When It Stiffens Again After Being Released

"It feels great while I'm getting it done, but a few days later I'm right back where I was."

This is something people who have had manual therapy for years often say. I don't hear it as a sign that the treatment failed. I hear it as meaning that being released and being changed are two different things.

What state is stiffened tissue in?

Connective tissues like muscle, fascia, and ligament are not simply taut rubber bands. Inside them, water and gel-like substances are mixed together, and how that mixture behaves depends on what is being done to it.

This tissue has an interesting property. Leave it still and it gradually stiffens; move it appropriately and it slowly softens. In physics, this is called thixotropy.

A familiar example is ketchup. Sitting still in the bottle, it sets and won't pour, no matter how far you tip it. Shake it and tap it, and suddenly it flows. Nothing was added and nothing was taken away — its composition hasn't changed. Its property has changed.

The connective tissue in our bodies behaves the same way.

• Stay in one posture for a long time and it stiffens
• In the morning, after sleep, it is especially stiff
• Move a little and it slowly softens
• Stay still again for a long time and it stiffens again

So why does it stiffen again?

Here is the key question. If treatment softened it for a while, why does it revert within days?

The reason is that the conditions that made it stiff are still there.

There is an order to how tissue stiffens.

stiffens  →  moves less  →  stiffens more
   ↑                             │
   └─────────────────────────────┘

This loop turns on its own. Stiffen and you move less; move less and you stiffen more.

Pressure and inflammation can be layered on top of this. But which of them comes first is not an order that has been confirmed in people. What has been measured reaches this far: tissue in a place that has hurt for a long time really is different from tissue that hasn't. Whether the pain changed the tissue, or the change in the tissue produced the pain, is something researchers are still leaving open.

When manual therapy softens stiffened tissue, one point in the chain is broken for a while. But if the conditions that made that tissue the way it is are left as they were, the loop soon starts turning again. Sometimes a few days is enough.

The approach I take, and the other side of it

I work by giving the tissue the right stimulus so that it softens on its own. I am creating the conditions for thixotropy to occur.

Which means I should bring the ketchup back. Stop shaking the bottle, and the ketchup sets again. That is the other side already contained in the word thixotropy — the softening and the setting are the same property, seen at two moments.

There are numbers for this, measured in people. In the wrists of twelve participants, shaking or vibration dropped the muscle's initial resistance by about 19–20% — and after roughly 15 seconds of rest, most of the original stiffness had come back.

So to say "release it once and it never comes back" is not true. And I don't think I need to say it. The coming back is exactly what explains why one treatment does not finish the job, why you need to move in between, and why maintenance matters. (When a correction keeps coming undone — maintenance is half the treatment)

Tissue that has a tendency to stiffen keeps trying to stiffen. So treatment is not a single event; it is the work of changing a direction.

And even this is not enough on its own

You can soften the tissue, but if the conditions that made it that way go unfound, it easily stiffens again.

• Is pressure in the lower abdomen high, so the lower back keeps bracing against it?
• Is the diaphragm stiff, so breathing is shallow and the neck and shoulders do its work instead?
• Is one side of the pelvis tilted, so the other side keeps holding the balance?

The painful spot is not always where it began. Pressure is one of the things that layer on; so is the way you use the body, the way you breathe, and inflammation that has been there a long time. So I feel the abdomen of someone who came in for a shoulder, and I watch the breathing of someone who came in for a neck.

The role herbal medicine plays

Manual therapy works only inside the treatment room. The loop that stiffens tissue, though, turns all day long.

Herbal medicine works during the hours away from the treatment room. It draws off pooled fluid, settles inflammation that won't cool down, and helps circulation where pressure has risen. Its role is to keep handing signals to the body through the hours when no one is touching it.

If manual therapy softens what has stiffened, herbal medicine shifts the conditions toward stiffening less. That is why neither one alone is enough.

And there is a third thing. Movement. Thixotropy happens only where there is stimulus. Lie still, and the tissue stiffens again. That is why we settle together on how you are to move once the treatment is over.

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If it has been released many times and keeps reverting, that is not because your body is bad. Tissue reverts by nature.

It is that the spot making it stiff hasn't been found yet, or that we haven't yet built a way to slow the reverting down. Releasing by hand, shifting the conditions that made it stiff, and your moving in between — that is why those three have to travel together.

Not all stiffness releases this way. There is real structural damage, and there are conditions that need surgery; when I see those signs, I recommend examination first.

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References

• A released muscle returns to its original stiffness while resting — measured in people — The Journal of Physiology, 2001
• Comparing 71 people with chronic low back pain against 50 without, sliding between fascial layers was about 20% lower in those with pain — BMC Musculoskeletal Disorders, 2011

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)