Muscle Balance

OVERVIEW

This section emphasizes the wide-ranging involvement that AMS can have upon the body. What originally begins as a local restriction of muscle function is allowed to escalate (through lack of stretching) into a multiple-joint pain syndrome, resulting as the body attempts to restore it's center of gravity in compensation for limited motion at a distant joint.

ANALYSIS OF THE "HUNCHBACK" POSTURE

Figure MD1 depicts the efficiency of maintaining correct posture

The figure on the left demonstrates the "sway-back" posture, which is related to shortening of the hip musculature in conjunction with weakness in the abdominal musculature. In an effort to retain the center of gravity and to maintain good balance, a substitution is instituted: the shoulders are posteriorly displaced. Unfortunately, this substitution will only result in compromised joint, vascular and nerve function as time passes. The figure on the right demonstrates correct posture: vertical alignment is achieved through normal muscle tone (strength and flexibility are "balanced" throughout the body; no substitutions are required).

The "hunch-back" posture is commonly seen amongst the elderly. While osteoporosis can certainly magnify postural faults, the primary cause of "hunch- back" is muscle imbalance. Inevitably, the upper back muscles are found to be weak, the chest muscles are stronger and in a shortened position, pulling the head and shoulder girdles forward, with a tendency to compress nerves in the neck. We can expect to find shortening of the hip flexor muscles (muscles on the front of the hip that bring the thigh forward) because these individuals usually tend to spend a great deal of time sitting. While many elderly patients take immediate rebuttal to the latter statement, advising that they are quite active, the reality is that while they are running about for several minutes at a time they are actually sitting for several hours each day.

Since postural faults are additive over time, at some point sufficient muscle shortening occurs to create functional restriction(s). This is analogous to a civil war era cemetery. The more recent tombstones from the 1950s are upright, those from the 20s are beginning to lean, and the ones from the 1870s have assumed an acute angle, all due to the force of gravity, once they were dislodged slightly from true vertical alignment. And achieving correct vertical alignment must be our goal if we are to become maximally effective during the course of our physical activities. There is a huge amount of strain placed upon a back by painting a room when the hip muscles are so shortened that one can't stand straight, but remains bent at the hips. As postural faults and muscle and joint pain syndromes accumulate over time, even a small deviation can produce pain symptoms when a faulty posture is maintained for any significant amount of time. When you have shortened muscles, one wrong move can literally be "the straw that broke the camel's back".

MYOFASCIAL DYSFUNCTION IS RELATED TO LONG-STANDING MUSCLE IMBALANCES OF STRENGTH AND FLEXIBILITY
The figure on the left depicts how the denser connective tissue known as fascia separates the major muscle groups into separate compartments. Here the thigh is given as an example. This intricate myofascial system provides stability to the body and acts to conserve energy (when posture is correct). When poor postural habits exist over a period of time, first muscle imbalances of strength and flexibility occur, then semi-permanent changes occur in the fascial system, which due to its resilience tends to trap the subject in the faulty posture until corrective exercises are instituted. Muscle balance applies to athletes in particular. I have often observed weight-lifters develop muscle imbalances because they neglected to perform an equal number of sets for opposing muscle groups, or because the had muscle imbalances before going to the gym, then magnified these imbalances by performing heavier work with muscle s that were already shortened. For example, there is an inherent tendency for many individuals to over-develop the pectoral (chest) or quadriceps (frontal thigh) musculature, because this musculature is naturally larger than its antagonists, and many can relate to having a desire to wanting a bigger chest and large muscular thighs. But such preferential training will tend to create muscle imbalances resulting in "hunch-back", with weakening of the upper back, and a tendency to hyperextend the knee joint during running and kicking activities, placing extraneous forces upon the knee and upper back ligaments, because respectively the chest and the abdominals, and the hamstrings (posterior thigh musculature, antagonists to the quadriceps) remain relatively weak.
 

CAT AND MRI SCANS USUALLY PRODUCE NEGATIVE FINDINGS WHEN AMS IS INVOLVED

Many patients have been perplexed that expensive testing procedures like the CAT and MRI scans have produced negative results. In these cases, careful evaluation by a physical therapist will usually detect a seemingly minor rotation of a spinal vertebrae that was not detected by the scanner. This is commonplace. Stretching exercises increase the joint space and resolve pain symptoms. Another elusive source of muscle and joint pain is when posture becomes faulty during the increased demands of athletic and occupational activities, due to muscle shortening. For example, observing the patient at rest or standing fails to provide information that when they use stairs their shortened thigh musculature creates excessive movement of the pelvis, resulting in low back strain and pain. Since X- rays and scans observe the patient at rest, the failure to maintain correct dynamic posture is frequently overlooked.
 
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site last updated on February 11, 2010 by Paul J. Fransen, P.T.

 

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