There is bad science, weird science, fringe science and then there is good science.  Anything but good science?  Don’t even think about it…  Look here to find the information about why you do what you do, when you do, what you do!

MUSCLE STIFFNESS AS A PRODUCT OF MUSCLE ARCHITECTURE,  or the Zen of Muscle

Gregory T. Lawton, D.N., D.C., D.Ac

I wrote the original version of this article in early 2003 but did not attempt to publish it other than using it as a handout for massage students at the Blue Heron Academy.  Frankly, in 2003 I became so frustrated with the resistance in the massage community to real science that I decided not to publish anything further in the general massage literature or media.  The article is still not completed or edited and I have not added the research citations that should accompany it.  I have been lazy!  However, the thoughts and ideas presented in the article may be of some benefit.  The article explores the “new” biological discoveries associated with muscle cells, tissue, physiology and biomechanics, or what this author calls gel biosomatics.  Muscle architecture is composed primarily of connective tissue polymers that function like thixotropic gels.  This latest research regarding cells as gels, and muscles as gel like polymers, has advanced our understanding of how muscles respond to manual therapy.

In lectures that I have provided to advanced students at the Blue Heron Academy I have asked an unusual question.  When you feel a muscle at rest, what are you feeling?  When I ask this question I usually get a bunch of puzzled looks and head scratching.  What does he mean, “What do you feel when you palpate a resting muscle?”  What I am really asking is actually what happens when a muscle is at rest, and what are we really feeling when we palpate a muscle that feels stiff or tight?  This is an important question for massage therapists because it goes right to the heart of what we feel in soft tissue and what we treat.

There are many misconceptions about muscle tissue, what it is, how it works, what happens when something goes wrong, and how it should be treated.  We are at a very strange point in our knowledge about muscle cells, tissue and, function, because much of what we think that we know, or have been taught in school, about the physiology of muscle tissue is wrong.

This article entitled, “Muscle Stiffness as a Product of Muscle Architecture, The Zen of Muscle”, presents a “chicken and egg” explanation of muscle physiology and biomechanics.   It is hard to know what is more important, what the muscle is composed of or how the muscle actually functions.  The answer to the silly question, “When a muscle is at rest, what are you feeling?” is indeed Zen like.  When a muscle is at rest what you are feeling is the muscle!  In other words, the architecture of all of the fluids and soft tissue, muscle, fascia, vessels, and nerves that composes the area that you are feeling.  That architecture is essentially “inert”.  That is, muscles at rest are neurologically silent so what you are actually feeling is just tissue mass or bulk at rest.  If the resting muscle had a resting tone there would have to be some abnormal neurological condition that was producing motor neuron activity in the muscle.    But let’s look at this word tone, or muscle tone. 

Since I have a background in communications electronics I think of tone as an active signal and something that implies electrical activity.  Tone is something that I can turn up with a dial. Resting muscles are neurologically silent and they demonstrate no motor neuron activity.  They are at rest.  Any “tone” that you feel in the muscle is simply muscle mass and bulk and this mass has a property called “stiffness”.  I prefer to refer to resting muscle “tone” as stiffness and active contraction due to motor neuron activity as motor tone. 

Stiffness is an important concept in understanding muscle function and physiology.  Chances are unless you just graduated from a very progressive human biology or physiology class you are about two decades behind in your understanding of cells and tissue, what they are made of and how they work.  Cells are gels, and muscles are polymers.  For those of you that haven’t been to chemistry class in a while, a gel is like jello, and polymers make plastics.  Remember the old, “the cell is a bag of water with microscopic organs in it theory”?  There are now new theories of cell composition that challenge the old models.  Cells are gels, and they behave like gels.  They are not bags of water. They get stiff when they get cold or sit around without activity and they soften up when they get warm and active.  And so the story goes.  If you studied any muscle physiology you probably learned about the actin/myosin “rachet” theory.  That theory and model is also being challenged by current research.

The coiled strands of proteins and polymers that compose our connective tissues and muscles act more like the Blob and as moving gels and coiled springs.  Gels exhibit physical changes in consistency and they exhibit motion when they are exposed to electrical activity, chemical change, temperature, mechanical forces, and alterations in the acid/base balance.

In the past I have written several articles that reviewed the role of mechanoreceptors and theories that we use to affect muscle behavior through effects on the peripheral nerves, spinal cord, and brain.  This is one way that our techniques and treatment protocols effect soft tissues.  Now we know much more about another way that massage affects tissues, and that way is simply by the affect that manual compression and friction has on the gel like nature of tissue.

Gels have a physical property called thixotropy.    Thixotropy is a property associated with some gels whose molecular bonds are changed by movement and the other triggers mentioned above.  Muscle is viscous, and the muscles viscosity is changed by certain physical triggers or events.  In other words, muscle gets stiff when it is inactive and it gets less stiff when it is active.  Consider a bottle of catsup.  You hold the bottle upside down and nothing comes out, so you shake the bottle vigorously and the catsup begins to flow out and onto your French fries.  This is thixotropy.  Muscle tissue exhibits this same behavior.

