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 received manual therapy for a long time often say. I don't hear this 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.

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.

The most familiar example is ketchup. Sitting still in the bottle, it hardens and won't pour out. But shake it and tap it, and suddenly it flows. Its composition hasn't changed — its property has changed.

The connective tissue in our bodies is the same.

• Stay in the same posture for a long time and it stiffens
• After waking in the morning 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 comes the key question. If treatment softened it for a moment, why does it revert within a few days?

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

There is an order to how tissue stiffens.

Pressure stays elevated for a long time
      ↓
The tissue's elasticity declines
      ↓
Cells degenerate, and low-grade inflammation lingers
      ↓
The tissue stiffens
      ↓
Movement decreases
      ↓
Pressure rises even higher  ← (back to the start)

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

When manual therapy softens the stiffened tissue, one point in the chain is broken for a moment. But if the spot that generated the pressure remains as it was, the loop soon starts turning again. A few days is enough.

Cracking versus softening

Here I divide the approaches to treatment.

The approach that cracks with force pushes the joint momentarily to change its position. There's a sound, and immediate relief. But the tissue's property stays the same. It's closer to the stiff tissue merely being relocated while still stiff. That's why it reverts. And the body defends against the sudden force.

The approach that softens is different. It gives the tissue the right stimulus so that the tissue softens on its own. It creates the conditions for thixotropy to occur. It takes a little more time, and there's no dramatic sound. But because the property changes, it doesn't easily revert.

This is exactly why I don't crack the bones with a pop. Not because the gentle method is milder, but because I choose the side that doesn't revert.

And yet even this alone is not enough

Even if you soften the tissue, if you can't find the spot that generated the pressure, it stiffens again.

• Is the 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 are doing its work instead?
• Is one side of the pelvis tilted, so the other side keeps having to maintain balance?

The painful spot is the end of the chain, and the pressure that made it stiff is at the front of the chain. So I press on the abdomen of someone who came in with shoulder pain, and I observe the breathing of someone who came in with neck pain.

The role herbal medicine plays

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

Herbal medicine works during the hours away from the treatment room. It draws off pooled body fluid, calms inflammation that won't cool down, and helps circulation at the spot where pressure has risen. It plays the role of continually sending signals to the body.

If manual therapy softens what has stiffened, herbal medicine creates the conditions in which it won't stiffen again. This is why neither one alone is enough.

And there is a third thing. Movement. Thixotropy occurs only when there is stimulus. If you lie still, the tissue stiffens again. This is why I always tell you how you should move after treatment.

To sum up

	Cracking with force	Softening
Immediate sensation	Relief, a sound	Gradual ease
Tissue's property	Unchanged	Changed
Body's response	Defends	Accepts
Durability	Easily reverts	Easily maintained

Being released and being changed are different. If you felt better only while being treated, then either the property hasn't yet changed, or the spot that generated the pressure hasn't been found.

Finally

The property of thixotropy itself is well known in physics and materials science. But the way of applying it to the treatment of human connective tissue is a perspective I have built through clinical practice and study. I distinguish between established fact and my own interpretation when I speak.

And not all stiffness releases this way. There are cases of actual structural damage, or conditions that require surgery. If I see such signs, I recommend examination first.

Still, if you've released it many times and it keeps reverting, that is not because your body is bad. It's only that the front of the chain hasn't yet been found, or the property hasn't yet changed. Let's go together toward the side that doesn't revert.