Diablo Physical Therapy & Sports Medicine

Muscle Imbalance Syndromes and What They Mean to Physical Therapy Patients

Thu, 10 Jan 2019 21:09:04 GMT

Your body has hundreds of skeletal muscles responsible for moving your bones and maintaining your posture as well as smooth and cardiac muscles, which perform other functions. Your skeletal muscles cause movement by contracting and relaxing. They work in conjunction with other muscles; when in balance, movement and joint function work as expected. When they are not in balance, long-term pain and joint degeneration can appear.

The late Dr. Vladimir Janda was a Czechoslovakian neurologist and physiatrist who pioneered the evaluation and treatment of chronic musculoskeletal pain and the central nervous system’s role in mediating that pain. Janda’s approach is based on the premise that the musculoskeletal and central nervous systems are interdependent upon one another — that when one part of the body is affected or injured, the body attempts to compensate in other areas.

Dr. Janda identified several patterns of muscle imbalances:

Upper crossed syndrome

In upper crossed syndrome, the upper trapezius, elevator, sternocleidomastoid, and pectorals muscles are facilitated while the deep cervical flexors, lower trapezius, and serratus anterior are inhibited.

What this means: Patients with upper crossed syndrome have tight chest, neck, and shoulder muscles and weak upper and mid-back muscles. They also tend to have neck and upper back pain, hunched shoulders, and a forward-leaning head.

Lower crossed syndrome

In lower crossed syndrome, the thoraco-lumbar extensors, rectus femoris, and iliopsoas are facilitated while the transversus abdominus and the gluteal muscles are inhibited.

What this means: In patients with lower crossed syndrome, tight hip flexors and a tight lower back result in weak abdominal and gluteal muscles, an exaggerated lower back arch, and lower back pain.

Layer syndrome

In layer syndrome, a combination of upper and lower crossed syndromes are present, showing alternating patterns of tightness and weakness.

What this means: Since both upper and lower crossed syndromes are present, patients with layer syndrome exhibit characteristics and experience symptoms of both.

Common Causes of Muscle Imbalance

The two recognized causes of muscle imbalance are biomechanical and neuromuscular. Biomechanical imbalances are caused by repetitive motions or sustained postures.

Neuromuscular imbalances are associated with the movement patterns that evolve from birth and the predisposition of muscles to be either tight or weak. Dr. Janda noticed that certain types of skeletal muscles were neurologically predisposed to tightness (tonic muscles) or weakness (phasic muscles) with the tonic muscles tending to be more spastic and the phasic muscles tending to be more flaccid.

Examples of biomechanical imbalances include:

Repetitive motion — With repetitive movements or overuse, muscles can remain in a state of semi-contraction, which can affect joint position and cause an imbalance.
Sedentary, seated positions — Sitting for extended time periods tightens and shortens the hip flexors, which affects hip joint movement and reduces the activity of the gluteus maximus.
Poor posture — Slouching can shorten your shoulder muscles while lengthening the muscles in the upper back.
High heeled shoes — High heels can cause imbalances throughout the body including the feet, lower leg, knee, thigh, hips, spine, and shoulder. They can change the knee’s position, which affects the thigh, hips, spine and shoulder.
Improper exercise techniques — Exercising using a limited path of motion can cause muscle imbalances and overuse.

How Physical Therapists Assess and Treat Muscle Imbalance

We start by observing your posture, gait, and overall flexibility and assessing the range of motion of your joints. Depending on the nature of the condition, x-rays, ultrasounds, or MRI results may also be reviewed. Typical treatments of muscle imbalance syndromes include strengthening exercises, repetitive drills, stretching, massage, and ice or heat therapy.

Here at Diablo Physical Therapy, I see patients with a wide range of biomechanical and neuromuscular imbalances with repetitive motion / overuse injuries being extremely common. I also see a lot of patients with low back pain, consistently finding the same tight and weak muscle patterns as Dr. Janda described. Treating these imbalance patterns has a huge effect on how their backs feel.

The human body attempts to compensate for changes to itself, often overdoing it as a result. If you’re experiencing chronic muscle or joint pain, an evaluation by a physical therapist is in order to uncover the cause and help you back on the path to wellness.

About the Author

John Barman

John Barman is a co-founder of Diablo Physical Therapy and specializes in orthopedic and sports-related injuries, with an emphasis on biomechanics. As a long distance runner, cyclist, and seasoned physical therapist John understands the rigors of these sports on the body. Request a session with John by contacting our Menlo Park location for an appointment.

Physical Therapy Month – A Safe Alternative to Opioids

Tue, 16 Oct 2018 01:32:00 GMT

You probably know that October is National Breast Cancer Awareness Month, but did you know that October is also National Physical Therapy Month? Both campaigns have important messages to share. In our case, National Physical Therapy Month is all about raising the awareness of physical therapy as a safe and effective alternative to opioids for treating chronic pain conditions.

This is important for two reasons:

Let’s talk about side effects. The major side effects of opioids include: addiction, withdrawal, overdose, death, depression, and family/work problems related to addiction. The side effects of physical therapy include: decreased pain, improved mobility and balance, and prevention of other health problems.

Physical Therapy for Chronic Pain Conditions

Chronic conditions such as fibromyalgia, low back pain, and hip and knee osteoarthritis can all be managed via physical therapy. Here’s a quick look at each:

If you’re suffering from a chronic condition that causes pain, I hope you’ll join me in celebrating National Physical Therapy Month. Pain management is evolving. Let’s work together to better manage your condition and alleviate its pain through physical therapy. Call Diablo Physical Therapy and Sports Medicine to schedule an evaluation.

