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Muscle Imbalance Syndromes and What They Mean to Physical Therapy Patients

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.

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