So in Part 1, we briefly talked about how the nervous system acts as our body’s software system, and how important it is to consider neurology when it comes to managing pain and movement dysfunction. Today we are continuing to explain things a bit further.
More often than not, our pain and/or movement dysfunction, whether it is limited mobility, excessive muscle tension, lack of coordination of specific movements, or specific presentations of pain, is more often governed by the nervous system, not our tissues. When I work with clients, whether we are breaking down a squat pattern during training, or assessing specific muscle function during rehabilitation of a lower back injury, we consider that neuromuscular dysfunctions primarily exist for neurologic reasons and not because of some inherent quality within the muscles or joints themselves. This is not to imply that tissue damage is not a real entity, but tissues heal within days, weeks, or months, whereas the neurologic components of movement dysfunction can persist indefinitely. Yes, even that car accident you experienced 30 years ago or that scar from surgery way back in high school could still potentially be feeding your brain fauly input, and thus creating a suboptimal output.
This is often why that after an injury, symptoms can sometimes continue to persist for years, despite the tissues in the area having healed. This is also why we can’t simply apply thought processes like:
- muscle tight = stretch muscle
- muscle pain = massage muscle
- joint immobile = forcefully mobilize joint
- joint pain = ice, compression, avoid use
We need to ask ourselves:
WHY is the muscle tight? WHY is there pain in the muscle? WHY is the joint immobile? WHY is the joint in pain? HOW is the nervous system operating in a way that is feeding into the symptoms?
In order to answer these questions well, we need to have a means of thoroughly assessing muscular function through the lens of functional neurology. We need to be able to take into account a myriad of potential factors that foam rolling, stretching, massage, corrective exercises, and other traditional therapies might not be able to. That is not to say that these things are not useful or that they don’t work. I still employ each of these things when appropriate. However, I’ve found more often than not that until the specific neurological components of dysfunctions are addressed fully, symptoms typically continue to persist, at least to a degree.
In addition to utilizing advanced neurological treatments, we must also be proactive in our approach to self-care. We have to employ healthy habits regularly, making sure to move well, move often, eat to nourish our bodies, manage our stress, and continue to educate ourselves so that we have better understanding and more context when dealing with life experiences. The nervous system is incredibly complex, and we are just beginning to scratch the surface of functional neurology and it’s potentially paradigm-shifting effects on pain and performance. If we want to most effectively and efficiently fix our pain or move better or improve strength, we need to think beyond just muscles, bones, and connective tissues. Our physical, emotional, mental, and spiritual health are all intrinsically connected. One’s emotional well-being can have a direct impact on how the body feels physically. In the same way, physical experiences of pain can affect one emotionally; the frustration and depression often associated with chronic pain sufferers is very real. Being able to assess and gain clear understanding of how all of these components are playing into your symptoms is powerful.
In order to better illustrate the interconnectedness of all of our systems a bit further, let’s take a look at an example. The glutes, which are commonly blamed for all kinds of musculoskeletal issues, are a good place to start. “Glute activation” is one of the hot topics within the realm of performance training and rehabilitation.
Most approaches assign a protocol something like:
Perform self-myofascial-release (SMR) with a foam roller or ball on the “tight” or restricted tissues, most likely the antagonists of the glutes: the iliacus, rectus femoris, TFL, etc.
Stretch the said restricted muscles with some sort of isometric or dynamic mobility drill, in this case a half-kneeling hip flexor mobilization is commonly prescribed.
Activate the “weak” muscle in question via some sort of “activation” drill, usually something like a glute bridge.
While this approach is generally touted as the holy trinity of performing a DIY therapeutic intervention, it simply does NOT work as effectively as most professionals would have you believe. It can help and it can work to an extent. However, just as if not more often, it doesn't work. This is because it simply is not a very specific treatment approach, and it is operating on a lot of assumptions that may or may not be true. This approach, while probably the best overall way to self-treat musculoskeletal issues, has a lot left to be desired, and does not take into account other possible neurological drivers for glute inhibition such as:
Associated joint mechanoreceptors in areas like: iliolumbar ligament, 2nd metatarsophalangeal joint, pelvic ligaments in the SI joint or pubic symphysis, transverse ligament of the foot, iliofemoral posterior ligament, nasosphenois cranial suture, etc.
