Muscle imbalance

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Muscle imbalance
Agonist en antagonist.jpg
Muscle imbalance is an imbalance between agonist and antagonist muscles.

Muscle balance is necessary for muscles to perform their customary roles and move normally; muscle imbalance occurs when there is a lack of parity between corresponding agonist and antagonist muscles. [1] Muscular imbalance can also arise when a muscle performs outside of its normal physiological muscle function. [2] [3]

Contents

Muscles are considered balanced when the muscles that surround a joint work together harmoniously, i.e. with appropriate opposing force, to keep the bones aligned where they meet at the joint. This permits normal human movement. [3]

Muscles can be categorized as either functional or pathological. Muscle imbalance can be caused either by adaptation of a functional muscle or by dysfunction in a muscle suffering a pathology.

Symptoms

Classic symptoms of muscle imbalances are usually pain associated with the affected joint. [1] Symptoms can vary depending on what stage their muscular imbalance is, functional or pathological, but commonly exhibit small tissue damage or lesions accompanied by a change in muscle movement patterns. [1] Symptoms may occur after injury or surgery, where the recuperation of the joint affected is left untreated causing either tension or restriction to flexibility and strength of the prime movers. [2]

Tennis elbow

This shows an example of the repetitive movement that may cause tennis elbow. Tenniselbow.JPG
This shows an example of the repetitive movement that may cause tennis elbow.

Tennis elbow is the most common elbow problem among athletes, highly associated with world class tennis players, it is a condition that involves the common wrist extensor origin, in particular the origin of extensor carpi radialis. [4] The causes for tennis elbow includes any activity, not only tennis, where the repetitive use of the extensor muscles of the forearm may cause acute or chronic tendonitis of the tensinous insertion of these muscles at the lateral epicondyle of the elbow. [5] The condition itself is most common with painters, plumbers, and carpenters. Further studied have shown that auto-workers, butchers and cooks also get tennis elbow more often than the rest of the population. [5]

Lazy eye

Strabismus, an ocular condition that prevents both eyes simultaneously focusing on the same point Strabismus.jpg
Strabismus, an ocular condition that prevents both eyes simultaneously focusing on the same point

Lazy eye, in particular strabismus may be the result of coordination between the extraocular muscles, which prevents a person on directing both eyes in unison towards the same fixation point. [6] The main cause of strabismus is usually the muscular imbalance of the six surrounding muscles that allow both eyes to focus on the same object. [7] As each eye does not have the same focus, different images are sent to the brain, confusing it, resulting in the brain ignoring the image from the weaker eye and if left untreated will cause a loss of vision in the ignored eye called amblyopia. [7] Further symptoms of strabismus include decreased vision, double vision, headaches, asthenopia and eye fatigue. [6]

Scoliosis

An ex-ray of a spine affected by scoliosis belonging to a 15 year old Scoliosis (15-year-old).jpg
An ex-ray of a spine affected by scoliosis belonging to a 15 year old

Scoliosis, is a medical condition where a person's spine has several irregular curves that are located between the neck and the pelvis. [8] Symptoms of scoliosis in mild cases usually exhibit abnormal posture, back pain, tingling or numbness in the legs and in worse cases can exhibit breathing problems, fatigue, permanent deformities and in rare cases heart problems. [8]

Functional and pathological muscle imbalance

Functional imbalance

Functional Imbalances are when the muscles adapt in response for detailed muscle movement patterns, including unequal values in strength or flexibility of antagonistic muscle groups, usually apparent in athletes of different sports ranging from soccer to baseball. [1] This type of imbalance is the first stage, it is painless, atraumatic (causes minimal tissue injury [9] ), adaptive to change and activity specific. [1] Studies confirm this as they find the link between muscle imbalance and athletes who perform at elite levels, this also relates to injury occurrence is not treated to muscle specific rehabilitation. [10]

