Muscle consistency

Contracture, overload, spasm, hypertension, hardness, knots, myofascial points, increased consistency …

– My neck hurts

The physical therapist feels the area in which pain is perceived and concludes:

– Your neck is stiff.

If there is a confusing issue in the field of pain it’s the aching muscle. The so-called “muscle-skeletal pain” is a damn jumble, a conceptual disaster.

The muscle is a tissue of varying consistency to palpation and the joints also show a varying opposition to pasive movement. By feeling and moving, the physical therapists draw conclusions about the muscular condition, their responsibility in the genesis of pain.

Muscular consistency is influenced by many variables. A muscle of increased consistency can be too tight, or not. If it’s tightened, it can be due to neuronal stimuli or specific conditions of the muscle fibers.

Contracture is not synonymous with contraction. Increased consistency is not synonymous with contraction. A muscle that is painful with palpation doesn’t have to be contracted. Pain is not something that makes the painful muscle contract. It is a false cliché.

The static muscle aquires more consistency and higher viscosity, but moving it actively or pasively is enough for its consistency to decrease. It’s a strange property of the so-called non-Newtonian fluids, the thixotropy. A “hard” muscle becomes “soft” simply because it’s thixotropic. The same happens with ketchup, paints, honey …

Muscles can be unnecessarily contracted (as lights could be unnecessarily turned on when there is no one in the room) and express their discomfort or vulnerability through pain. Relaxing them is enough for consistency and pain to yield.

There may be bad postural, psychological, programming conditions, overexertion… There may be myofascial trigger points that fatten the vicious circle of pain (always with the collaboration of a vigilant and catastrophic brain). There may also be a brain that defends an area from individual’s purposes.

After the pain and increased consistency of muscles from one area, there are many variables: muscular, neuromuscular, cerebral … There are contractures, contractions, viscoelasticity, protections, alerts, bait points …

The physical therapist palpates, moves, questions, values ​​… informs, back to palpating, moves, shows, convinces…

The universe of static and kinetic muscle is complex. It’s not my universe. I’m a neurologist. The physical therapists have a great job to do: to clarify that universe for themselves and for citizens.

– It hurts …

– Let’s see, calmly… This is very complex.

PD Elefante, a worthy reader of the blog, recommended me this post:

Don’t miss it!


>Muscle and brain


Jacqueline Du Pré

Muscle pain, muscle-skeletal pain, contractures, myofascial points, overloads, strains … are used and abused terms of which we know little about.

Muscle takes the blame for chronic pain. Causing pain with deep palpation is enough to conclude that we have found the key: pain comes from this muscle.

Pain never comes from a muscle or any other tissue. Information, signals that should be interpreted come out of the muscle. These signals can be those of suffering (there is destruction of fibers or insufficient energy supply), exhaustion (mechanical stress over the possibilities) or awareness (surveillance). There may also be a bit of everything. The signals arrive at distributed central networks that process various aspects of ongoing or planned actions and there arises the perception of pain and other motor programs that say which muscles have to contract and which ones need to relax.

– You have a contracture.

Researchers don’t agree on the meaning of a contracted muscle.

For some it’s a muscle problem. The muscle does nothing but cause trouble in a vicious circle. The contracture is the result of previous poor metabolic conditions due to overload, and contracture worsens these conditions. The contracted muscle is responsible for this.

For others, the responsible muscle is quiet, inactive and the contracted one is the opposite, the antagonist. Contracture and pain are adaptive, protective responses.

Sometimes the origin is elsewhere. The apparently responsible muscle doesn’t have anything to do with this matter.

Sometimes the muscle is stiff, but not contracted.

Physical therapists palpate the tissues to draw conclusions. Contractures, trigger points, painful movements … also observe those movements to detect patterns. They palpate, speak …

Sometimes it all started with an incidence of tissue damage, an accident, a “pull”, a tear, an “overload”. Other times there is no previous event. Maybe something emotional …

When something non-muscular happens inside, the muscles execute the motor programs adapted to their defensive mission. When that something is muscular in origin, programs try to protect its integrity while it’s being repaired.

Sometimes there is no muscular damage or overload, only an alarmist forecast of possible damage. Muscles obey and contract following the cerebral script of nociceptive alert, of catastrophism. The alert may ooze an extra of acetylcholine in the neuromuscular junction, an extra of CGRP and substance P in muscle nociceptors, perhaps also bradykinin, prostaglandins. This can increase the nociceptive signal. The alert makes signals go to the posterior horn, thalamus cortex … another damn vicious circle.

It’s a matter of eggs or chickens, but the hen-house has long been working and it probably won’t make sense to ask the question. There will always be eggs and chickens.

My cello teacher comes to my mind. She was an excellent physical therapist even though she wasn’t aware of it. She kept playing, palpating, talking. Other times she would take the cello and play. I would look closely (mirror neurons).

– Let go. More. Feel the inert weight of the arm. Use the whole body. Effortlessly … you’re not relaxed … Now! … Think you’re smearing a slice of bread with butter … Look at my shoulder …

From all this arose a better sound, even music from time to time …

We know little about pain and muscle. We have hypotheses. We don’t know if they are correct.

We know that pain is a cerebral decision. Everything we perceive is a cerebral decision.

We know there are myofascial points that can be unnecessarily encouraging vicious circles.

Muscle or brain? It doesn’t make sense. Neurons exist because there is movement and vice versa. Nociception, perception, cognition, emotion, action. They are different sides of a single process: decision-making.

The brain expresses its decisions through pain and motor planning. Muscles may be in distress. Underpaid job under poor conditions. There may also be an alarmist brain, a bad manager of good muscle resources.

The physical therapists also make decisions. Muscle? Brain?

I remember my cello teacher…