We now have two strong theories and their associated principles of action that we can use to understand and to guide our clinical applications of massage and manual therapy.  These two theories involve:

1.      The well documented effects of massage and manual therapy on peripheral biological sensors and nerves, the spinal cord, and brain.  These effects are both nervous, as in the effects on motor neurons, and biochemical, as in the effects on the body’s humoral responses mediated by the nerve synapses and the brain.

2.      The recently discovered and formulated effects of massage and exercise on the gel like components of connective tissues and these biosomatic gels thixotrophic behaviors.

To make this simple, massage both sedates and tones the nervous system and this in turn reduces or balances muscle motor tone, and massage transforms the plastic like characteristics of soft tissue into a less stiff state.  When you feel a normal resting muscle you are feeling the relative stiffness of the gel.  When you massage the muscle and perceive a change in muscle “tone”, you have produced a change from more to less stiffness.  In medical massage we call this change a clinical response.

Some of the properties that have been noted with thixotropic materials (muscles) include:

1.      Stiffness depends on the amount of activity or inactivity that the muscle has experienced just prior to palpating the muscle for stiffness.

2.      Guarding behavior, inactivity, immobility, and sedentary behaviors increase muscle stiffness.

3.      Stiffness is intimately related to the amount of, or lack of, water in the connective tissues.  Stiffness results from both adequate water content and dehydration in tissues. 

4.      Movement, exercise, massage, heat, and ph or biochemical changes can decrease stiffness.

Muscles perform work by contracting.  Until relatively recently everyone believed that the only way that a muscle could produce tension was by motor neuron or electrical activity, and the “all or none principle”.  That worked for a while, until  someone asked why muscles were still stiff at rest with no measurable neurological activity.    It then became evident that there had to be some other contracting force, it has now been discovered to be the thixotropic properties of gels.  However, things have changed even more.  Remember the cell membrane and semi permeable barrier theories, and the descriptions of all of the cell membrane channels and pumps?  Oooops!  Since cells are gels, most of what you learned about cell function related to the cell membrane and other metabolic activities of the cell has been changed as well.

I remember my own progress in “discovering” these new biological principles and theories.  At one point I was providing a seminar to a group of massage therapists in Connecticut and I was discussing the contractile properties of ligaments and relating that capacity to the presence of actin in the ligament.  At that point I had not yet made the connection to ligaments thixotropic properties and when I was asked a question about how ligaments could “contract” I didn’t like the answer that I provided.  I puzzled over ligament contractive properties until I discovered ligaments thixotropic responses. 

Actin is ubiquitous, it is found all through the body’s cells and tissues.  It is a contractile element that is even found in single celled organisms and when so found it is a factor in cell motility or locomotion.  The presence of actin in tendons and ligaments allows these, formerly thought “inert” tissues, to contract.    This is an important concept because prior to these discoveries it was felt that ligaments that had been subjected to over stretching, or a sprain, could not contract to re-establish their structural integrity and always required surgical intervention.

These research findings that relate to cells as gels, muscle and connective tissues as thixotropic, and the contractile properties of all connective tissues, including ligaments, contribute to a broader identification of manual therapy and therapeutic exercise as the two most significant treatment modalities for soft tissue injury.    These findings also expand our understanding of the clinical response in tissue that results from manual therapy.  Since we now know what we want to achieve in connective tissue in terms of physiological and biomechanical change, and we know how this process occurs, we can better refine and deliver the exact treatment techniques that produce biosomatic change in the target tissue.

The muscle that we are treating, and the deep tissue connective tissue structures that we are addressing are not in this context as important as the techniques of compression and friction, or the combined joint physics procedures that we use to twist and stretch muscle, tendon, fascia, and ligaments.  It is the properties of the connective tissue architecture itself that respond most significantly to our manual therapy, regardless of the muscles function or location.  It is the universal properties of connective tissue as gel like thixotropic structures that responds to manual and exercise therapy. 

The “mysterious” changes that massage and manual therapists have observed in tissues subsequent to manual technique or stretching procedures are now understood as simple natural responses to manual activities directed at a body region.  The neurological “re-programming” responses falsely attributed to treatment modalities like PNF, don’t have to work through tendon reflex mechanisms, but can be understood to work by affecting the plastic like nature of connective tissues, muscles, fascia, and tendons.  Studies on muscle stiffness have noted that stiffness responds to stimuli.  Short duration stimuli like holding a single stretched position for a few seconds has been shown to reduce muscle stiffness.  This change in stiffness results from changes in the gel architecture and not changes facilitated by tendon reflexes.

Our new understanding of the body’s biosomatic gels frees the manual therapist from the tyranny of complex and confusing names and labels and leads us to a common unified understanding of massage as simply manual therapy that effects the basic architecture of muscle and connective tissue. It also frees us from non physiological massage systems and/or various pseudoscience massage disciplines and allows the medical massage therapist to know and to understand the correct physiological mechanisms of connective tissue function and remodeling and to simply concentrate on the “work” of manual therapy.