High signal nociceptive input where the brain is still perceiving pain or damage to a given area from some sort of past injury or trauma and thus is inhibiting muscles it thinks may increase the damage to the area if used.
Reproductive organ and glandular dysfunction.
The circulation/sex meridian.
The glutes may show up as inhibited or hypertonic via neurological manual muscle testing due to any of the above reasons, and potentially many others. Performing SMR on or stretching your psoas will not address any of these reasons. Performing glute bridges with a mini-band will not address any of these dysfunctions. Instead of addressing the neurological mechanisms behind the tightness or pain, we often use these modalities in order to improve our ability to compensate. Getting better at compensating is not the same thing as optimizing neurological signaling. You might just be spinning your wheels at best, and potentially feeding into the dysfunction and exacerbating it at worst.
Here’s my typical approach in a clinical setting:
Get a thorough injury history of the person I am working with. More often than not, because of how our nervous systems can hold onto trauma indefinitely, knowing the onset of the pain, the mechanism of injury, past injuries, the nature of their lifestyle or what they spend a lot of their time doing, how they train, etc. can give me loads of insight into what might be feeding into the neurological dysfunction driving their lack of glute function.
Utilize neurological manual muscle testing to assess the baseline function of the glute(s) in question.
Test the glute at multiple angles of hip extension (We can bias which fibers we are testing by adjusting the angle of the joint that the muscle acts on).
Test the glutes to see if its unilateral or bilateral (bilateral weakness often tells me to look at the spine, associated meridians, or an associated organ).
Test the glutes in multiple positions (Does it test different when the person is lying on their back, lying on their stomach, lying on their side, standing vs seated?).
Utilize different stimulus or anti-stimulus to narrow down the potential locations and causes of the gluteal inhibition. It could potentially be coming from (just to list a few):Associated joint mechanoreceptors in areas like: iliolumbar ligament, 2nd metatarsophalangeal joint, pelvic ligaments in the SI joint or pubic symphysis, transverse ligament of the foot, iliofemoral posterior ligament, nasosphenois cranial suture, etc.b.)High signal nociceptive input where the brain is still perceiving pain or damage to a given area and thus is inhibiting muscles it thinks may increase the damage to the area if used.A dysfunctional circulation/sex meridian.
Reproductive organs and glandular dysfunctions.
Once I’ve narrowed down the priority neurological components, clearing them out of the nervous system will allow the brain to operate with better information, and thus rid itself of its perceived need to inhibit the glutes.
THEN we can perform any tissue work as needed. Often times if a dysfunction has been lingering for a while, the tissue themselves have adapted. Muscles not having been able to contract and relax properly will often lead to the building up of adhesions and lack of movement between muscles. Targeted tissue work tends to really help here.
We then want to begin to retrain the glutes to work functionally in a variety of movement contexts like squatting, hinging, walking, etc. Teaching the nervous system how to use the muscle effectively again is important if we want to prevent issues in the future.
If we simply just release, stretch, activate, we can completely miss the much higher priority causes of the glute inhibition in question. This simplistic approach at worst can make the issue worse, and at best will take much longer than necessary at alleviating the issue than if we were to optimize the neurology.
Understanding how much of a driving force the nervous system is in our sensations of pain and movement capacity is the first step to improving your road to recovery. In the big picture, the hardware DOES matter; we need to ensure that we heal properly, and that we continue to utilize tissue therapy like myofascial release and stretching, and exercise. We also need to attempt our best effort of doing everything else we can from a self-care perspective as well, like sleeping enough, managing our stress, and other lifestyle factors . That said, in my experience, addressing the software side of the equation pays huge dividends in speeding up and increasing the effectiveness of healing, rehabilitation, and building strength. If you are still dealing with lingering symptoms that just won’t seem to go away no matter what you do or how long it’s been, chances are that you could benefit from working with a P-DTR-trained therapist. If you have any questions, insights, or want to understand something further or more specifically, let me know!