Download Muscle imbalance

Muscle imbalance
As. PhDr. Kamila Řasová, Ph.D.
Department of rehabilitation
3rd Medical Faculty, Charles University in Prague
Back and Neck Pain
•
95% of back pain has no diagnosable cause
•
within 1 – 2 years, a minimum of 50% of such cases would go on to develop
further recurrent pain episodes.
•
Studies have show that a high percentage of people with back pain have nothing
more than tight (semi-contracted) back muscles.
•
It can be the cause of any number of muscle, fascia, metabolic and mechanical
postural dysfunctions and syndromes.
•
Untreated imbalances can lead to “degenerative spinal conditions” that causes
excessive forces on the spine’s joints, ligaments and discs from overactive
(hypertonic, semi-contracted) muscles and underactive (hypotonic, overly
stretched) muscles.
http://www.heattreat.ca/muscle-imbalances.php
Skeletal muscles work together to allow movement.
3. month
3 months model in verticalisation
Stabile posture as a whole
Segmental level: co-contraction
of antagonists
Spinal level: reflex under
brainstem level
Segmental level: co-contraction of antagonists
Two groups of muscles based on their phylogenetic
development (Janda, 1987)
• The tonic system consists of the “flexors”, and is
phylogenetically older and dominant. These muscles are
involved in repetitive or rhythmic activity (Umphred, 2001),
and are activated in flexor synergies.
• They are prone to tightness or shortness.
• The phasic system consists of the “extensors”, and emerges
shortly after birth. These muscles work eccentrically against
the force of gravity and emerge in extensor synergies
(Umphred, 2001).
• They are prone to weakness or inhibition.
Tonic Muscles
Phasic Muscles
Prone to Tightness or Shortness
Prone to Weakness or Inhibition
Gastrocnemius, Soleus
Peroneus Longus, Brevis
Tibialis Posterior
Tibialis Anterior
Hip Adductors
Vastus Medialis, Lateralis
Hamstrings
Gluteus Maximus, Medius, Minimus
Rectus Femoris
Rectus Abdominus
Iliopsoas
Serratus Anterior
Tensor Fascia Lata
Rhomboids
Piriformis
Lower Trapezius
Thoraco-lumbar extensors
Deep neck flexors
Quadratus Lumborum
Upper limb extensors
Pectoralis Major
Upper Trapezius
Levator Scapulae
Scalenes
Sternocleidomastoid
Upper limb flexors
Table 1: Tonic & Phasic Muscles
Spinal level: reflex under brainstem
level
• Vertical chain to punctum fixum:
pelvis-thorax-scapula-head
sole-knee-
http://www.smsystem.cz/index.php?option=co
m_content&view=article&id=64&Itemid=63&l
ang=es
Chain of deep stabile system:
multifidi - transversus abdominis –diaphragm-pelvic floor
The role of diaphragm: – connection between respiration
and posture, in co-contraction
with m. transversus
abdominis stabilizes chest, in dysfunction leads to
hyperfunction of neck.
The role of planta pedis
Crossed Syndromes
Upper Crossed Syndrome” (UCS)
cervical crossed syndrome
Lower Crossed Syndrome” (LCS)
pelvic crossed syndrome
alternating sides of inhibition and facilitation in the upper quarter and lower quarter
Layer Syndrome (LS)
stratification syndrome
- combination of UCS and LCS
- characterized by alternating patterns of tightness and
weakness, indicating long-standing muscle imbalance
pathology.
Janda, 1987, 1988
•
What Causes Muscle Imbalances?
1.
A lifetime of poor posture
2. Jobs or activities that require a lot of forward bending (flexing) and/or
lifting/twisting from that forward bend.
3. Jobs or activities requiring long or excessive use of extension (bending
backwards)
4. Jobs that require static position or repetitive motion – like computer
work, cashiering, etc,
5. A lack of exercise. Over exercise, and Incorrect exercising.
6. Repetitive Stress - Both Physical and Emotional - Just think about
defensive attitudes, confidence, shyness and aggression. These
immediately affect our musculature and it all shows up in our body’s
posture.
7. Lack of restorative sleep
8. an accident injury
9. Once injured, the pain and physical reactions to that injury can create
further imbalanced muscle problems if not properly treated.
Why to treat muscle imbalances?
