Hypertonicity
Hypertonicity is the name of the phenomenon recognized as tight muscles that won’t relent. Daily stretching and painful foam rolling routines are a way of life for sufferers of this prevalent form of muscle imbalance. In fact, most of us are walking around with at least a few hypertonic muscles. Muscular imbalance and dysfunction has been observed by physicians and healers for centuries. Modern medicine’s concern is more focused on organ function than skeletal muscle function. There are medical specialists for every organ system of the body, but there are no “medical muscle doctors.” People have had “knots” in their necks for aeons and will continue to as long as we don’t change how we assess and treat muscle dysfunction.
What is Hypertonicity?
A hypertonic muscle is one that has too much tone when the body is at rest. Tonus is the unconscious contraction of skeletal muscles in order to maintain posture and body structure while resting in any position. This continuous contraction provides resistance to gravity’s constant downward pull on our bones. The amount of tone that a muscle has is measured by the degree of its contraction at rest. The prefix “hyper” means an excessive amount. Tonicity means resting muscle tension. Therefore, hypertonicity means there is too much muscle tone than required for most physical tasks.
Medically Diagnosed Hypertonicity
Only qualified medical doctors can legally diagnose disease. Skilled body workers that point out your tight muscles are offering an assessment based on palpation. In P-Dtr, we learn to assess hypertonicity accurately with novel therapeutic tools that most doctors don’t have knowledge of. Not all tight tissues are hypertonic. Medicine defines two types of hypertonicity. Idiopathic hypertonicity and pathological muscle hypertonicity. Idiopathic hypertonicity including muscle guarding and splinting are still mysterious phenomena to doctors. It is a common component of most musculoskeletal conditions. Hypertonicity is important to explain because It is the most common complaint that a bodyworker or manual therapist will address. In many cases, no one seems to know where the hypertonicity comes from.
Physiology of Hypertonicity
Hypertonic muscles are contracted, shortened and are palpably tight. Balanced muscle tone is needed for smooth movement and in order to protect ligaments, joints, and muscle tissues from uneven wear and tear. Muscle tone is controlled by the nervous system. Signals travel from the tissues, to the central nervous system via receptors and nerves. The spinal cord or the brain (CNS) responds and tells the muscle how much to contract. When injury throws the signaling between the muscles and the CNS out of balance, the result is often hypertonicity. In each case, the hypertonic muscle’s stretch reflex is increased. This means the more or faster you stretch a muscle, the tighter it gets and the less stretch it takes to make the muscle contract in response. This is why you can’t successfully stretch or roll out hypertonic muscles.
Common causes of hypertonicity
- Overuse
- Joint dysfunction
- Postural shortening
- Postural over stretching
- Acute Trauma
- Pain spasm pain cycle
Although this article addresses each cause separately, when a client has hypertonic muscles, the causes and presentations of symptoms can and often do overlap.
1. Muscle Overuse
Muscle overuse is very common. We do it all the time at the gym and even when doing housework. Overusing a muscle fatigues it, increases the build up of metabolic waste and fluid in the tissues and makes it more susceptible to injury. Overuse also increases the amount of mechanical tension and pressure around joints where the muscles attach to bones and ligaments. This increases the amount of pulling force on its tendons and bony attachments, eventually irritating these structures and often causing micro tearing, tendinosis and pain. This is a different stress than encountered in weight training where low repetitions of heavy weight stresses the entire muscle belly for short durations and rest time is taken. Overuse doesn’t allow the tissue to fully heal as collagen and fibrin are sent to bond the area. This creates disorganized non functional scar tissue akin to a shoddy repair job. In response, the nervous system signals the muscle to contract, which further increases tightness in the muscle. This condition is a precursor to protective muscle splinting aka hypertonicity.
2. Joint Dysfunction
Hypertonic muscles of the low back and pelvis are often present if the sacroiliac joints, the facet joint capsules or ligaments of the lumbar spine are irritated and overused. This accompanying hypertonicity is called muscle splinting, and it is a protective mechanism for what the CNS sees as fragile and vulnerable tissues. Muscle guarding often progresses with time and the sufferer anticipates painful movements and over-engages antagonist muscles to resist movement into pain. By limiting motion, the nervous system imposes an embargo on movement to allow the tissues to rest and heal. Therefore traumatic injury or irritation to any joints can cause the CNS to splint the area and create local hypertonicity.
3. Postural Shortening
Postural or adaptive shortening occurs when a muscle is held in a shortened state for a prolonged time. The CNS adapts to that shortened state by increasing its tone to match the new length. One common example of this adaptation is the anteriorly tilted pelvis. Sitting places the hip joint into flexion, shortening the hip flexor muscles that cross from the pelvis to the thigh. Chronic sitting posture allows the hip joint to be flexed for long periods of time and can result in adaptive shortening of the hip flexors bilaterally. This postural distortion creates constant passive strain on the muscles and joints.
4. Postural Over-stretching
Over stretching tissues over time creates cumulative damage wherein the damage goes unnoticed until it’s too late. Simple postures assumed day in and day out can be the cause of lasting disfunction. Poor ergonomics at the workplace, slouching, or twisting to one side daily take their toll as the body gets used to these unbalanced postures. Activities outside of work often also contribute. Maintaining unbalanced postures while cleaning or gardening can overstretch the low back extensors of the spine. Sleep habits can also reinforce bad posture while we sleep. Any uneven sleeping posture can easily overstretch muscles, resulting in tight muscles caused by overstimulation of the stretch reflex.
