Are you or your patient a chronic muscle clencher? It may very well be the main cause of your tiredness, your many aches and pains, and speculatively even your high blood pressure. Unable to calm your body down? Keep on reading to learn how to identify and abolish this woeful muscle activation strategy, responsible for many maladies.
I have wanted to write this article for some time, but I did not, and honestly still do not know how to adequately explain nor phrase this very diffuse and – to my knowledge – unknown issue. However, I consider this issue so important, even vital, to general health, that I have to give it my best shot.
Be warned that this article is not going to be very scientific, because there’s no science on this topic as far as I am concerned. I haven’t really heard anyone discuss this topic in detail at all, which is why I feel the need to do so. You should know that this article is purely based on my own personal experience, treating chronic illness, and especially so after learning and using manual muscle testing (MMT) in my practice. Identifying clenching strategies is difficult, as the pattern is not unique and is often performed in a subtle manner.
Discovering this fundamental neuromuscular problem has also forced me to somewhat tone down my opposing views on the psychosocial theory of pain. I’ll talk more about that soon enough. So, without further ado;
What is “clenching”?
A “Clenching”-strategy is a person’s involuntary, excessive muscle activation strategy. The person is not able to exert force without coactivating and clenching improperly many muscles, and is not able to do so at a lighter force. It’s all, or nothing. ALL THE TIME.
Actually, there are three types of clenching. Two are bad including one being worse, and one is relatively harmless as long as it’s under control.
- Clenching as a strategy to brace or force-stabilize an injured or unstable structure
- Involuntary, constant global clenching
- Voluntary clenching, i.e competitive mind-set
Let me address these individually, and then I’ll discuss the solution.
Protective clenching / bracing
Whether it is a knee, shoulder, hip, neck or whatever else that happens to be injured, pushing through the pain will almost always create a bracing response to cope with the pain and instability. E.g, a person clenches all of the leg’s muscles every time he loads the leg that has a bad knee. If the pain is long-lasting, this strategy will not always go away on its own, especially if the person has been pushing through a lot of pain to cope with everyday life.
The bracing is somewhat beneficial because it helps to cope with the stressor; the instability and pain. In opposition, after the acute phase of the injury, the pattern of bracing will often not cease on its own. This exacerbates any muscular imbalances that are already present, because bracing an entire limb reflexively will imbalance normal muscle activation patterns, leading to uneven stimulus of the affected structures.
Such a person may go to a therapist and will be prescribed exercises to deal with the injury. Let us look at an example: A common driver of hip pain, is weakness of the deep six hip rotators. A therapist may identify this and prescribe strengthening of these muscles, for example by performing a clamshell exercise. For an ordinary, non-compensating patient this will stimulate the muscles well, it’ll feel weak and gradually the strength levels as well as muscle tone will increase. The hip will start to feel better.
For a strong compensating individual however, with a long history of pain in the given region, he is unlikely to be able to target these muscles without clenching the whole complex of muscles, maybe even the whole limb, or whole body. Firstly, this will greatly reduce the stimulus of the targeted muscles during the exercise, and because they’re being worked while simultaneously clenching a lot of synergistic structures, the likelihood of them being able to activate normally without compensation in daily life is very, very slim.
Therefore, such a strategy may severely reduce effectiveness of a form of therapy, even when the therapist was right in both diagnosis and prescribed the proper exercises. I learned this the hard way!
Corrective exercises for such patients must be very specific initially, and must be performed slowly without allowing the patient to clench the regional complex of musculature. Valsalva maneuver should also not be allowed, as it is as well a type of braing of the intrinsic core musculature. Hujing et al. 2003 as well as Stecco et al., has shown that between 30-40% of muscle force transmission passes through fascial connections, and if we study anatomy trains illustrations it will suddenly make a lot of sense why a person may attempt to clench their jaw, hold the breath or whatever else to increase their total strength. Although beneficial in situations where brutal strength is required, severe clenching strategies must not be allowed during rehabilitation.
Again, it’s fine to do this on a max 1RM squat, but it’s absolutely not fine when doing rehabilitative exercises or other simple exercises.
Global involuntary clenching strategies
A patient with a global involuntary clenching strategy (GICS), will be bracing their bodies, holding their breaths, clenching their jaws, and so on, for large portions of the day. Every single day. They are usually not able to exert moderate force with their muscles without bracing all of the body, and surely not without at least bracing the regional muscles, e.g hip complex. They are all or nothing; they aren’t able to exert resist a light pressure during MMT, nor a moderate pressure. They can, however, resist a high pressure, but only if they are allowed to brace the whole body.
