Maggie McKay (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Have you ever worked out, been injured and then had to deal with tight muscles? How do you get past that so you can return to play? Dr. Jared Anderson, a Sports Medicine Physician with Skagit Regional Health is here to tell us what we need to know about tight muscles.

Welcome to Be Well with Skagit Regional Health. I'm your host, Maggie McKay. So nice to have you here today, Dr. Anderson.

Jared Anderson, MD, CAQ: Thank you, Maggie. It's good to be here.

Maggie McKay (Host): First of all, can you tell us why tight muscles even happen?

Jared Anderson, MD, CAQ: Yeah, there's a lot going on with the tight muscle. A muscle that's tight is usually a muscle that's trying to overwork or is covering for some other muscle that isn't quite working as efficiently as it should. Tight muscles happen as we work out, as we move, when our system, our muscle system isn't quite in balance. Often what happens is when there's a muscle imbalance, our muscles try to compensate or our body recompensates by recruiting other muscles to cover for that imbalance. The muscles that come into cover for that compensation, typically aren't as efficient and often tighten up in order to perform the task that they're trying to do. Many times we've heard somebody say, boy, I have to stretch my hamstring out over and over every day. I have to stretch out my hamstring and it never seems to get any better. I have to do it over and over. Why would this be? If the tight muscles would improve by stretching it, in a few days of stretching it should get better. But, the problem is usually the muscle that's tight is actually just a muscle that's overworking.

At any time that we have a tight muscle without a specific injury, we should change our thinking from, you know, what's the best stretch for this tight muscle to where is that muscle imbalance that's making this muscle tighten, or what muscle group is that set of muscles covering for?

Maggie McKay (Host): Can tight muscles lead to injury? Can they cause injury?

Jared Anderson, MD, CAQ: Oh, definitely. A tight muscle is often a precursor saying, Hey, I'm not working as efficiently as I should be, and so I'm trying to use a muscle to help stabilize or balance that position. It'd be like, if the power goes out at your house, and you have a generator. That tight muscle's like the generator trying to fill in the gap for when the power is out, but eventually that generator can run out of gas and then we're left with nothing to cover for it and that would lead to a joint or a muscle to strain or tear or the muscle to twist and we lose stability, and then you get a sprain of the joint or a fracture or something like that.

So, we want to make sure that those tight muscles, they're kind of like the warning shots to tell us something isn't quite right in the system and we need to try and address it as best we can.

Maggie McKay (Host): And how do you treat tight muscles?

Jared Anderson, MD, CAQ: This is kind of maybe a part where I want to change how we think about tight muscles. Often we think of massaging it out or stretching it, and those can be good temporarily, to relieve some of the stress on the muscle. But if I have a muscle that's tight, I want us to think, where is the muscle imbalance that's making that muscle tight? Or what muscle is that tight muscle covering for? You treat tight muscles, by realigning the system so that each muscle only has to do what it's supposed to do. There's myofascial work or massage that can free up restrictions within the muscle. There's stretching that temporarily relieves that tight muscle. But usually that tight muscle is doing the extra work covering for a muscle that's not showing up. So, the way to find or treat a tight muscle is to find out where the system is imbalanced and try to correct that imbalance.

Maggie McKay (Host): And so do you have to go to the doctor for that? Because how would we know?

Jared Anderson, MD, CAQ: So let me use the hamstrings as an example. If the hamstrings are tight, they're covering for a muscle that's not working. So typically, if we're looking at that or trying to figure out for ourselves what it is; often it'll be the muscle up front, which is the opposite. So the hamstrings are in the back, then the quads might be up front and the quads might be extra tight or not working as well. If the hamstring is tight, we also need to look diagonally across the body, up into our core for that imbalance or compensation to happen. It is really hard to tell on yourself because your body is really good at finding somebody to cover the gap for you. So often we don't even notice that we're moving improperly without somebody watching us how we move. What I do as a sports medicine physician, is I look for those muscle imbalances. I look for the compensations in what we call a functional movement assessment, to be able to look from the neck down to the big toe and see which joint, which muscle group and which system isn't working how it's supposed to.

If you're treating it for yourself, I guess there's a couple, there are a couple of simple things or at least common things that happen because of the way our world is built. We spend a lot of time sitting in chairs, driving, typing at a computer, things like that. And so often the most common imbalances that I see, are that the lumbar extensors or the muscles of the lower back are really tight because we're not able to access our hips as much because they're spending so much time in chairs. So the lumbar extensors and the hamstrings try to make up for the hips that aren't able to be as active as we need them to be.

So if I were to have somebody just set up a program or say, boy, I have tight muscles, where can I find that imbalance? One of the most common places to look is the lumbar extensors are very overactive, or those low back muscles, that low back tightness, and also the core muscles up front aren't able to engage in a way that, that gives me access to the muscles of the back.

So being able to activate the core without the lower back muscles extending or turning on too tight as well, is one of the best places to start for any type of pain, whether it's a knee problem, knee tendinitis, shoulder tendinitis or impingement or anything like that.

Maggie McKay (Host): Are there any recommended foods or supplements to help ease tight muscles?

Jared Anderson, MD, CAQ: Well, the best food, and I'll say that in quotes, for tight muscles or sore muscles is usually water. Most of us don't drink a lot or enough, especially as we're active. So that's usually the best thing to have. Ensuring you have electrolytes for the amount of activity or conditions is very important as well. If you get cramping, checking with your doctor for some blood work can be important to help figure that out. Often, we lose magnesium as we sweat, and so sometimes if we get repetitive cramping like in the calves or something, that can be a sign that maybe our magnesium is a little bit low. And there are ways to try like taking an Epsom salt bath is a way to have some of that magnesium absorbed directly into the muscles.

