Patients often report a sensation of tightness and pain in muscles such as their upper trapezius. Should you reach straight for the massage cream or needles? Is there a better/longer term solution to help improve your patients "tight and sore" muscles?
In a recent BJSM study, Bourne et al. (2016) studied the effect of eccentric and concentric/eccentric strengthening exercises on hamstring fascicle length, assessed by 2D ultrasound. 30 males were allocated to one of three groups: 1. Nordic hamstring exercises (eccentric only), 2. 45 degree hip extension (concentric/eccentric), and 3. Controls (no exercise), and both active groups achieved a significant increase in fascicle length compared to controls.
Subjects performing eccentric or concentric/eccentric exercises achieved an increase in fascicle length at Week 5, Week 10, and following the intervention, along with increases in muscle strength and hypertrophy.
This study suggests that we may be able to use strengthening to achieve increases in muscle fascicle length. Extrapolation of these results to patients with pain or pathology is not always clear cut (or even possible), and will be patient dependant, however, for muscles that feel tight, we may be able to perform strengthening instead of soft tissue techniques.
Bourne et al. (2016) assessed fascicle length in hamstrings. While the effect of strengthening on trapezius fascicle length has not been assessed to date, the effects of strength training on muscle strength are well documented (3). Thus, we may be able to utilise this research, along with clinical reasoning and specific research on upper trapezius muscle activity to improve muscle strength, length, robustness and capacity to cope with the demands of daily life.
Castelein et al. (2015) identified that upper trapezius EMG levels are higher in shoulder shrugs with the arms overhead, with lower associated EMG levels in levator scapulae. Utilising exercises such as this may allow you to preferentially targets upper trapezius more than levator scapulae with your patients, addressing their strength, length and capacity issues.
So should we use soft tissue release or strengthening for muscle tension? It is somewhat of a false dichotomy, as soft tissue release and joint mobilisation can be effective as a component in the treatment of various musculoskeletal conditions when clinically indicated, used in an evidence-informed way, and alongside education and exercise. There are a number of approaches to the same musculoskeletal conditions such as "tight traps", including strengthening, taping, soft tissue release, joint mobilisation, education cognitive functional therapy, etc etc and all have their place. However, the next time you reach for the massage cream to perform soft tissue release on your patient's "tight" upper trapezius or other area, think of how you can "strengthen to lengthen" or incorporate strengthening into your program. You can create a sustainable approach to treating muscle tightness, achieve long term effects, and empower your patients while getting them strong.
Related
Online course - Cervical spine assessment & treatment for neck pain & upper limb symptoms
References
-
Bourne, M. N., Duhig, S. J., Timmins, R. G., Williams, M. D., Opar, D. A., Al Najjar, A., ... & Shield, A. J. (2016). Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. British Journal of Sports Medicine, bjsports-2016.Chicago
-
Castelein, B., Cools, A., Parlevliet, T., & Cagnie, B. (2016). Modifying the shoulder joint position during shrugging and retraction exercises alters the activation of the medial scapular muscles. Manual therapy, 21, 250-255.
-
Suchomel, T. J., Nimphius, S., & Stone, M. H. (2016). The importance of muscular strength in athletic performance. Sports medicine, 46(10), 1419-1449.