This extreme muscle activating strategy is very taxing on the body. It is exhausting, and it creates massive muscle imbalances that do not resolve on their own, even when the patient rests more, exercises more, feels happier, feels sadder, it doesn’t really matter. The clenching persists and thus also its symptoms, although the severity of the symptoms will go up and down in relation to other factors, such as the before-mentioned.
These patients are often, sadly, the ones who often go from therapist to therapist with lots and lots of unresolved issues, all over the body. Their body may hurt everywhere, and they are often being told that it’s fibromyalgia or that it’s “all in their heads”, because the therapist can’t find sufficient signs and backing to explain these global aches and pains. They are often perceived as hypochondriacs. They often feel tired and exhausted, and may have shortness of breath. Such as person is extremely often a victim of global neuralgia, stemming from both brachial and lumbar plexus compression syndromes due to severe muscle imbalances, again stemming from their improper bracing strategy. The constant clenching will also cause more or less constant increase in intraabdominal pressure, something that may lead to pelvic floor dysfunction, reoccurring hemorrhoids, and so on.
When they talk, you can often see the platysma and infrahyoidal musculature pop out, like in the image highlighted in the beginning of this article. They may seem somewhat vigorous and stressed out when talking, no matter their current mood. Their movements are sometimes rough and quick. There’s a lack of balance in their movement patterns. This is by no means a complete list, nor should it be viewed as absolute – it is simply my best attempt of describing the signs of global clenching.
I have seen this strategy utilized by kids of 6 years old, ranging all the way up to adults of 70+. What seems to be a common ground, is a high toned personality, usually a person with slim body figure, high stress and/or worry levels, lots of responsibility, and so on. It may be business leaders, or someone who has been through trauma (such as violence, abuse, accidents), or someone with heavy metal toxicity (Read Amalgam Illness by Andrew Hall Cutler for more reliable information on this topic – it is a very controversial and poorly understood issue), or kids who have divorced parents, or people with difficult childhoods, and so on. I would say that the stronger the clenching strategy is, the more common it is to see more of the above mentioned traits, but of course, there are no absolutes.
If you are a patient of mine and you’re reading this article, please do not feel that I am trying to put you in a “group”, and surely do not feel that I am implying that all of the above-mentioned indicators applies to you. I DO NOT. I am merely trying to write down all statistical significant traits that I can think of, to help other therapists identify this dysfunctional neuromuscular strategy.
A person with GICS will usually respond poorly to high intensity exercise such as powerlifting, as it requires them to hold their breath and brace their bodies, exacerbating the existing dysfunction and its consequent imbalances. I have, ignorantly, done the mistake of prescribing valsalva-type training such as powerlifting to such clients in the past, only to realize that even though execution (technique) looks seemingly perfect, they were still getting injured. I really struggled with this for some time, but in the end I figured out why. They needed the opposite type of training; what we were already doing was harmful to them!
Proper exercise for a person with GICS is more of a moderate bodybuilding type of training regimen, where they should focus on muscle isolation, feeling the muscle work, and avoiding valsalva maneuvers and co-activation of whole muscle complexes. The exercises MUST be done slowly, because if they are allowed to go fast, they will clench. Bodybuilding training is also beneficial because it helps to tone the body and thus increases self esteem both for men and women. A double win!
A GICS patient will often require a tremendous amount of work and dedication to rid themselves of this strategy. It is extremely deeply rooted in their limbic system. Expect several months, maybe years, to completely let go. There will of course be dramatic improvements all along this way, so do not feel discouraged when reading these time aspects; it doesn’t really matter. Getting started and ceasing the clenching strategy is what matters!
Voluntary / competitive clenchers
This section probably isn’t all that enlightening, but it’s worth mentioning.
Some people are simply competitive, and clench purposely to obtain greater strength. If you are assessing such an individual with MMT or prescribing him corrective exercises, the results will be diminished by improper bracing strategies, as mentioned earlier. However, unlike the other groups, a voluntary clencher will easily be guided on how to properly perform the exercises as well as how to react to your MMT pressure. The competitive, voluntary type clencher is usually male.
The key here is awareness. Actually, awareness is the key for all of these groups, but the competitor-type individual will easily adapt to guidance and easily feel when they’re doing it right or wrong. If you ask them “did you clench your whole body?” they’ll confirm it and usually stop doing it on their own, if you let them know that it’s not appropriate.
How I first identified clenching strategies
I have touched on this already, and also in other articles, but after I started using MMT in my practice, I quickly discovered a relatively rigid pattern where muscles that were painful, also were weak. They could be tight, they could be big, they could be small, but they were virtually always weak. And, rehabilitating these muscles with proper exercises resolved the pain permanently in the great majority of occasions.
However, I had a few difficult patients where everything happened to be up-side down. The non-painful sides were weak, but the painful sides seemed strong. I scratched my head over this for several months. I tried to release those muscles, no results. I tried to strengthen them, no results. I simply could not help these patients with my then current approach!