5. Acute Trauma
Spindle cells measure the speed and amount of tissue stretch. if an unstable joint or muscle is stretched too fast or too far, it can create hyper-activation the muscle spindle’s stretch reflex and cause a spasm that persists long after the initial event. It may be trauma from an accident or it can occur when doing stretches in the gym or Yoga studio or playing sports. Think of receptors like pressure sensitive gauges. If too much stretch is measured too quickly, it may overload the capacity of the meter and affect further readings. Dysfunctional signals from these overloaded receptors elicit dysfunctional neuromuscular responses. Those muscular responses are muscle inhibition and hypertonicity. Know that even though stretching can be healthy, when it doesn’t improve your symptoms, or worse, exacerbates them, stop stretching! Your receptors are the issue, not your muscles.
6. Pain Spasm Pain Cycle
Muscle tightness causes pain, which then triggers further tightness, which then triggers further pain, and so forth, This is known as the pain-spasm-pain cycle. Prolonged contraction of a muscle can also result in a disruption of the blood circulation to the area. Initially, the prolonged contraction interrupts venous return of blood, causing a buildup of waste products. These waste products are acidic and irritate the muscle tissue, causing increased pain, which then further perpetuates the pain-spasm-pain cycle. The result is increased reflexive spasm of the muscle
Pathological Hypertonicity
There are a few related medical terms that I want to differentiate and clarify. Hypertonia is a term used for medically diagnosed spasticity and rigidity. Medical doctors treat hypertonia caused by upper motor neuron lesions which result from injury, disease, or conditions that involve damage to the central nervous system. The decrease in upper motor neuron function leads to loss of inhibition, resulting in hyperactivity of lower motor neurons. Different patterns of muscle weakness or hyperactivity can occur based on the location of the lesion, causing a multitude of neurological symptoms, including spasticity, rigidity, or dystonia. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition.These consequences result in abnormally increased muscle tone.
Hypertonia vs Hypertonic muscles
Dystonic hypertonia refers to muscle resistance to passive stretching. Gently stretching the inactive contracted muscle to a comfortable length at very low speeds results in a tendency of the limb to return to a fixed involuntary posture. I wanted to mention pathological hypertonicity for distinction as well as emphasis. This is because both pathological and idiopathic muscle hypertonicity are created through the same neurological pathways. This is vital and practical information to those of us who practice functional medicine. This also means there is hope for some who were inaccurately diagnosed with a central nervous system disorder.
Medical Intervention for Idiopathic Hypertonic Muscles
The medical treatment for hypertonia is to avoid the activity that causes pain and provide frequent range of motion exercise via physical therapy. the idea is to try to offset the muscle imbalance by stretching tight muscles and strengthening weak muscles.
Medical Treatment
Doctors often prescribe muscle relaxers and anti inflammatory drugs and physical therapy for hypertonic muscles. The most common therapeutic approach is some form of massage or manual manipulation applied to the short, hypertonic muscles and joints in an attempt to inhibit excess muscle tone and increase joint range of motion. Stretching muscles often reduces motor neuron excitability. Foam rolling, static stretches and PNF stretching also may reduce muscle spasticity. Chiropractors and manual therapists reset joints which has been found to decrease local hypertonicity and pain and increase range of motion. Icing and other topical anesthetics are also used to decrease pain and facilitate movement. Inhibitory pressure (applying firm pressure over muscle tendon), body heat retention and slow repeated rotation or rocking of the affected body part may temporarily stimulate relaxation and decrease hypertonia. P-Dtr explains why some of these approaches work and also why they don’t from a neurological standpoint.
How I Resolve Hypertonicity
P-Dtr is the only system I studied that had a reliable test for identifying hypertonicity. With this tool, I can assess and address the neuromuscular changes in real time. As layers of dysfunction are resolved, fascial restrictions become easy manipulated and the body reorganizes and simultaneously integrates the changes on a neurological and physical level.
Clinical Wisdom
I have been practicing clinical massage with a focus on orthopedic, postural and chronic pain since 2000. In 2015 I began my study in P-Dtr. Up until that point, I learned how to assess and “read” posture and pain as a manual therapist concerned with stretching tissues back into a visually and palpably ideal posture and texture. I also learned how to feel and assess joint and ligament restrictions and could suggest more mobility with manual interventions. P-Dtr taught me how to observe the active signs of neurological dysfunction acting on the musculoskeletal system. Now I learned to palpate the signs of receptor dysfunction. I learned how to discern the palpable feeling of receptor dysfunction vs the fibrosis, scar tissue and fascial thickening due to adaptation I had been addressing all these years. As I know now, some of those “knots” were not knots. That’s why they didn’t go away when I massaged them.
Neuro Orthopedic Bodywork
Neuro orthopedic bodywork is the basis of Kiambu Dickerson LMT.’s current treatment practice. If you have chronic musculoskeletal or postural issues that don’t seem to resolve, come in for assessment and he will let you know what he finds. Many cases mostly resolve within four hours of focused treatment. Kiambu practices a unique blend of neurological and manual techniques designed to provide results quickly. He is informed by nineteen years of hands on bodywork and constant continuing education.