So that can be very beneficial. One of the best things to feed a muscle is after working out, you have what's called a golden hour of time to replenish that muscle's energy. So within that first 30 minutes or hour of working out, you want to replenish the muscles. Otherwise, it can take up to 27 hours for those muscles to regain their strength and activity. So, making sure you get some protein and some carbohydrates right in right after the workout is really important.

Maggie McKay (Host): Wow. What if you're doing intermittent fasting? That, then you have to wait. Then you're out of luck, right?

Jared Anderson, MD, CAQ: Well, yes, if you're doing that, I mean, there's lots of different conditions. If you're doing intermittent fasting, which can be helpful too, just know that those muscles that you worked out really hard will take longer to recover. You're not going to want to do multiple days of the same muscle group in a row.

Maggie McKay (Host): Got it. Dr. Anderson, what are your top do's and don'ts to return to play when having tight muscles? You want to get back to it, whatever it is, football, tennis, swimming.

Jared Anderson, MD, CAQ: Right, yeah, so, I've been practicing in the area for about 11 years, and I use these three points for almost everyone to get back to play from a musculoskeletal injury. These are the return requirements that I give to the athletes that I talk to.

So number one, you want to be non-tender to touch. You want to feel like if you poke one side, you know, say you, again, you have your hamstring that's hurting. You want to be able to touch the hamstring on that side and compare it to the other side, and it needs to be non-tender to touch.

You want to have a full pain-free range of motion. So I need to be able to straighten and bend my knee the whole direction. Again, if I'm working at the hamstring, be able to move my hip in all directions without pain.

And then number three, I need to have 90% strength compared to the opposite side or compared to expected. So, being able to pull with the same force on that hamstring or the same number of repetitions on that hamstring, would be important. So those three, once you have those three, non-tender to touch, full pain-free range of motion at 90% strength; usually we can find a way to protect or stabilize the joint or the muscle to get you back to your sport.

Maggie McKay (Host): So when we do return to the sport or activity, how do we know how much we can do?

Jared Anderson, MD, CAQ: Good question. So if we're doing an activity and I have pain during that activity that I can't correct or can't alleviate, then I need to stop and I need to go back to my rebalancing exercises to find where those muscle groups are having an issue.

So if I have pain during an activity that I can't correct, I stop that activity for then. If after I go for a run, and I have pain the same day, or later that day, like in my IT band or something, where it's not just a tight muscle, or not just a muscle that's worked out, but a muscle that is sore or painful, the next time I work out, I decrease that amount by 50%.

If I don't have pain until the next morning after an activity, then I need to decrease by about 25%. So using running as an example, if I'm running four miles, and I have pain that I can't get rid of during that run, I need to stop. If I have pain that same day, around two-three hours later, or later that evening, then I need to decrease by 50%.

If I have pain the next morning after an activity, I need to decrease it by 25%. And then, once I decrease to that level, I need to do two workouts at that same level before increasing back up again.

Maggie McKay (Host): So ease back into it.

Jared Anderson, MD, CAQ: Ease back into it, those are the percentages that I use to try and help give guidance so I can know, hey, when am I ready to increase again, or, if I was running four miles and I had pain during that run, I would have to stop. If I had pain later that day, I would go back and my next run would be at two miles. And if I had pain later the day of that two-mile run, then I'd have to decrease by another 50% down to one mile.

But, if I didn't have any pain at that one mile, then I could increase back up, to about one mile after doing a one mile run at that, for two times.

Maggie McKay (Host): And what about things like ice or heat or Tiger Balm or those Salonpas, just as an example, are those effective?

Jared Anderson, MD, CAQ: They're often effective for alleviating the pain of a muscle. So again, our goal is to get the muscles to move well. Those areas where the muscles are tight. The way some of those work is ice decreases the blood flow to an area to decrease some of the swelling, and it can be really alleviating over a joint where there's a bursa or some swelling at that point. Typically, heat is good for the muscles because it increases the blood flow to allow those muscles to flush, to allow those muscles to reactivate. And then those other topical, Icy Hot, Tiger Balm or Salonpas or things will help bring blood into the area. It acts like a hot cold contrast bath, basically, to allow those muscles to settle down. When we have pain, we have to do something to treat that muscle to, to, I'll say, baby that muscle a little bit because it's working so hard for us trying to make up for a deficit somewhere else.

So we want to treat that muscle, but again, ultimately, I guess our goal is to say that muscle is tight because it is working for someone else or covering for someone else who’s not showing up to do their job.

Maggie McKay (Host): Is there anything else you'd like to add in closing?

Jared Anderson, MD, CAQ: I want to change how we perceive a tight muscle and say, boy, this muscle is tight, it must be my problem. That muscle is tight because it's your biggest helper trying to cover for another muscle. So if we, instead of just stretching out that muscle, if we look downstream or upstream from that muscle and try and find that joint that doesn't move or a muscle group that's not working, then I think we'll get so we don't have to work on those muscles anymore.

Maggie McKay (Host): This has been so educational and helpful. Thank you so much.

Jared Anderson, MD, CAQ: Thank you for having me, Maggie.

Maggie McKay (Host): Again, that's Dr. Jared Anderson. If you'd like to learn more, please visit SkagitRegionalHealth.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm Maggie McKay. This is Be Well from Skagit Regional Health. Thanks for listening.