America is facing an epidemic of opioid misuse and abuse. According to the National Institute on Drug Abuse, more than 115 people die every day in America from an overdose of opioids. More than 1,000 people per day are treated for misusing them. Think it can’t possibly happen to you? Between 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. That’s nearly one third! These drugs are highly addictive. This is a huge national health crisis that came about when pharmaceutical companies marketed opioids as safe and non-addictive. We know better now, but opioids are still being prescribed for chronic pain at an alarming rate. The Centers for Disease Control (CDC) says that in 2016, health care providers wrote 214 million prescriptions for opioid pain medication.
If you’re in pain, you want pain relief, right? If the pain is bad enough, you may even want a quick fix in the form of a pill. Anything to make the pain go away. I get it, but there’s a better way. Physical therapy is much safer than prescription opioid pain relievers, and it’s both non-invasive and effective at treating pain. Physical therapists work to discover and treat the cause of your pain while opioids merely mask it. In fact, the CDC recommends physical therapy as a safer alternative to pain than doctor-prescribed opioids.

Fibromyalgia — Nearly 5 million people in the United States suffer from this condition, with 80-90 percent of them being women. There’s no cure, but fibromyalgia-related pain, mobility, and range of motion issues can be managed via physical therapy. Opioids will only mask the pain and put you at risk of addiction.
Low back pain — Consistently, about 25 percent of people in the US have suffered from low back pain in the last three months, and about 61 percent of back pain patients receive prescription opioids for their pain. Meanwhile, opioids are largely ineffective at treating low back pain. Physical therapy can help to reduce the pain as well as improve or restore mobility.
Hip and knee osteoarthritis — These conditions are painful and may require a complete joint replacement surgery. In some cases, carefully supervised prescription opioids may be appropriate, but they bring the risks we’ve discussed earlier. Physical therapy is crucial in treating these conditions before and after surgery. Your treatment program will be personalized to address your specific condition and goals.

About the Author

Dara Richman

Dara Richman specializes in Orthopedics and Sports Medicine here at Diablo PT. As an avid athlete herself, she understands the desire to stay in peak performance. When she’s not working with patients, you’ll likely find her racing mountain bikes. Request a session with Dara by contacting our Danville location for an appointment.

How to Treat a Sprained Ankle with Physical Therapy

Thu, 27 Sep 2018 04:25:00 GMT

We’ve all twisted our ankles before. Sprained ankles typically result when the foot rolls onto the ankle, stretching or even tearing the ligaments. Ankle sprains are a common sports injury, but they can also happen when walking, jumping, or running.

The extent of the sprain affects pain, ankle stability, and recovery time. For example, a grade I ankle sprain, while tender, has minimal ligament damage and little loss of function. Recovery typically lasts a week or two. On the other hand, a grade III ankle sprain involves completely torn ligaments. The ankle joint is unstable, and recovery can last up to six or more months.

While many of us have suffered through a sprained ankle by icing it and giving it time, minor-to-severe ankle sprains require proper treatment and rehab. This is important not just for your immediate recovery but also for your future. Without treatment, ankle sprains can weaken the joint and contribute to future injuries, which in turn, can lead to long-term complications such as ongoing instability, chronic pain, or arthritis.

Recovering from an Ankle Sprain

Minor sprains have traditionally been treated with rest, ice packs, propping up your ankle, and avoiding putting weight on it for a while. For more severe sprains, physical therapy is usually prescribed. However, more and more evidence shows that even grade I sprains can benefit from physical therapy. Regardless of severity, if you’ve recently sprained your ankle, come in and get it evaluated.

That’s where we come in — and the sooner the better. Here’s why: Early treatment is important to prevent other injuries in other areas later on. Seeking physical therapy now gets you on the path to recovery faster, helping you to recover from an ankle sprain without compromising other parts of your body.

So, what will we work on in physical therapy for a sprained ankle?

Preventing Ankle Sprains

During our physical therapy sessions, I recommend balance exercises and stretches that should be done before and after athletic activities. You’ll also want to continue strengthening your feet and legs, wear appropriate footwear, avoid sudden and sharp changes in direction, and watch the surface you’re walking, running, or jumping on.

Because there’s a high incidence of ankle sprains with certain contact sports and running, I often recommend “prehab,” which is a type of physical therapy used to prevent injury in the first place. This therapy can also help reduce pain from a current injury, or prepare for a smoother post-op recovery. For athletes in ankle sprain-prone sports, prehab — training in the off season — may be helpful in preventing sprains and improving recovery times should one occur.

Since many sprains are more than a simple twisted ankle, it’s important to seek appropriate care. Physical therapy can be an effective treatment tool to help get you back on your feet and prevent future injury. So keep pushing towards your goals, and don’t let a sprained ankle slow your progress.

Balance and proprioception — You probably know what balance is (your ability to stay upright) but proprioception might be new to you. Proprioception is your body’s ability to sense where it is in relation to the environment. Balance and proprioception assessments and exercises are important to regain proper ankle function and prevent future recurrences.
Strength — It’s tempting to rely on braces or shoes for support, but what happens once you no longer have that external support? Wouldn’t you rather have built-in support? Building your strength is key. Strengthening everything above the ankle including your hips and glutes will help to better position the foot and ankle.

About the Author

Dara Richman

New Golf Performance Program

Fri, 13 Jul 2018 04:22:00 GMT

Maximize your golf potential and performance with today’s most comprehensive and golf specific training techniques. Utilizing our expertise in assessing the biomechanical deficits limiting the ability to optimize the golf swing combined with a golf specific fitness assessment, we are able to customize a golf performance program.

Note: this service is only available at our Menlo Park location.

New Alter-G Treadmill

Wed, 11 Jul 2018 04:27:00 GMT

We have the treadmill that lets you take up to 80% of your body weight off!!!! If you are looking to train, lose weight, or return from an injury….this is for you. Come in for a trial.