i will piss some people off...!

okay, since the last post was about acupuncture... let me make a comment about certain practices in "physical therapy." i have nothing against physical therapy per se, and i know that at times they achieve remarkable results. but one practice i am philosophically against is what is called "isolytic stretching." that is, it is a stretch that goes to the natural barrier (the pain threshold) and (like buzz lightyear says) BEYOND! thus, it "lyses" (breaks/cuts/TEARS) the bound muscle tissue.

i have heard SEVERAL times that patients experience the WORST pain of their lives during such isolytic stretch treatment sessions... patients mention that they actually see STARS. and, almost invariably, the area stretched feels worse, to the point of becoming incapacitated. for example, one patient being "treated" for frozen shoulder couldn't even MOVE her arm after one session.

i often treat patients who are simultaneously going through physical therapy. and it really frustrates me when i accomplish a measure of release, and then the next time i see them, they are worse than before (because, in the interim, they saw their pt).

let me attempt to explain why isolytic stretching is inadvisable.

muscles have their own intelligence. if you attempt to either stretch a muscle or load a muscle beyond its capacity, then the muscle will react in a manner to protect itself from TEARING. it goes into a state of spasm. knots (trigger points/ashi points) form in the muscle to shorten it.

this is an ENTIRELY NORMAL and appropriate response.

things become problematic when the muscle doesn't release afterwards. then, treatment interventions become necessary. the trick (problem) is that the muscle still THINKS that it is in a threatening situation, and will NOT release unless it is convinced otherwise.

one option is to try to SPECIFICALLY work out the knots (via trigger point therapy, acupuncture). while this can be painful, because it is specific, it tends to release the muscle little by little, in the same way that unknotting a rope will gradually bring more length to it.

stretching can also work, to a limited degree, but only if it is gradual and within bounds. gentle stretching is like coaxing a muscle to re-experience length in a non-threatening way.

there are also neat "tricks" to bypass the muscle's guarding mechanisms. two "trends" are orthobionomy (also known as strain/counterstrain or fold and hold) and muscle energy techniques (also known as pnf or post-isometric-relaxation [???] stretching). these trends take advantage of natural reflexes built into the muscle to bypass the pain/guarding mechanisms, AND are generally painless (away from pain) in themselves.

isolytic stretching, on the other hand, is counterproductive. it disrespects the body's natural intelligence; it in fact "rapes" the problematic muscle. the muscle (once traumatized) doesn't want to stretch; but isolytic stretching ignores the PTSD encoded in the muscle, and just REINTRODUCES trauma to it... how is that therapeutic IN ANY WAY???

i know i'm going to piss some people off, notably pts. again, i admire a lot of pts, and their work. i'm just voicing a critique of a particular technique. please please think about it, if you are a pt, or if you are seeing a pt, or if you are injured (musculoskeletal). does any of this make sense?