Pathological imbalance

Pathological muscle imbalance occurs when the imbalance of the muscles begin to inhibit function. [1] This pathological muscle imbalance may or may not result from a traumatic event, it is usually associated with pain and dysfunction, although there are cases where pain is not apparent, however pathological muscle imbalances ultimately lead to joint dysfunction and changes in normative muscle movement patterns. [1] It would be good to note that this imbalance can progress to either tissue damage and pain or altered movement pattern, with the constant being tightness or weakness. [1] A study has shown that athletes that exhibit shoulder pain have been linked to have decreased rotator cuff muscle strength and have concluded that they are more susceptible to rotator cuff tears and type II superior labrum anterior and posterior lesions. [11]

Diagnosis

Muscle imbalance can be characterized by different factors, namely where the muscle imbalance is on the body, diagnosis varies for these specific areas as each area needs to be handled differently. Other signs include joint pain or muscular pain, abnormal joint movement patterns or in some cases, muscle tears and lesions. [11] It can be diagnosed by demonstrating any one of the following:

Treatment

Although treatment for tennis elbow prior 2010 was unknown because the etiology remained unclear, tests confirmed that the cause was an imbalance with the agonist-antagonist functional relationship. [4] [13] Treatment now includes anti-inflammatory medicines, rest, equipment check, physical therapy, braces, steroid injections, shock wave therapy and if symptoms persist after 6 to 12 months, doctors may recommend surgery. [5]

Although treatment varies depending on how bad eye alignment is and also the underlying causes of strabismus. [14] Treatment for strabismus may include orthoptics a term used for eye muscle training, this treatment can be provided by orthoptists and also optometrists. [15] Other treatment may include wearing eye patches aimed at strengthening the weaker eye while inhibiting the stronger eye, an alternative to eye patches is the use of an opaque lens, other treatments may include eye drops to temporarily inhibit the stronger eye and at any age eye muscle surgery can be done to correct the muscular balance of the ocular muscles. [7] [14] [16]

Although the cause of scoliosis can sometimes remain unknown (idiopathic scoliosis) there is treatment available that targets at strengthening the back muscles, for milder cases usually do not require medical attention, more severe cases require either muscle strengthening exercises aimed at the back muscles and even special back braces or surgery can be recommended if the case is extreme. [8] Studies have shown that treatment with a special back brace among children ranging from 10–16 years can be successful and using this method of muscle training scoliosis can be cured with non-surgical treatment. [17]

Prognosis

In terms of selective muscle weakness or poor flexibility muscular imbalance is frequently regarded as an etiological factor in the onset of musculoskeletal disorders. [2] There are a variety of areas that can be affected, each causing different symptoms hence there are also different treatments available, but in general cases muscle strengthening techniques were developed for the use on the weak or tight muscles. [18]

History

For a long time muscular imbalance had many different theories that revolved around it. It wasn't until 1949 when there was a first manual on muscle testing appeared, written by therapists Henry and Florence Kendall, which discusses muscle weakness in polio patients and treatments approaching tight and weak muscles. [18]

In the 1960s Dr. George Goodheart and Dr. Vladimir Janda each took their own paths in treating patients with muscular imbalance, Goodheart focusing on muscle weakness being the primary cause of muscle imbalance, whilst Janda took on the muscle tightness approach, both developed a large following that continues on today. [1]

Controversies

There is evidence to support two different approaches to muscular imbalance, the first is a biomechanical approach that believed the cause was due from repeated movements in one direction or sustained postures, this was widespread by Kendall. The second is a neuromuscular imbalance due to certain muscle groups being tight or weak, popularized by Janda this approach is based on movement patterns that evolve from birth. [3] Today there are many different types of therapists who treat muscle imbalance, these include chiropractors, osteopaths, physical therapists, medical doctors and massage therapists each assessing tightness or weakness as the primary cause of muscular imbalance. [18]

Related Research Articles

<span class="mw-page-title-main">Charcot–Marie–Tooth disease</span> Neuromuscular disease

Charcot–Marie–Tooth disease (CMT) is a hereditary motor and sensory neuropathy of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. This disease is the most commonly inherited neurological disorder, affecting about one in 2,500 people. It is named after those who classically described it: the Frenchman Jean-Martin Charcot (1825–1893), his pupil Pierre Marie (1853–1940), and the Briton Howard Henry Tooth (1856–1925).

