Cuing for independent muscle-tension control
Probably the most annoying but valuable tool you can learn to avoid needing Physiotherapy.
Why it’s so valuable
In my experience, there’s two major reasons why someone can find themselves dependent on treatment (e.g. physio, osteo, massage, etc.) despite a lack of pathology:
They have frequent increases in muscle tension that they can’t control that become uncomfortable
They can not maintain safe postures or mechanics as a result of excessive muscle tension - resulting in poor loading patterns that (re-)creates an injury.
What you may have tried already
One of us clinicians massages it, you feel better for 1-2 days, but then it gets tight again
You use heat, baths, self-massage, muscle-relaxants, etc., which gives some control, but generally have to stop what you are doing and are, in effect, only treating symptoms
What we would prefer
What would be of use would be to consciously control how much contraction the muscle has, and then eventually establish appropriate automatic habits. Sometimes you will want very low levels for efficiency in low-load situations, sometimes you will need maximal during performance work.
Can you actually learn this?
The good news is the wiring is all there and this is simply a skill you can learn. Most people are quite good at flexing their biceps of their dominant arm, a little worse of their non-dominant arm, and then if I pick a muscle you’ve never flexed in the mirror you may have no idea how to get it to fire. The lesson being, you can already do this for muscles you’ve practiced.
The Drills:
Monitoring:
In order to learn, you’ll need to have feedback. The tension changes you will make on your first attempts will likely be small. If you can’t detect tension or changes in tension while you’re practicing, this is obviously going to be quite hard.
Let’s imagine a 0-10 scale. 0 is completely flaccid/relaxed/soft; 10 is full spasm (like when your foot cramps). Don’t confuse this with a pain scale! We want you to be able to monitor and control levels of tension at levels below what would cause discomfort so that we may prevent pain before it begins, but also for improving the efficiency of our movement and posture.
Throughout the day, ‘check-in’ with the muscle we’re working on and give it a number the represents its level of tension (as mentioned above). Notice how that number will likely be different for various postures or activities. If you have a hard time sensing any type of non-painful contraction, take a guess and then touch the muscle with your finger to see how firm it is to get feedback. If your finger can sink into the muscle very easily it’s lower on the scale, vice versa if it feels like the firmness of your biceps while you’re ‘flexing’ them.
Breathing:
First, decide where you are on the 0-10 scale mentioned above. Then, start monitoring your breathing without changing how you do it (there are other drills where we do change the breathing patterns, but I find people are tempted to take deeper breaths, which sometimes cues them to fire the muscle we are trying to relax). As you exhale (breath out) use this as a cue to relax the muscle and lower the ‘tension number’ we started with.
Contract/Relax:
This may seem to be counter-intuitive, but sometimes I have people contract the muscle we’re trying to work on in order to gain more awareness of the area so that they can eventually learn to monitor and control levels of muscle tension more effectively. First, find your baseline level of tension on our 0-10 scale. Next, practice increasing the level of tension as high as you can without changing your position. Once you can do this I cue people to start doing more refined drills. For example:
If you started at 5 and found you could increase to 8, I start having people move between 5 and 8 on intervals of 1 (e.g. 5, 6, 7, 8, 7, 6, 5)
Once this is easy, intervals of 0.5 (e.g. 5, 5.5, 6, 6.5, 7, 7.5, 8, 7.5, 7, 6.5, 6, 5.5, 5)
And lastly, I like to use a ‘scale of thirds’ from music theory: (e.g. 5, 6, 5.5, 6.5, 6, 7, 6.5, 7.5, 7, 8, 7, 7.5, 6.5, 7, 6, 6.5, 5.5, 5)
Coming soon: mindfulness meditation and imagery
Couple last points:
This is a challenging skill that will require a lot of practice. When you’re in pain these may help symptoms and when you’re not in pain it’ll be a good time to practice to under lower-pressure conditions. It’s a slow go but most people can get quite proficient at it and then apply it wherever and whenever it’s needed.
You’ll notice that I’ve borrowed these from styles of meditation. Stress is linked to many health conditions and musculoskeletal pain/tension is no exception. Feel free to use these to manage your overall stress levels as well - which can only help with our physiotherapy goals.