Eventually as my therapeutic experience grew, these handful of patients were starting to really bother me. All my other patients were getting better, but these ones were marginally improving, if at all. I knew that the muscles were weak even though they seemed strong, although I didn’t understand why. The exercises they were using didn’t improve the condition at all. WHAT COULD BE THE PROBLEM?
It all changed when I got a patient whose compensation pattern, i.e his clenching strategy, was extremely obvious. I could literally see how he braced ALL of his body reflexively for just about anything. And this compensation was more obvious when testing weaker structures, yet less obvious on muscles that were functioning better and had a greater strength. This patient was very open about his emotional struggles, and fits with many of the traits I described above in the GICS section.
After this, I started noticing the same pattern in other, more subtle compensators. They were subtle clenchers! No wonder I had not discovered the compensation, because they were so good at this “cheating” strategy that no jerking movement could be observed what so ever. The only thing that separated these from a normal group, i.e a normal strong and functional muscle test, was that “something didn’t quite feel right” or “didn’t quite make sense”. Women are especially subtle and difficult to assess for this dysfunction. Even now, after I’ve worked with this for quite some time, I have to ask “did you clench your whole body?”, especially when assessing women, if something doesn’t quite add up.
GICS makes pain science make more sense
I strongly consider myself a “structuralist”, using logical mechanical approaches in my treatment approaches, as is evident in all other articles that I’ve written. Extremists within the psychososcial pain theory community claim that there is no correlation between structure and pain at all, which I consider to be utter nonsense. However, there are a lot of studies, especially statistical studies that show strong correlation between psychosocial factors and pain. Logically, all of these can’t just be made up – there has to be something to it. Maybe a golden middle way, or perhaps some important nuances?
Seeing a lot of different patients, and most of them having poor posture and issues correlating with this, I can truthfully say that posture is NOT what separates people with a lot of issues from those who do not. It is their clenching. People who clench a lot, in my experience, they get a lot of problems. Nerve pain seems to be the most common denominator for clenchers. Thoracic outlet syndrome, lumbar plexus compression syndrome, and similar “syndromes” are very prevalent in the GICS group. I am seeing 20 year-olds with global nerve pain issues. 20 year-olds! And even though they generally do have poor posture, other patients with the same postures or even worse postures, do not have the global maladies, often presented as nerve pain, as these patients do.
Therefore, I propose the notion that clenching syndromes may be the real culprit and cause of correlation between musculoskeletal problems, especially chronic ones, and the statistically significant psychosocial aspects that many studies are pointing out.
How to identify GICS and other clenching strategies
For now, the only way that I’ve managed to identify improper clenching strategies, and especially distinguishing between the different types, is by using muscle testing. Muscle testing is a skill and takes time to develop; and unfortunately the lacking concrete criteria of identifying GICS does not make it any easier. Detecting GICS and similar issues may therefore prove difficult for some, so don’t expect to identify these things without spending a lot of time doing MMTs on a great variety of people.
Either way, let me tell you how I do it: Let’s say a person has greater trochanter bursitis, which, for your information, is almost always caused by weakness of the tensor fascia latae muscle. So, the first natural thing to do would be to assess this muscle, for example with a muscle test. But, the test will falsely show that the muscle is very strong, due to bracing. Most therapists will then go on to release it, but we are NOT going to do that, because the likelihood of this muscle actually being strong and functional is close to zero if there’s trochanteric bursitis present. So we ask the patient: “are you clenching your whole body?”, most of the time they’ll admit that yes, they did, but sometimes they won’t.
You retry the test, and if it’s now weak, that could either mean that they don’t know how to NOT clench, or that they’re just not a GICS-type clencher. If it’s still super strong, ask them again to meet your pressure naturally. If they simply “get” what you’re saying, and calm down the clenching without much instruction, it’s probably just competitiveness. If this goes back and forth a few times, however, and the patient isn’t able to activate the muscle without clenching the whole body or regional complex, or nothing at all, then you can proceed to test other muscles unrelated to the injury. If the patient is able to perform elbow or shoulder flexion and extension, for example, without any clenching, then it’s probably a protective strategy that’s going on with the hip complex. If, however, the clenching persists instinctively no matter where you perform your muscle test, then this is most likely a GICS type patient.
If your patient presents with neuralgic issues that are seemingly not disc related, always consider GICS. I have not once seen a patient with lumbar plexus compression syndrome, for example, who did not have GICS. I have however, seen a couple of patients with thoracic outlet syndrome (articles addressing both issues are linked further up) who did not, due to the slightly more multifactoral nature of its aetiology (e.g clavicular depression in posture). That said, myofascial nerve entrapment (MFNE) syndromes such as the before-mentioned are the often epitome signs of GICS.