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. The extensor carpi ulnaris acts to extend and adduct at the carpus/wrist from anatomical position.

<span class="mw-page-title-main">Kyphosis</span> Medical condition

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis. It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease, osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.

<span class="mw-page-title-main">Bursitis</span> Human disease

Bursitis is the inflammation of one or more bursae of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

<span class="mw-page-title-main">Cervical spine disorder</span> Medical condition

Cervical spine disorders are illnesses that affect the cervical spine, which is made up of the upper first seven vertebrae, encasing and shielding the spinal cord. This fragment of the spine starts from the region above the shoulder blades and ends by supporting and connecting the skull.

<span class="mw-page-title-main">Arthrogryposis</span> Medical condition

Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning 'curving of joints'.

<span class="mw-page-title-main">Diplopia</span> Double vision

Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occurring involuntarily, it results in impaired function of the extraocular muscles, where both eyes are still functional, but they cannot turn to target the desired object. Problems with these muscles may be due to mechanical problems, disorders of the neuromuscular junction, disorders of the cranial nerves that innervate the muscles, and occasionally disorders involving the supranuclear oculomotor pathways or ingestion of toxins.

<span class="mw-page-title-main">Lordosis</span> Medical condition

Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spine. Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacral regions is also termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos.

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<span class="mw-page-title-main">Quadratus lumborum muscle</span> Muscle in the lower back

The quadratus lumborum muscle, informally called the QL, is a paired muscle of the left and right posterior abdominal wall. It is the deepest abdominal muscle, and commonly referred to as a back muscle. Each is irregular and quadrilateral in shape.

<span class="mw-page-title-main">Hypermobility (joints)</span> Human condition: joints that stretch further than normal

Hypermobility, also known as double-jointedness, describes joints that stretch farther than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or perform other contortionist "tricks". It can affect one or more joints throughout the body.

<span class="mw-page-title-main">Congenital muscular dystrophy</span> Medical condition

Congenital muscular dystrophies are autosomal recessively-inherited muscle diseases. They are a group of heterogeneous disorders characterized by muscle weakness which is present at birth and the different changes on muscle biopsy that ranges from myopathic to overtly dystrophic due to the age at which the biopsy takes place.

Congenital myopathy is a very broad term for any muscle disorder present at birth. This defect primarily affects skeletal muscle fibres and causes muscular weakness and/or hypotonia. Congenital myopathies account for one of the top neuromuscular disorders in the world today, comprising approximately 6 in 100,000 live births every year. As a whole, congenital myopathies can be broadly classified as follows:

<span class="mw-page-title-main">Bethlem myopathy</span> Medical condition

Bethlem myopathy is predominantly an autosomal dominant myopathy, classified as a congenital form of muscular dystrophy. There are two forms of Bethlem myopathy.

<span class="mw-page-title-main">Ulnar nerve entrapment</span> Medical condition

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification, and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates forelimb plus joint is used.

<span class="mw-page-title-main">Shoulder impingement syndrome</span> Medical condition

Shoulder impingement syndrome is a syndrome involving tendonitis of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder.

<span class="mw-page-title-main">Orthotics</span> Medical specialty that focuses on the building and designing of artificial legs

