Patient Reported outcomes: Too much of a good thing.

Stretching is a good thing. It seems. Yet it all depends.

Several months ago I've gotten a call from a student of mine who is a DPT now. She asked me to take on a peculiar and difficult case of rotator cuff syndrome.

She said that for almost a year, the client had constant pain in shoulder joint, severe limitations in range of motions in many planes and angles, that he was through all possible forms of conservative treatment, including physical therapy, chiropractic adjustments, acupuncture,  and different  styles of massage. According to her, I was the last stop before corrective surgery.  She also mentioned that he was a kind of a high profile clients, specifically ex-governor of California Gray Davis.

I agreed.  Ex-governors are also people.  Their pain is just as bad as pain of anybody else.

The client came over and during examination told me his story in more details.  Originally he had moderate pain and limitation in range of motion.  But every new procedure he was subjected to included forcible stretching, after which his pain and limitations became greater and greater, until the pain became constant.  As much as I learned,  Mr. Davis isn't a whiner by nature.  But the constant pain drained him.  He looked tormented.

While examining  the shoulder I discovered that  pain and limitation in range of motion were not uniformed;  in some plains and angles they were greater.  But even the movements that he could do caused lots of pain.

It became obvious  that the muscles that stabilized and moves shoulder joint didn't work in assembly, and production of energy within this muscles wasn't adequate.    All the rotator cuff and surrounding muscles: Teres minior, latisimos dorsai, pectoralis major, etc  were overstressed, shortened and inflamed.  Muscles that were suppose to stabilize the joint didn't and couldn't  do that, and pain was the protective reaction against the possibility of the joint getting out of socket.

I started to implement  the entire protocol for Rotator  Cuff syndrome, including lymph drainage, fascia mobilization, muscular mobilization  and trigger point discovery and elimination.  After that I started to perform post isometric relaxation for all these groups of muscles and  other muscles that participated in  movement and support of the shoulder joint.

Post isometric relaxation is also a special kind of stretching, but the kind that could be performed on the muscle with elevated muscle tone and cannot harm it.  To understand the difference between regular stretching and post isometric stretching please click here.  To learn more about  the Rotator Cuff protocol please click here.

Practically within several first treatments it became obvious that this was the right course of actions, because the client started feeling better.  Pain became less severe, range of motion increased the client started to sleep normally.

Today Mr. Davis feels much better; back playing golf. To view his testimonial please click here

As you can see in case of limitation of range of motion stretching along can increase motions but would contribute to instability of joints.  Joints instability is a precondition for sports related injuries, decreases capability to perform well in sports it and eventually leads to disproportionate  to age development  of osteoarthritis.  For better understanding please click here.

In most cases of normal range of motion when it's produces pain it does means that stretching along shouldn't be applied , but post-isometric relaxation techniques, in order to balance energy within the same muscles, which will correct muscular assembly work, will increase the joints  stability etc.

Today we have to recommend, and teach home programs for self-massage including stretchings. It's difficult to sustain results when client receives treatments only in the office.

Please click this link to my medical massage educational video, where I demonstrate post-isometric relaxation techniques on many body parts, and much much more.

As for me, I constantly provide myself with self massage as well as utilize  post- isometric relaxation techniques . Please be advised that relaxation techniques means stretchings. Dr. Karel Lewwit who developed and proposed this techniques, under relaxation meant normalization of muscular resting tone , which is possible when pathological changes within muscles are eliminated. When normalization is completed, one can use stretchings only.

These is great material to use for self-care, and then to learn it and teach your clients.