• A muscle that is chronically semi-contracted
causes metabolic dysfunction within the
muscle tissues. It also squeezes blood vessels
and nerves running through the muscle. This
interferes with healthy blood supply and
proper nerve signaling.
• Muscle imbalance and poor muscular
coordination often result to injury.
An examination
TrP
Limit of movement
Role in blockage of join
in „antagonists“ at vertical
chiens causes punctum fixum
Mainly in deep stabile system
Treatment
Post Isometric Relaxation Technique (PIR)
one of the simplest and most effective Muscle
Release Techniques
release spasms, Hypertonicity and reflex
compensations in muscles
lengthens fascia and allows the muscles to return to
their proper resting length
increase range of motion
reduce chronic pain and myofascial restrictions
restore normal biomechanical function.
PIR is the basis for other forms of
muscle therapy
•
Muscle Energy Therapy (MET) utilizes neurophysiologic muscle reflexes to improve functional mobility of the
joints. MET uses active muscle contractions (controlled isometric contraction-release) followed by complete
relaxation and subsequent passive stretching to increase range of motion (ROM) of the related joints. “Passive
stretching” means the therapist does the stretch for you.
(Hanna) Somatic Education is based upon a whole body therapy that helps to improve muscular function, control
and teaches you the ability to “feel” your muscles (mind-body awareness). There are Hanna Somatic practitioners
who can provide assisted therapy and once you understand and can perform the techniques properly you can do
them at home on your own – a minimum of twice a day. If there are no practitioners in your area there are video
tapes, CDs, and books available that provide detailed instructions on how to perform these exercises and help
raise the awareness of how your own body/muscles are performing for you.
Myofascial Release (MFR) This technique coaxes muscles in spasm to relax, and breaks down adhesions in the
fascia. Bodies respond to this therapy by releasing tension that has been stored in the fascia, thus allowing more
functional flexibility and mobility of the muscles, fascia and associated structures. This technique is more useful
for those with long standing muscle imbalances that have developed dysfunctional fascia problems as well.
•
Cranio-Sacral is a very gentle process, using less pressure than the weight of a quarter. Make no mistake this is an
extremely powerful whole body, muscle and spinal adjustment. Patients’ often think nothing much is being done
while treatment is underway, but they soon change their minds when the treatment is over.
Global Postural Re-education (GPR) The technique is known as Souchard's Global Postural Re-education and it
employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that
have become tight and weak from underuse. Developed in France, 25 years ago, GPR is only now being introduced
in the United States.
Janda principles
1. Normalize the periphery
•
•
•
•
normalizing afferent information entering the
sensorimotor system.
providing an optimal environment for healing (by
reducing effusion and protection of healing tissues)
restoring proper postural alignment (through
postural and ergonomic education)
correcting the biomechanics of a peripheral joint
(through manual therapy techniques).
2. Restore Muscle Balance
• Techniques to decrease tone must be specific to the
cause of the hypertonicity. These include postisometric relaxation (PIR) (Lewit, 1994) and postfacilitation stretch (PFS) (Janda, 1988).
• isolated muscle strengthening is not emphasized in
the Janda approach. Instead, muscles are facilitated
to contract at the proper time during coordinated
movement patterns to provide reflexive joint
stabilization.
. Increase afferent input to
facilitate reflexive stabilization.
3
• increasing proprioceptive input into the CNS with a specific
exercise program, “Sensorimotor Training” (SMT) (Janda &
Vavrova, 1996). This program increases afferent information
entering the subcortical pathways (including spinocerebellar,
spinothalamic, and vestibulocerebellar pathways) to facilitate
automatic coordinated movements.
4. Increase endurance in coordinated
movement patterns.
• Endurance is increased through repetitive,
coordinated movement patterns. Since fatigue is a
predisposing factor to compensated movement
patterns, endurance is also more important than
absolute strength.
• Exercises are performed at low intensities and high
volumes to simulate activities of daily living.
Lewit approach
Relaxation of TrP, mobilization of joint
blockage
Activation of co-activation: Diaphragm and
deep abdominal muscles
Therapy models
Neurotherapeutic facilitation
Vojta reflex locomotion
Task oriented approach
Therapy by Bobath concept
Rasova K. archive
Body is stabilized enough to allow
elicitation of the swing movement.
Therapist practices abilities to achieve specific
task, in this case mopping the floor.
Motorické programy aktivující terapie