Muscle Tension: Why You're in Pain — and How to Fix It

My daily routine: musculoskeletal pain is the reason you visit me in the practice every day. There are many reasons for this pain. By far the most common reason, however, is muscle tension. My actual expertise as an orthopaedic surgeon is only very rarely needed. I only come into play when there is significant damage to bones, tendons or joints. In such cases, a classic orthopaedic-surgical treatment (e.g. an operation) may indeed become necessary. That is, in fact, what I am in the practice for 12 hours a day. But these things are rather uncommon. A great many patients come because of muscle tension. Approximately 80% of complaints originate from the musculature. From painful, tense muscles. Painful muscles cannot be seen on X-rays, nor on MRI scans, nor on ultrasound. Even if imaging (often incidentally) reveals wear and tear, the musculature is nevertheless very frequently responsible for the pain. Since nothing is visible and the radiologist then writes "unremarkable findings", many — indeed most — people with such complaints are sent home without treatment, told "there's nothing there". Yet the pain is real. Every day, with almost every movement. Tense muscles do not only cause pain; they can also cause restricted movement (stiffness), dizziness, nausea and headaches (so-called autonomic accompanying symptoms). A permanently tense muscle can also remain tense for years. Painful, hardened, shortened. Normally we can voluntarily contract our muscles and relax them again.

One must reintroduce the "forgotten" muscle into the neuronal network. Make it conscious again. Through active movement. This is also why massages do not help for long. They do release the muscle, but the innervating nerve will soon cause the muscle to tense up again. The only thing that helps is training and exercises that you do yourself. Because no one else can activate and deactivate our brain and our nerves, and thereby our muscles. There is a solution for this. Even if it sounds complicated, it is not. It is worth thinking your way into it, because this alone could eliminate a great many unnecessary pains.

So let me try to explain the whole thing — if it is not comprehensible, then it is my fault, so please send me a message. I shall try. We need to relax the permanently tense muscle and reacquaint the neuronal system (brain and peripheral nerves) with the muscle. With the muscle that has been forgotten by consciousness and is automatically held in tension at all times. That means: learning to voluntarily contract and relax the muscle. I would like to give you 2 techniques for releasing hardened/shortened/tense musculature (myogeloses, muscle induration, trigger points, etc.): eccentric training and myofascial release.

Under normal circumstances, the muscle is consciously innervated. It can then also be deliberately released again. If it is unconsciously innervated on a permanent basis, one cannot simply release it at will. So how can we actively control the nerve (and the associated muscle) again and learn to consciously release it? We have already described this in connection with typical chronic tensions such as Achilles tendon pain or tennis elbow. With eccentric training.

First, you actively contract the affected muscle. (Contracting is voluntarily much easier than releasing. Releasing normally happens unconsciously. So we need to practise and become conscious of the releasing). We begin by contracting the muscle against a resistance. And thereby shortening the muscle. Now we slowly yield to the resistance (e.g. gravity, or a weight, or the force of our own other hand). In other words, we allow the tense muscle to slowly elongate through the resistance. Here lies the secret. Very slowly and with full concentration on the muscle. In doing so, the brain/nervous system learns to slowly allow the muscle into elongation — that is, to release the tension. Important: slowly and in a controlled manner. And feeling every millimetre of the muscle giving way. Through this training, one can ACTIVELY learn to relax a muscle. Passive learning does not work well with a tense muscle. The trick to the whole thing is: active learning, active releasing of the muscle. Only you can do this yourself. No one can do this work for you. True health can ONLY come through oneself. You cannot have a therapist standing next to you every day demonstrating the exercises for you (or can you? That is only possible online 😊).

Ultimately, it is eccentric training. But not as fast/hard strength training — rather as slow, conscious movement. Once you have understood the principle, you can perform this exercise for EVERY muscle. Every muscle that is permanently tense and/or painful. I hope I have been able to explain the principle of eccentric training reasonably clearly. The best way to see the principle of eccentric training is in this video for the calf muscles: the first video at the very top. Here we see typical complaints and permanently tense muscles as well as the movement that the muscle normally performs: the principle can be applied to all these areas and many more to alleviate pain. In this way, you can relax and release (almost) every tense and painful muscle. Permanently relax. Sometimes one has to be a little inventive to come up with exercises for certain muscles.

Besides eccentric training for muscle tension, another good option is targeted local stretching of the muscle. Sometimes certain muscles (e.g. back muscles) cannot be easily engaged through exercises. For this, there is a technique to release the muscle locally, right where it is. It is called "myofascial release": first, you press your thumb vertically deep into the muscle belly (the myogelosis) and hold the pressure. Now you push the thumb transversely, as far as the tissue allows (approximately 2–3 cm) and hold the tension. In doing so, we stretch a small section of muscle locally, right where it is. Hold this tension for at least 30 seconds. Sometimes you will then feel the muscle tension subsiding (= the tissue becomes softer). Afterwards, slowly release the transverse pressure and finally release the vertical pressure. It takes barely a minute. If you cannot reach with your thumb, you can also lie on a tennis ball and let the tennis ball apply the pressure (do not forget the transverse displacement). Important: hold the pressure — do not just stroke across or roll over it, in other words, do not merely massage. That may feel pleasant, but the stretch is too brief in duration. The muscle only releases after 30 seconds. The whole thing is a technique from osteopathy/manual medicine. Simple and logical. Osteopathy is not hocus-pocus or some secret science either (which many like to market it as, so that it sounds more interesting — more premium and more expensive? — of course).

