Muscle Balance- The key to chronic pain and Optimum function

Geoff Lecovin, D.C., N.D., L.Ac., CSCS

There are generally two schools of thought regarding causes of chronic musculoskeletal pain: Structure and function.

The structure approach relates pain with the pathology of specific static structures e.g. degenerative joint disease. This is the typical orthopedic approach. It stresses diagnosis based upon local evaluation and imaging tests such as x-rays, MRI’s and CT scans.

The functional approach recognizes the function of all processes and systems within the body, rather than focusing on a single site of pathology.

While the structural approach is necessary and valuable for an acute injury, the functional approach is often preferable when addressing chronic musculoskeletal pain, as it looks at the body as a whole and recognizes the interdependence of the musculoskeletal and nervous systems.

From a functional perspective, there are two classifications of muscles: tonic and phasic. The tonic muscles primarily consist of flexors and are involved in repetitive rhythmic activity. These muscles tend towards weakening. The phasic muscles work eccentrically against gravity. These muscles are prone to weakness.

While these classifications are not rigid, clinical observation has shown consistent patterns of dysfunction resulting in changes in the neuromusculoskeletal system.

There are three common syndromes of dysfunction: Upper (UCS), lower (LCS) and layered.(LS).

 UCS is characterized by tight upper trapezius, levator, sternocleidomastoid and pectoralis muscles as well as weakness in the deep cervical flexors, lower trapezius and serratus anterior.

 LCS is characterized by tight mid-low back extensors, rectus femoris and iliopsoas as well as weakness of the transverse abdominals and gluteal muscles.

LS is essentially a combination of both and indicates long term muscle pathology.

These imbalances can cause abnormal posture, repetitive strain injuries, tendonitis and bursitis and joint pain. They can also affect joint surfaces leading to degeneration. In some cases joint degeneration may be a direct source of pain, but the actual cause of pain is often secondary to muscle imbalance. Therefore, it’s important to find and treat the cause of pain (muscle dysfunction) rather than focus on the site of pain.

Evaluating muscle imbalance begins with postural assessment and observation of movement patterns. It also includes palpation and muscle testing to determine hypertonic and weak muscles. Once these patterns are identified, treatment can include lengthening and strengthening techniques. Lengthening can be achieved through soft tissue manipulation, PNF stretching, joint manipulation and sometimes acupuncture techniques. Strengthening is done by specific exercises, starting with conventional weight lifting and progressing to plyometric training and sensorimotor training such as balance exercises.

Using a functional rather than structural approach by assessing muscle balance and function is the key to long term relief of chronic pain. It often involves a multidisciplinary approach. As with other aspects of life, it’s all about balance. Finding the balance in your body can lead to less pain and injuries, optimum health and achieving your fitness goals, whether they be running a marathon or looking fit.