*** How to Improve Muscle Balance and Stability

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How to Improve Muscle Balance and Stability for Increased Performance

By Sam Visnic, FT

This concept, unfortunately, is the most underemphasized aspect of many fitness programs everywhere. What is muscle balance really? How do you test it? What the heck does it have to do with stability and performance?   Well, let's take a moment to explain why this concept is important. First of all, we must understand that all joints in the body must be aligned properly to be able to absorb shock, allowing forces to dissipate into the ground, and decrease wear and tear. Muscles surrounding the joint must have optimal amounts of tension in all directions to hold the joint in its place. If the muscles are not balanced, the joint position is altered and the arthrokinematics of the joint are also altered. If the joint is not moving properly due to poor muscle balance, then assisting muscles (synergists) must do extra work to help stabilize the joint. Over time, the synergists that continue to be overloaded will become ischemic, constricted, and may develop chronic, painful trigger points. This means that the muscles will suffer from a lack of blood flow and eventually lose the ability to completely clear waste products from the tissue and will lead to pain, dysfunction, and overall, decreased performance.   Obviously, if a joint hurts, and you still lift weights, you will avoid the painful range and will alter your movement pattern to accommodate the weak joint. This problem can snowball into problems in other joints due to faulty movement patterns and decreased neuromuscular control. This is seen in many common injuries such as tennis elbow and golfers elbow, which can lead to over-compensation in the shoulder, lower back, and other joints. We must keep in mind that the entire body functions as one unit.   How do we test muscle balance? In my practice, I use a variety of techniques and measurements to be exact. You, however, don't need any fancy equipment or measurement devices. You will look at the posture of your client. This will give you everything you need to determine which muscles are weak and which are tight. I suggest that you analyze your client when they don't know you are doing it. If they know that you are analyzing their posture, they will try to fix it.   First, take a look at your client from the front. Does your client's head tilt to one side? Are your client's shoulders level? Are your client's hips level? Does your client have flat feet, causing their knees to collapse? Now from the side: Does your client's head jut forward? Does your client have rounded shoulders or do they seem to be slouched forward? Does your client seem to have a pelvis that tips forward, causing excessive lower back curvature?

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Faulty Alignment of the Head, Neck, Shoulder Complex

Welcome back for the second installment of my four-part series on muscular imbalance and its effects on performance. I hope you took the opportunity to read the first part of this article and perform the assignment. Did you take a look at the postural alignment of your clients? Did you notice the faults that I had mentioned? See anything common amongst them? This article will start a foundation for understanding misalignment of the head, neck, and shoulder complex.   Faulty positioning of the shoulder girdle can be caused by a number of reasons, such as jobs that involve long periods of sitting or computer work, sport specific muscle imbalances, or an excessive amount of volume performed in a workout program such as too much bench pressing without an equal amount of pulling exercises. Faulty positioning of the shoulder girdle will also cause many orthopedic, as well as neurological symptoms, such as thoracic outlet syndrome, numbness and tingling in the hands, shoulder impingement, and shoulder instability.   Protraction of the shoulder girdle will also decrease respiratory volume and overload the secondary muscles of inspiration such as the pec minor, omohyoid, upper traps and scalenes. This can lead to painful myofascial trigger points and ischemia in the tissues, causing neuromuscular inhibition of the antagonists and faulty biomechanics in the joints.     Faulty positioning of the head and neck will lead to increased stress on the neck musculature, jaw complex, and will also contribute to myofascial trigger points that can cause headache and migraines. One important factor that I learned from Paul Chek is that females have approximately 40% less neck musculature than their male counterparts and yet their heads still weigh about 8% of their bodyweight, which is the same in males. It seems likely that this could be a reason why many more women, on average seem to suffer from headaches, migraines, and general neck pain. Think about it, if you have weak neck muscles, yet they must support something roughly the weight of a bowling ball, it won't take long before they become overloaded.     Let's take a look at the most common misalignment of the head, neck, and shoulder complex. This misalignment is called "Upper Crossed Syndrome" by Vladimir Janda, MD.   The "Upper Crossed Syndrome" involves a few distinct features.     one being a forward head posture, which in a positive test involves the zygomatic arch under the eye to gravitate more than 3cm forward of the sternoclavicular joint as seen in the picture.   The second visual assessment is the position of the shoulders. As seen in the picture, the shoulders appear slumped or rounded forward, and there is a noticeable rounded appearance of the thoracic spine.   The third visual assessment is from the posterior view. The scapula appear to be winged and abducted. The normal position of the scapula is about 2-4 inches from the spine.   Through his research Janda has found that certain muscles in the body tend to be prone to becoming facilitated/tight, or inhibited/long and possibly weak. This is the reason why certain muscle imbalance syndromes tend to be so common. The muscles that tend to become short and hypertonic are the suboccipitals, upper trapezius, sternocleidomastoid, levator scapulae, pec minor, lats, and pec major. The muscles that tend to be inhibited or weak include the rhomboids, lower trapezius, serratus anterior, posterior deltoid, external rotator cuff, and the deep cervical flexors.                 So how do we start to correct this problem?   First of all, we must remind our clients to maintain a corrected postural alignment as often as possible. Cues such as "Pull your shoulders back", and "Tuck your chin back," will do well for starters. Have your client perform these corrections every hour on the hour, even when they perform their cardio exercise. Take advantage of correcting them while they are in the gym with you, because they may not do it on their own at home.   Stretches should be emphasized on all of the tight muscles listed above prior to their workout. Performing the stretches for 3 sets each for 30 seconds will serve to decrease neural impulses sent to the muscles and prevent over-recruitment during exercises.   Exercises can also be added at the end of their routine to assist in strengthening the weaknesses. Three exercises that I use frequently in my routines are the Prone Cobra, Chin Tucks, and Standing Cable Rows with emphasis on scapular retraction, and depression. For the Prone Cobra and Floor Chin Tucks, your goal is to eventually work your clients up to 3-5 minute straight holds, but to start, hold each for 30 seconds, then rest 15 seconds, and continue in this manner until the client cannot hold for a full 30 seconds. Other variations can be used for weaker or stronger clients. Rows should use a slow tempo and high reps if postural endurance is the goal. Use a 3 second lift, a 3 second hold, then a 3 second negative for 15-20 reps. Remember to keep rest times down under 1 minute to emphasize endurance.   Sam Visnic is an ISSA Fitness Therapist, NMT, and CHEK Practitioner at SPORTS Physical Therapy in Las Vegas, Nevada. He provides rehabilitation and high performance exercise programs for a variety of athletes who wish to achieve maximum performance and remain injury free.