Orthotics is a medical specialty that focuses on the design and application of orthoses, or braces. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Muscle strain is one of the most common injuries in tennis. When an isolated large-energy appears during the muscle contraction and at the same time, bodyweight applies huge amounts of pressure to the lengthened muscle, which can result in the occurrence of muscle strain. Inflammation and bleeding are triggered when muscle strain occur which resulted in redness, pain and swelling. Overuse is also common in tennis players from all levels. Muscle, cartilage, nerves, bursae, ligaments and tendons may be damaged from overuse. The repetitive use of a particular muscle without time for repair and recover in the most common case among the injury.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics. ISBN   9781450408288.
  2. 1 2 3 A., Schlumberger; W., Laube; S., Bruhn; B., Herbeck; M., Dahlinger; G., Fenkart; D., Schmidtbleicher; F., Mayer (1 January 2006). "Muscle imbalances – fact or fiction?". Isokinetics and Exercise Science. 14 (1): 3–11. doi:10.3233/IES-2006-0229.
  3. 1 2 3 "What is Muscle Imbalance". www.muscleimbalancesyndromes.com. Retrieved 2015-08-31.
  4. 1 2 Alizadehkhaiyat, Omid; Fisher, Anthony C.; Kemp, Graham J.; Vishwanathan, Karthik; Frostick, Simon P. (2007-12-01). "Upper limb muscle imbalance in tennis elbow: A functional and electromyographic assessment". Journal of Orthopaedic Research. 25 (12): 1651–1657. doi: 10.1002/jor.20458 . ISSN   1554-527X. PMID   17600835. S2CID   24350534.
  5. 1 2 3 "Tennis Elbow (Lateral Epicondylitis)-OrthoInfo - AAOS". orthoinfo.aaos.org. Retrieved 2015-09-07.
  6. 1 2 Kaiser, Peter K.; Friedman, Neil J.; II, Roberto Pineda II (2014-02-28). The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Elsevier Health Sciences. ISBN   9780323225274.
  7. 1 2 3 "Strabismus: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-09-07.
  8. 1 2 3 "Scoliosis". Harvard Health Publishing. April 2019. Retrieved 16 July 2020.{{cite web}}: CS1 maint: url-status (link)
  9. ↑ "atraumatic".{{cite journal}}: Cite journal requires |journal= (help)
  10. ↑ Franettovich, M.; Hides, J.; Mendis, M. D.; Littleworth, H. (2011-04-01). "Muscle imbalance among elite athletes". British Journal of Sports Medicine. 45 (4): 348–349. doi:10.1136/bjsm.2011.084038.109. ISSN   1473-0480. S2CID   73084026.
  11. 1 2 Mihata, Teruhisa; Gates, Jeffrey; McGarry, Michelle H.; Lee, Jason; Kinoshita, Mitsuo; Lee, Thay Q. (2009-11-01). "Effect of Rotator Cuff Muscle Imbalance on Forceful Internal Impingement and Peel-Back of the Superior Labrum A Cadaveric Study". The American Journal of Sports Medicine. 37 (11): 2222–2227. doi:10.1177/0363546509337450. ISSN   0363-5465. PMID   19773527. S2CID   33489691.
  12. ↑ "Muscle Imbalance, Part 1: A common, often undetected cause of aches, pains and disability. - Dr. Phil Maffetone". 2015-04-29. Retrieved 2015-09-08.
  13. ↑ Bisset, L.; Paungmali, A.; Vicenzino, B.; Beller, E. (2005-07-01). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia". British Journal of Sports Medicine. 39 (7): 411–422. doi:10.1136/bjsm.2004.016170. ISSN   1473-0480. PMC   1725258 . PMID   15976161.
  14. 1 2 "Strabismus". kidshealth.org. Retrieved 2015-09-08.
  15. ↑ "Esotropia | Exotropia | Treatment Options | Strabismus". www.strabismus.org. Retrieved 2015-09-08.
  16. ↑ "Lazy eye (Amblyopia)". Harvard Health Publishing. March 2019. Retrieved 16 July 2020.{{cite web}}: CS1 maint: url-status (link)
  17. ↑ Šarčević, Zoran (2010-09-01). "Scoliosis: muscle imbalance and treatment". British Journal of Sports Medicine. 44 (Suppl 1): i16. doi: 10.1136/bjsm.2010.078725.49 . ISSN   1473-0480.
  18. 1 2 3 "Muscle Imbalance, Part 2. - Dr. Phil Maffetone". 2015-04-29. Retrieved 2015-09-08.
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