Unfortunately both GICS and MFNE are relatively difficult to diagnose and will be missed by most therapists, but it’s important to know about these things in order to gradually increase awareness with regards to its existence.
What to do about chronic muscle clenching
Chronic muscle clenching, especially GICS, is a significant dysfunction that mandates neuromuscular reconfiguration, to use such a term. I consider GICS (especially) so severe that it must be addressed and altered.
Awareness is the key.
Once the therapist (or, rare, patient him- or herself) has identified a clenching pattern, the patient will need to be aware of this when performing corrective exercises and whatever other situations where this may be important. This applies to GICS, competitiveness and to protective bracing strategies.
For GICS, however, the bracing doesn’t stop at exercises or similar issues. It’s constant. The patient has to be aware of their habit by first learning that they do it, and then how to not do it. This is done by performing muscle tests on them again and again and again until they’re able to attempt to resist your pressure naturally without clenching. I say attempt because they won’t be able to resist you, but they should be able to attempt it , and they should be able to distinguish somewhat between clenching and non-clenching resistance. In the beginning, they’ll have no clue that they are clenching, nor what they are supposed to feel, nor how not to clench. It takes a lot of repetitive work to get them to feel the difference, because this is the key. It takes a lot of work.
They can’t work on something they do not feel.
Once a GICS patient feels the difference between clenching and non clenching (it doesn’t matter whether they’re able to exert true force or not, at this point), they’ll be able to identify when they’re doing it in daily life, and thus also to stop it. They’ll feel weak, they’ll feel that they aren’t able to use their potential, but that’s fine. It takes time to get rid of a dysfunctional habit that’s been active for 10-20-30-40 years. Patience! Keep up the great work.
A little story
A friend came into my clinic with forearm pain. He also had a long history of other issues, such as hamstrings, back, shoulder, etc. He was very strong (deadlifting nearly 300 kgs / 660 lbs), and had been exercising for many years. But, he kept getting injured, continuously. Any other person would have stopped training for all the injuries, but not this stubborn guy. He had spent thousands of dollars on treatments prior to seeing me, to be able to keep training.
Anyway, this time it was forearm pain. I had treated him for other issues prior to this, but relatively good results, but as I said, there was always something more, or recurring. There was some time since I had seen him, actually, the last time was before I started noticing these clenching habits with other clients. Upon the visit, I finally noticed that he turned out to be a clencher as well; no big surprise, considering his extensive injury history. I told him that he was clenching and that this had to stop. He was surprised and a little doubtful – “I am not clenching”, he said. “At least I can not feel that I am doing it!”. I told him some stories of other people, that he seemed to be the same type, and that I wanted him to start paying attention to his clenching habits. We did some muscles tests back and forth until he started to feel what I was talking about.
By the way, this guy is very busy, runs several businesses and has lots of responsibility. A relatively common trait for GICS-ers.
About three weeks later he sent me an SMS. He told me that he had noticed how he, during daytime at his desk job, was clenching his quadriceps muscles CONSTANTLY throughout ALL THE DAY. He had never noticed this before. Later on, he noticed more and more patterns, and after this, I didn’t see him for an injury for a long time.
Chronic muscle clenching (syndrome?) is in my view quite a pathological habit. This applies especially to GICS; global involuntary clenching strategies, but may also apply to the lesser versions (protective clenching & competitive clenching) in the right circumstances, if undetected and unaddressed.
GICS often affects highly stressed or worrisome people, perhaps also those who has been through difficult situations in the past, and involves inability to exert force without clenching the whole body or a regional complex. Protective bracing, however, is usually developed as a strategy to cope with pain or instability. Competitive bracing is relatively self-explanatory, but it involves bracing the body in order to gain more strength, increasing the odds to “win” at whatever is being attempted.
The primary treatment for GICS and similar clenching strategies is awareness. The patient has to become aware of their habit, what it feels like doing it as well as not doing it, and then stop it whenever they notice it happening, especially in daily life. Powerlifting or similar high intensity training that promotes a lot of clenching and bracing, is not a great hobby for someone that struggles with GICS. They need slower, more careful exercising until they are able to greatly diminish their clenching habits.
Finally, clenching “syndromes” are something very diffuse and diffcult to pinpoint. Identifying this deeply rooted dysfunction was – without any doubt – a missing link in my treatment protocol, and a very important tool to have in the toolbox. It helped me to finally understand why some people were not responding to exercises and approaches that had great results on other patients with the same kind of complaints (e.g quadratus lumborum pain, which is a synergist in respiration). I truly believe that GICS is a huge driver of dysfunction, and I hope that this article, although somewhat obscure and esoteric, has shed some light on it as well as a provide a possible approach f0r identification and resolution.