days and call me back. Guess what?! Her knee pain was GONE!

The other major lie that we’ve all heard is that your knees can’t past your toes. Absolute BS. In fact, I can personally say that the first time I really felt my quads fire during a squat was when I finally let my knees go past my toes. It’s also the first time I didn’t end of having soreness in my low back after a bunch of squats. Here’s why: Fry et al did some research looking at joint forces at the hips and knees when knee movement is restricted to avoid going past the toes or allowed to do so. They found that if it is restricted, there’s a 1000% increase in hip forces. One thousand y’all! It also caused your torso to come more forward since the hips had to stay back. This then places more pressure on your back. Between those factors, it’s no wonder my back was getting sore with back squats! Some of whether or not your knees need to come forward and the degree to which they do is definitely dependent on your specific anatomy.

Okay, now for the fun stuff. Strength. Note that this is specific for the person dealing with knee pain with squatting…

As I mentioned earlier, if you have strength surrounding the joint, it will unload it and you won’t deal with pain that comes from pressure on the internal structures (for example, osteoarthritis bone changes won’t cause pain) But…how do you build strength if you’re dealing with knee pain already?? The following exercises will be a great start!!

Even better if you mix in things to spike your heart rate like a 30” arm only bike sprint…gets your heart rate going, thereby increasing fluid circulation to the legs/knees which will drastically help “flush out” any inflammatory chemicals. Therefore, decreased swelling and pain!

There are plenty of great drills not listed here, but this is a great start:

-Knee Gapping.

Ok this one is for you if you just feel a lot of pressure in your knee when you squat and feel like it limits you. You know that feeling when your knee is even a little swollen and it won’t quite bend all the way back into full flexion? Yea, this helps with that. A ton. You can use a small ball, like a lacrosse ball, or a tightly rolled up towel like I am here. This helps glide the tibia (the lower leg bone) forward as you go into end range motion, which is what’s needed, and increase the joint space so it doesn’t get as much of that pressure feeling. Help yourself into end range flexion by grabbing your lower leg and pull it in, as shown. Make sure to get some calf motion in by moving your ankle around as the gastroc does cross up over the knee and assist in this motion. (side note: please ignore the squeeky ball in the background from the pups)

- Spanish squats.

Easily my favorite exercise to not only get a quick solid quad burn, but to unload the knee and allow better movement. I’ve used this countless times with acute knee pain, chronic arthritis, post surgical, and a whole host of other people (and myself) to be able to squat sooner and build/maintain strength. The band is placed directly behind the knees. You want to make sure there is solid tension in the band throughout the movement - as you can see in this video, the band can hold my weight. Unlike a normal squat, you keep your shins perpendicular to the ground. The kettlebell is mostly to counterbalance and help me keep my chest upright. Shoutout to Zach Long, PT, DPT (aka @thebarbellphysio) for introducing me to these several years ago while we were at a course together.

- Copenhagen Planks.

So it may not be readily obvious how these help your squat, but the truth is the inner thigh muscles play a HUGE role in full depth squats, and if their capacity isn’t adequate, it can cause knee pain, particularly on the inside of the knee. Now, this exercise is MUCH harder than it looks, so I highly recommend starting it where you have the top knee supported on the bench (or couch or whatever you’re using). If that’s still too much, you can leave the bottom leg on the ground and allow it to help support as much as needed, but as little as possible (don’t cheat yourself!)

- Bulgarian Split Squats.

Not just for lifters. This is a fantastic exercises for hikers and trail runners as it not only works on the muscles you use in your sport, but it also challenges single leg and trunk/core stability which are very important. Get into a lunge position with the back leg up on a box/bench/couch/whatever and then drop your trunk straight down while both knees bend. I’m using a kettlebell in a goblet hold here, but you can also do a barbell in the front/back/Zercher position

- Hip Thrusters

Yes, I know, this is a butt exercise. But without strong glutes, your knees will be trying to compensate for lack of stability. No bueno. Besides, lets be real, is there a downside to having a nice ass? No.

In this video, my fiancé is demonstrating with both legs, but going single leg is a great option as well! Please note, he’s also going absurdly light with the weight here. You want to go HEAVY on this exercise. You’ll probably surprise yourself with how heavy you can go…I have multiple patients over 65 that do this one well over 100, if not 200 pounds for reps. Just make sure you can actually hit full extension at the top (meaning your hips finish in line with your knees and shoulders)

No barbell? That’s fine! Use a super heavy dumbbell or kettlebell…just know you’ll be limited by getting the weight on/off your lap and will need to up the reps to have any benefit.

Ok, hopefully these exercises are helpful!

One last quick note that I’d be remiss if I didn’t mention: When discussing knee pain, you have to consider lifestyle factors. All too often, knee pain is due to any increase in the body’s inflammatory response. And I’m not just taking about the injury response. If our diet, our sleep, and/or our stress is trash, it affects our entire system. So while I don’t wanna vilify the occasional cup of ice cream (that would make me a hypocrite), I do want to point out that if you’re crushing a whole pizza, McDonalds, and M&Ms every day, then it’s not entirely surprising that you feel lie you have “bad knees”…but if you take away the inflammatory-inducing foods, get 8 hrs of sleep, and move your body regularly, I bet you would find that you actually have good knees! They were just mad at you and letting you know they were mad…