Stretching. We really need to have a word.
For something so universally done in MSK it's become white noise. Patient says "ooh I feel tight," physio tells them to stretch it, the clinic director high-fives everyone and off we go. The whole thing runs on autopilot and almost nobody stops to ask the only question that matters: why is it tight in the first place?
Simple. Clinical. Reasoning.
Most of the time it isn't a length problem. It's protection. It's a body putting bouncers on the door because something doesn't feel right. Instead of understanding that, we try to force our way past it. Stretch, hold the magic 30 seconds, repeat and hope.
But stretching doesn't meaningfully lengthen muscle in the way it's been sold.
What it mostly does is change tolerance. The tissue isn't suddenly longer. The conversation with the nervous system is just different. That's why people feel looser for a bit and then it comes straight back. Nothing upstream has actually changed.
And if we're honest, we've all seen how easy it is to "prove" progress. A few degrees appear on a 1980s goniometer depending on who's holding it and how they line it up and suddenly the plan looks justified. The patient might feel exactly the same but the number has moved, so we call it improvement and carry on.
Here's the embarrassing bit: if you genuinely need to lengthen tissue in MSK, you're already at the edges of practice. Post-op stiffness, trauma, something left to drift for a long time. That's when stretching has a real job to do. But that is not what most clinics are dealing with day in, day out.
What you are dealing with is protective stiffness and handing out stretching for that isn't clinical reasoning. It's culture. It's easy, it's expected and it scales. Which is exactly why it survives.
If you're leading a clinical business where that's still the norm, this isn't just about individual therapists making poor choices. This is what happens when businesses are built without enough clinical depth. Inexperience gets dressed up with a title, thinking gets replaced by templates and "passable" quietly becomes the model.
Or keep stretching it. We both know how this ends.