Thursday Thoughts: Cut Me Some Slack! | Modern Manual Therapy Blog

Thursday Thoughts: Cut Me Some Slack!

Stretch, stretch, stretch!

Clinicians, patients, everyone loves to stretch and thinks it is necessary to increase flexibility, symmetry, and decrease pain. In most cases, the perception of tightness is just that, only a perception. Very rarely are muscles "adaptively shortened" as in the case of true contracture. True contracture happens after prolonged immobilization for 4-6 weeks or so.

Unless you have been immobilizing your knees in a near fully flexed position, it's pretty doubtful you have "tight" hamstrings. In most of these cases, you can dramatically improve ROM in something like an active/passive straight leg raise with some
  • motor control
  • bracing
  • pelvic floor activation
  • diaphragmatic breathing

Without aggressive techniques like ART, IASTM done harder than an angry kitten would lick you, ROM dramatically improves in the ASLR.

In cases of pain and strong stretch perception where motor control techniques will not work, you need to give the muscle with high tone some slack. Foam rolling or stretching an already taught cable does not make it stretch more. I was issued a challenge while taking The SFMA 2 to solve every mobility problem by treating it as a tone problem. I shot two videos where I slacked two areas with high tone, one using
  • passive hip flexion and ER to improve anterior impingement with an EDGE Mobility Band to modulate perception of "compression"
  • passive trunk sidebending and light rotation to slack hip flexors and hikers in a high level former gymnast who had trouble with rolling patterns and supine to sit with hips offset

In both cases, an entirely pain free slacking technique did the same thing much more aggressive and uncomfortable stretching technique would do. Videos below

Positional Release for Obliques

Hip Flexor Positional Release

The key parts about positional releases is that they are
  • pain free
  • easy to do
  • enable a patient to modulate stretch perception via tone reduction, thus enabling them to get to end range to perform their own self resets
  • EDGE Mobility Bands work great for extremity modulation and positional release!
Keeping it Eclectic...


  1. Molly BredenbergMarch 5, 2015 at 1:06 PM

    What do you have them do for s home program to keep that tone diminished?

  2. Great question! Without reinforcement, the effects will not last. Typically instruction on diaphramatic breathing, with emphasis on full exhale to reduce tone. Also, repeated motions to the new end range to keep the area reset and threat free.

  3. Yes, the diagonal activated ASLR works great after

  4. Yes, if I can shoot a video on the way I apply this I will soon.

  5. Great post and videos! Quick question regarding the concept of increased tone vs "muscle shortening/tightness". I agree 100% that it is rare to have muscles which are adaptively shortened, and that muscle "tightness" is not short muscle. What do you think is the cause of increased tone, do you attribute it to increased neural drive? If so, is it this increased neural drive that leads to increased muscle tone?

  6. Increased tone could be from guarding due to pain perception, stretch perception, or breathing pattern disorders among other things. The short term solution of tone reduction helps assist movement, along wiith the proper pain science education and homework is more important than the real "why."

  7. Ive noticed a lot of these techniques employed by other therapists using similar products.... Aka, voodoo bands. What's the difference in effect?

  8. No difference in effect. It's just compression for neuromodulation of stretch or pain perception. Unlike other clinician's instructions, I DO NOT instruct to wrap with 40-50% compression, you should wrap as lightly as possible so the limb does not go numb.