 

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Faulty Alignment of the Pelvis

Welcome back for this third installment of the article series. If you have read up on the previous topics and applied what you have learned, you should notice a few results already starting. Your clients should be much more aware of their posture, their weaknesses should be improving, and if your new found expertise has caught on, you have a few new clients who are impressed with your knowledge. If, however, you have not been able to fully correct your client with just the information that I have presented, then read on. This article is going to focus attention on the postural control center, the pelvis. Get yourself an anatomy book, and get ready, this is going to get a bit more complex.   As I mentioned, this article is going to be focused on what is commonly referred to as the core. This is not the term I use for the pelvic complex, because it is just one part of the entire core. A better term is the lumbo-pelvic-hip complex. It refers to all the parts that are associated. The major joints involved are the sacroiliac joints, pubic symphasis, and the hip joints. There are about 29 major muscles that influence this region, but for simplicity, we will only focus our attention on the important muscles that have the most influence on distorting posture and causing pain. The muscles of importance are the psoas major, quadriceps, hip adductors, erector spinae, lumbar multifidus, quadratus lumborum, gluteals, hamstrings, rectus abdominus, external obliques, internal obliques, and transverse abdominus. If you are not familiar with the origins, insertions and function of these muscles, please stop reading and look them up. This will allow a more basic understanding for what is to come.   The pelvis can assume many types of malalignments in different planes, but we will only focus on pelvic alignment in the sagittal plane. The most common deviation seen is excessive anterior pelvic tilt. This faulty alignment can be seen in the picture to the right. To measure this, first we must locate 2 main structures, the anterior superior iliac spine (ASIS), which will be a large bony structure about a 45 degree angle inferior and lateral to the umbilicus. Now the posterior superior iliac spine (PSIS). Trace the ilium around from the ASIS to the back of your client. It will be seen as a large dimple.  Now, with one finger on each structure, kneel down and view your client from the side. Which is higher, the ASIS, or PSIS? In most cases, the PSIS is significantly higher than the ASIS. This is called an anterior pelvic tilt. The pelvis is tipped more anterior than posterior. Don’t be mislead, some degree of anterior pelvic tilt is normal. What we are looking for here is excessive tilt, anything beyond 10 degrees.   So now that we have identified the pelvic tilt on our client, what do we do with this information?   If you have identified an anterior pelvic tilt, read on. If you have identified a posterior pelvic tilt, you may want to refer to a physical therpist for instruction on exercises and possibly an orthopedic evaluation to rule out any spinal conditions. (Posterior pelvic tilts in my experience is relatively rare, although I have gotten a few.)   Now lets look at the common tight muscles in this malalignment.   The short/tight muscles include: Psoas major, which by its anatomy can cause increased lumbar extension and hip flexion, causing the pelvis to tip anteriorly.  Quadriceps, particularly the rectus femoris, which also contributes to hip flexion. Lumbar erectors, which cause lumbar extension. Quadratus lumborum, if bilaterally tight, can cause increased lumbar extension. Hip adductors, anterior pelvic tilt results in internal rotation of the femur. This will shorten the adductor musculature.   