Myofascial Release:

We apply a similar principle in the fascia courses with a tennis ball on the sole of the foot:

The tennis ball stretches the plantar fascia. This loosens it and releases tension. The plantar fascia frequently causes pain itself, or the constant pull on the bone (red marking in the image) leads to a painful inflammation and calcification at the bone attachment on the heel bone (= visible as a heel spur on X-ray).

Muscle tension (myogeloses, trigger points, muscle induration) is a common — if not the most common — cause of musculoskeletal pain. It can ultimately occur anywhere and also cause autonomic accompanying symptoms (headaches, dizziness, nausea).

Tension can be released through movement (which promotes blood circulation and nutrient supply to the muscle; heat is also beneficial for this) and through stretching.

Normal stretching is less effective than a stretch in which the muscle is contracted whilst simultaneously being passively pulled into elongation against the contraction as the tension is slowly released (= eccentric training). The highest-quality form of stretching, so to speak.

For localised muscle tension (e.g. in the back), myofascial release (a technique from osteopathy/manual medicine) is well suited.

For highly resistant tension, medical measures such as the injection of a local anaesthetic directly into the tension point or dry needling (in which acupuncture needles are used to puncture the tension multiple times, thereby stimulating blood circulation and healing of the muscle) — known as trigger point therapy (also including shockwave therapy, cupping, kinesiology tape, etc.) — may also be considered. These medical measures are mentioned only for completeness and should please only be carried out by a doctor (please, please do not go poking around in your muscles with needles yourself — particularly in the upper back, where you could quite easily puncture a lung, resulting in a pneumothorax).

If all of this was too complicated, do not worry (it took me a long time to understand it too) — we put these exercises and this knowledge into practice in our courses. So simply joining in with the courses is sufficient.

Best of luck with the relaxing. And please do not approach relaxation with too much ambition, otherwise the opposite happens. Relax!!!

PS: Throughout this entire article, I have only spoken of the muscle. That is perfectly sufficient for understanding and for the exercises. Naturally, the muscle has a sheath (fascia) and a tendon at each end. All three can cause pain. However, one can understand the unit of muscle/fascia/tendon mechanically as a single entity, and they are always moved, stretched and trained together. One cannot move the tendon and/or fascia without the associated muscle. Therefore, with these muscle exercises, one naturally always treats the fasciae and tendons as well. I just wanted to clarify that once more, because one reads more and more about fasciae these days. The reason being: it sounds sleeker and more modern than muscle 😉

As set out earlier in this article, when treating tension, one simply cannot avoid active movement if one truly wants to achieve lasting improvement. An ointment that relieves pain can be sensible when we want to release chronic muscle tension, because its effect may make movement possible in the first place.

Warming ointments can be a good support when it comes to releasing tension, as heat promotes blood circulation at the affected area and thus ensures that nutrients and repair substances can be transported there. The same applies to heat patches or heating pads. As stated: always only as a supportive measure, not as a sole remedy.

Pain is the body's warning system. One should therefore not ignore it and under no circumstances (permanently) override it or mask it through the use of painkillers, because we could otherwise cause lasting damage.

If we therefore temporarily eliminate the pain with a painkiller, we have the opportunity to work on the cause of the pain — namely the tension. But this must then genuinely be done actively within this window of opportunity, otherwise one has merely gained a brief respite from the pain without changing anything whatsoever about its cause. And long-term use of painkillers is of course by no means advisable, as they have unpleasant side effects on the one hand, can even be addictive, and on the other hand we are switching off our body's natural warning system, which can have serious consequences.

Since muscle tension in many people nowadays begins with inner tension and stress, it can help — particularly in the area of prevention — to drink a calming tea.

The classic choice here is certainly valerian tea. But one can also reach for St John's wort, lavender or lemon balm, or choose a ready-made blend, of which there are numerous on the market.

It should be borne in mind, however, that in relation to muscle tension this is merely a minor supportive measure on the periphery and certainly not a remedy for what may already be pronounced pain conditions.

If one cannot manage to rid oneself of muscle pain caused by tension through appropriate movement and exercises, treatment by a physiotherapist can be helpful. A massage-only treatment is not, however, a long-term solution — there should always also be guidance on independent movement and exercises should be provided to take away.

As surgical problems are very rarely the underlying cause, an orthopaedic surgeon can usually only help by prescribing painkillers, which should be a temporary stopgap so that the underlying cause can be addressed. And here — one cannot say it often enough — only the movement of the tense tissue truly helps, in order to "bring it back to life".

Muscle tension can also occur with changes in the weather. Particularly when it gets colder and we begin to feel cold because we are wearing a jacket that is not thick enough or we have forgotten our scarf, we tend to pull our shoulders up towards our ears, which inevitably leads to tension in the neck area.

When weather-sensitive people feel stressed by a change in the weather, the inner tension may cause them to unconsciously tense their muscles on a permanent basis, thereby developing painful tension.