|Most patients state that it was pain that brought them to seek physiotherapy. However frequently reported precursors to onset of acute pain are either experiencing some twinges before the pain became bad, or even more commonly, stiffness in the body region in the days or weeks before the pain came to the fore. |
The sensation of stiffness is one we can all relate to. However there are in the main three different clinical scenarios that can cause this uncomfortable sensation. Deciphering the exact reason for the presence of stiffness is critical in deciding what needs to be treated and how to proceed.
Muscular stiffness a new or prolonged physical activity is something everyone will have felt at some stage.
Felt as a vague diffuse sensation right over the muscle, all sports players are familiar with this sensation. This stiffness comes on 24-48 hours after the first few training sessions after layoff. It can come on after an unusually long day of housework or gardening, or a day doing DIY such as painting or laying a patio, or at the return to pre-season sports training or after a steep hike, etc.
Known as DOMS (delayed onset muscular soreness) it is a muscle’s reaction to being asked to work hard which leads to a build up of lactic acid, the by-product of work. Excessive lactic acid makes muscle ache. This comes to a crescendo before the body can deal with the excessive volume of lactic acid from overwork, which explains why it takes a day or two before this stiff soreness gradually eases off and recovers spontaneously.
Simple home remedies for recent onset muscle discomfort include initially icing the area, then later heating the stiff region, either in a bath or shower, gentle stretches of the area and some straight forward over-the-counter painkillers. Nowadays some elite athletes use full body immersion in ice baths immediately after participation in their game or event to prevent DOMS and accelerate absorption of lactic acid, but this is not to be advised without a full medical check-up first!
A good rule-of-thumb is that if aching persists for more than five days, it may point to actual muscle injury, overstrain or tear. This is worth seeking a professional opinion and will benefit from physiotherapy assessment and treatment.
If the stiff sensation covers a number of areas or joints and has a definite pattern during the day, this may point to a generalised inflammatory disorder. In this case the pattern is the same over each 24 hour period: absent during sleep, stiffness worst on wakening and rising, improving shortly after getting up, gone or virtually gone mid morning through the middle of the day, but coming back in a milder, tired format in the evening. The length and severity of morning stiffness is a very significant symptom and may be the sign of a potentially serious rheumatic condition. This can be easily investigated by a simple blood test, so if you note this type of stiffness it is worth discussing your symptoms with the G.P.
Stiffness within a single joint can occur as a response to overuse or overstrain, similar to muscle stiffness. However it may also be a sign of early degenerative changes within the joint. This may appear as a single stiff joint which clears quickly in the morning but comes back after rest, such as after sitting at a desk or table for a couple of hours. Known as joint wear and tear or degeneration, this presentation of stiffness tends to feel deeper and localised. Joint stiffness is generally not present when the joint is at ease, but comes on with or after motion. Sometimes some slight or gross joint swelling may also be present, which is often worse after use.
There is much that can be done to manage and improve this. A straightforward self-management regime should include some exercises addressing joint motion or flexibility and others focusing on local muscle strength. Muscles are meant to be shock absorbers, protecting joint surfaces from excessive loading or impact, ultimately keeping the surfaces of the joint healthy and functioning well for life.
Nowadays orthopaedic surgeons can replace many severely worn joints, but such surgery is not to be undertaken lightly. Far better to catch degenerative signs early and learn how to prevent or slow down further wear and tear. A couple of sessions with your local Chartered Physiotherapist should give you all the information and self-management strategies you need to take care of a degenerative joint in the long term.
So to recap; muscle stiffness usually clears up in a number of days. If it persists, a physiotherapy assessment can identify if soft tissues damage has occurred and treat it as necessary. Stiffness in a number of joints with an obvious daily pattern of bad in the mornings, good during the day and tired in the evenings may represent an inflammatory disorder which should be managed with your G.P.
Finally single joint stiffness representing wear and tear responds well to physiotherapy to include exercises and self management strategies.