I have come to view the soft tissue components of the musculoskeletal system, as a large mass of biosomatic gel that responds to certain stimuli, like massage compression and friction, or the physics of joint mobilization that results from the forces of torque, shearing, traction, bending, accommodation, and shaking.  I understand soft tissue from a microcosmic view, but I treat soft tissue from a macrocosmic frame of reference.  In terms of diagnosis and causation, prevention and maintenance, the massage therapist needs to know the names and functions of the connective tissue structures of the body, from a therapy perspective this detailed viewpoint is far less important since the muscle and connective tissues may be viewed as just, “a darn gel”.

This perspective explains why massage therapists who lack detailed anatomical and physiological training can still produce clinical and therapeutic responses in patients.  Simply put, muscles and connective tissues behave and respond in a consistent universal manner in direct relationship to the physical forces or massage techniques that are applied to them.  Of course the better trained the therapist is the more skilled they will be at applying effective technique and achieving beneficial patient outcomes.

This article has presented a new understanding regarding the properties and function of muscle and other connective tissues as gel like structures.  Based on this new understanding the massage therapist can gain a clearer definition of and appreciation for the role of massage therapy in bringing about changes in connective tissue structures.  This unified view of massage and connective tissues as pliable plastic like gels not only expands our awareness of now massage effects tissue change but it helps to consolidate our treatment approaches through manual technique making the often confusing diverse theories and treatment approaches obsolete.

This article was written by Gregory T. Lawton, D,N., D.C., D.Ac, of the Blue Heron Academy of Healing Arts and Sciences. Dr. Lawton has been in practice for over 30 years.  Dr. Lawton is also a founding broad member of the American Medical Massage Association.  For information on the American Medical Massage Association please contact Dan Muschiana, Managing Director AMMA, at 1-888-375-7245 or visit the AMMA website at www.americanmedicalmassage.com.

Evidence Based Health Care and Education

The hot new buzz words in complementary health care are, “evidence based”.  What does evidence based health care mean?  It means that the methods and procedures being used by health care workers have been scientifically studied, reviewed and evaluated and found to have a benefit for the conditions and patients being treated.

Over twenty-five years ago American Health Source adopted the ethical value of evidence based procedures and methods of care as part of its membership ethical code. 

It is important to keep in mind that the performance of a study does not mean that that method of treatment was found to be effective or that if clinical effectiveness was reported for a method of treatment that a treatment modality is effective for all of the conditions and disorders for which it is used.  In other words the study may prove that a method of treatment does not work, or that it provides only a low level of response.

There are many treatment modalities currently used in complementary health care, few of which have compelling evidence proving effectiveness, and many of which have only been shown to affect levels of stress and relaxation in patients - but have not been shown to provide a cure for diseases.  However, the research is ongoing and the evidence of when and how complementary health care works is growing.  So the news is good and keeps getting better!

As you investigate this research don’t forget to look at:

The Journal of the American Manual Medicine Association:

http://americanhealthsource.org/research.htm

You also might want to join and participate with these groups -

http://www.massageprofessionals.com/group/EBMT

http://www.facebook.com/massage.evidence

Good Resources for Information:

2008 Physical Activity Guidelines for Americans

The Federal Government has issued its first-ever Physical Activity Guidelines for Americans. They describe the types and amounts of physical activity that offer substantial health benefits to American... Details >

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services

American College of Sports Medicine Fit Society® Page  

The page links to issues of the American College of Sports Medicine Fit Society Page® newsletter, a quarterly electronic newsletter written for the general public on a variety of popular health and fi... Details >

American College of Sports Medicine  

Consumer Reports on Health Care  

Consumer Reports on Health is a monthly, 12-page health newsletter published in print and in electronic form by Consumers Union. The newsletter offers independent, unbiased news, information, and reco... Details >

Consumers Union  

Exercise for Older Adults

Learn about the benefits of exercise for older adults. This document offers safe exercises to try, video clips, and instructions on how to chart your progress. ... Details >

National Institutes of Health, U.S. Department of Health and Human Services

Aim for a Healthy Weight

The overall purpose of this initiative is to help reduce the prevalence of overweight, obesity, and physical inactivity in order to lower the risk, and overall morbidity and mortality from coronary he... Details >

National Heart, Lung, and Blood Institute, National Institutes of Health

Find Healthier Choices at Restaurants  

This Web site provides consumers with a centralized resource for identifying the healthier choices and nutrition information from restaurants nationwide. Developed in collaboration with the National R... Details >

Healthy Dining  

Be Heart Smart! Eat Foods Lower in Saturated Fat and Cholesterol

Food plays a big part in the lives of most African Americans. Good food and celebrations go hand in hand. Yet, the traditional ways of frying foods and using fats for seasoning can increase your risk... Details >

National Heart, Lung, and Blood Institute Information Center

What Is Complementary and Alternative Medicine (CAM)?

There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. This fact sheet explains how the National Center ... Details >

National Center for Complementary and Alternative Medicine, National Institutes of Health

Yoga for Health: An Introduction

Yoga is a mind-body practice in complementary and alternative medicine (CAM) with origins in ancient Indian philosophy. This Backgrounder provides a general overview of yoga and suggests sources for m... Details >

National Center for Complementary and Alternative Medicine, National Institutes of Health