The long/inhibited muscles include: Gluteus maximus, which causes hip extension and opposes the psoas major. Hamstrings, this muscle can be tricky, It may be weak but appear tight simply because it is a synergist to the gluteus maximus and may be compensating. Deep abdominal wall, this includes the tranverse abdominus, and internal obliques which may become inhibited due to facilitated lumbar erectors.   The main contributor to anterior pelvic tilt is usually the psoas major. Dr. Vladimir Janda states that if the psoas major is tight, it can disrupt the muscle balance relationships of the entire postural chain. When the psoas is tight, it pulls the pelvis into anterior tilt, thereby increasing hip flexion and shortening all hip flexor muscles. Since the psoas has its origin on the lumbar spine vertebrae, when it shortens, it pulls the spine into extension. This causes the lumbar erectors and quadratus lumborum to shorten. The short/tight muscles will inhibit their antagonists. The gluteals, which contribute strongly to hip extension, will be inhibited by the psoas, causing the hamstrings to pick up the extra force. The deep abdominal wall will be inhibited by the lumbar erectors, and their synergist, the psoas major. Due to the neurological connection, other muscles in the deep stabilization mechanism may become dysfunctional. This may include the pelvic floor and lumbar multifidus.   Excessive anterior pelvic tilt can be caused by seated jobs, faulty abdominal training, poor muscle balance, poor posture, and pregnancy.   The problems associated with anterior pelvic tilt can include: dysfunction in the lower extremity (See part 4 of series), low back pain, incontinence, pelvic instability, upper cross syndrome (via the pelvo-occular reflex), and abdominal distention.               Correction of excessive anterior pelvic tilt includes postural cueing, stetching the tight muscles, and strengthening the long inhibited muscles. Postural cueing for the pelvis includes teaching the client how to find a neutral pelvis. This is done by teaching your client to perform a posterior pelvic tilt, then perform an anterior pelvic tilt, then find the position in the middle of the two. Or you could use the test position and instruct your client to tilt their pelvis until the PSIS and ASIS align properly. Remember, tilt the pelvis, not the whole body! Use this procedure in all exercises to re-enforce the motor program. Corrective stretches should be performed prior to initiating any exercises. Stretch the quads, psoas major, hip adductors, lumbar erectors, and quadratus lumborum. Refer to a good stretching book for demonstration. Strengthen the weak muscles by performing exercises that isolate the weaknesses first. I use floor bridging, and supine posterior pelvic tilting. Perform the floor bridges emphasizing an equal glute squeeze. Perform them at 30 second static holds, and then 15 second rests. Repeat this sequence until 3-5 minutes of total tension is reached. Eventually, your client should be able to work up to a static 3-5 minute hold. The key to posterior pelvic tilting is to not recruit the rectus abdominus, as it will increase thoracic flexion and encourage upper cross syndrome. Lie supine will knees bent and hands under your lumbar spine directly behind the umbilicus. Take a deep diaphragmatic breath and upon exhaling, gently draw the belly button toward the spine and apply a small amount of pressure into your hands by tilting the pelvis posteriorly. This will activate the external and internal obliques to tilt the pelvis. If the rectus abdominus is being recruited, you may be pushing too hard. Hold for 10 seconds, then rest for 10 seconds. This should be repeated up to 10 reps for 2-3 sets. Progress the legs away from your rear end as you improve. Now add these exercises to the ones you have been performing for the upper cross .

 

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is·che·mi·a

lack of blood: an inadequate supply of blood to a part of the body, caused by partial or total blockage of an artery
[Late 19th century. < modern Latin< Greek iskhaimos "stopping blood" < iskhein "to hold" + haima "blood"]

 is·che·mic    adjective