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Picture

A New Way to Look at Asymmetries

6/10/2013

3 Comments

 
When assessing the length of a muscle, it is important to distinguish between muscle stiffness and adaptive shortening. Take the Thomas Test, for example. You will notice that the ASIS will begin to rise far earlier than when motion stops. The reason for this: stiffness, or resistance to stretch. Adaptive shortening, on the other hand, is when motion no longer occurs due to muscle restriction. Should we still prescribe stretching exercises for our patients if stiffness is the issue?

Mizuno et al found in a couple studies that, while changes in stiffness did occur after stretching, those changes disappeared in as soon as 10 minutes. It would seem that we should not address stiffness with stretching. Just because muscle length isn't an issue doesn't mean we should ignore any differences in stiffness. Increased resistance to stretch on one side of the body compared to the other can still place abnormal stresses on certain tissues. Think about increased stiffness on one hip flexor in a patient with SIJ Dysfunction. Some of our training may lead us to think that we should direct our patients to stretching of the hip flexor, but as you can see, we would have little effect on the impairments.
Picture
So how do we address these differences? Shirley Sahrmann discussed this topic in a lecture that we highly recommend listening to. Instead of focusing on the side with increased stiffness, we should address the side with decreased stiffness. Strength training has been found to increase muscle stiffness (Magnusson, 1998). By bringing both sides of the body to symmetry (equal stiffness), an equal distribution of forces prevents any abnormal stresses on the body. Stretching still has its place, of course, but we must be sure to distinguish between muscle stiffness and adaptive shortening when choosing to apply the intervention. Next time you're measuring muscle length, check for stiffness and muscle length!
References:
Magnusson SP. (1998). Passive properties of human skeletal muscle during stretch maneuvers. A review. Scand J Med Sci Sports. 1998 Apr;8(2):65-77. Web. 10 June 2013.

Mizuno T, Matsumoto M, Umemura Y. (2013). Decrements in Stiffness are Restored within 10 min. Int J Sports Med. 2013 Jun;34(6):484-90. Web. 10 June 2013.

Mizuno T, Matsumoto M, Umemura Y. (2013). Viscoelasticity of the muscle-tendon unit is returned more rapidly than range of motion after stretching. Scand J Med Sci Sports. 2013 Feb;23(1):23-30. Web. 10 June 2013.
3 Comments
Scott
7/13/2013 09:06:27 am

Interesting topic. Seems intuitively off to me though, so would love to hear your opinion. If one side is stiff AND limited, just strengthening would not fully create symmetry would it? If the increased resistance to stretch was still within normal range, maybe the other side is just weak. Am I thinking about this the right way?

Even in my DPT curriculum the terms tight, stiff, and short have been thrown around a bit and used interchangeably by some. Maybe you have a good resource that goes into detail about the differences and what is actually going on physiologically?

Reply
Chris link
7/19/2013 01:21:04 am

Thanks Scott, great comments. You are correct that if one side is both stiff and limited, you would not only want to strengthen the opposite side, but stretch the ipsilateral side until normal range was achieved. And you are correct, from my understanding of Sahrmann's lecture, decreased stiffness on one side would be associated with weakness, so we would want to strengthen that side. Basically, we should be looking at stiffness and adaptive shortening as two different impairments, thus requiring different interventions. Both can contribute to injury, especially if asymmetry persists. That is a great point about the confusion between stiffness, tight, etc. Since you brought it up, I think it is an excellent opportunity for a review on the topic, especially with the neurological components contributing to mechanical stiffness. I'll let you know what the review is ready. Thanks again!

Reply
BDSM Olathe link
10/13/2013 04:45:10 am

Was just bored and thought I would post to say hello

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test