Muscle Imbalances (And How They Can Create Pain/Dysfunction)
What is Muscle Imbalance?
Muscle imbalance can be described as an inequality in the distribution of forces between the agonist and antagonist muscles of a joint. In other words, muscles acting in one direction on a joint are pulling harder than muscles acting on the joint in the opposite direction. This can negatively affect how the joint functions.
How Does a Muscle Imbalance Occur?
There are several ways in which the force ratios between agonist and antagonist muscles can be disrupted and result in a muscle imbalance, including the following:
- Poor posture
- Eg. prolonged periods of being hunched over a computer
- Improper training
- Eg. too much emphasis on training agonist muscles over antagonist muscles
- Eg. tennis elbow, muscle sprains, multiple sclerosis, stroke
Forward head posture and forward rounded shoulders are very common examples of poor postural habits. These can largely be attributed to increasingly sedentary lifestyles that many people are adopting in our society. It comes down to the simple fact that many of us will spend hours each day in front of a computer, TV, textbook, cellphone, tablet, steering wheel, and many other objects and tasks in which we often can find ourselves slumping into very forward rounded positions.
Eventually, poor postural habits like this can lead to a muscle imbalance because the agonist muscles that are consistently being shortened will begin to maladapt to the position by tightening, whereas the antagonist muscles will begin to weaken from frequently being underused and in a lengthened state. These negative muscular changes brought on by poor postural habits then result in a forward rounded position that is maintained even when not engaging in these activities that reinforce it. The following are some of the muscles and muscle groups that would be affected in this example:
- Eg. tightening of pectoralis major and minor, upper trapezius, levator scapula
- Eg. weakening of middle and lower trapezius, rhomboids, deep cervical flexors
How Does a Muscle Imbalance Cause Pain and Dysfunction?
Whether it was poor posture that led to the muscle imbalance or not, it will likely become the result if the issue is not addressed (again, due to the gradually worsening pull of the joint in one direction). A progressive decrease in mobility and flexibility can eventually take form, as some movements will be limited by muscle weakness, while others will be limited by muscle tightness.
To give a more detailed example: in our case of forward head posture, one major issue is that every inch that the head sits forward from its normal, neutral position, it feels ten pounds heavier. Of course, this means that there is a significant amount of extra work being put on the structures of the neck that support the head. Not only can this result in irritation for the neck muscles and other structures that are working excessively hard, but it also greatly increases the risk for more serious issues in the future, such as degenerative disc disease.
How Do You Fix a Muscle Imbalance?
Assuming your muscle imbalance has arisen from poor postural habits, improper training, or an injury that has since been resolved, the fix involves reversing the problems that have led to it. Muscles that have tightened up need to be stretched, and muscles that have weakened need to be strengthened. At the same time, good postural habits need to be re-established. If the imbalance is a result of improper training at the gym, an additional recommendation would be to develop a new routine that includes a good distribution of exercises across all muscle groups once the imbalance has been resolved.
Of course, some of these suggestions might be easier said than done, especially if a lack of mobility or an excess of pain is inhibiting you from performing certain exercises or stretches that you think might help. Fortunately, there are many professionals that can assist with restoring mobility, managing pain, developing workout programs, and providing education on posture and exercise. Don’t be afraid to seek assistance from a physician, kinesiologist, physiotherapist, chiropractor, or any of several other kinesiology and health professionals.
Finally, consider visiting some of our other blogs for more information on related topics that may be helpful in fixing (or preventing) a muscle imbalance:
- Neutral Spine – https://www.novaactiverehab.com/neutral-spine/
- Posture – https://www.novaactiverehab.com/posture-and-postural-cues/
- Pain Cycle – https://www.novaactiverehab.com/pain-cycle/
Note: if your imbalance is the result of a serious disease or a more severe, on-going injury, the fix may not be as simple. Seek advice from a physician and see if the prior suggestions can benefit you.
The Pain Cycle (and How to Break It)
What is the Pain Cycle?
The pain cycle is a continuous loop of negative issues that can develop when we sustain an injury. There is a positive feedback effect that occurs throughout this loop, in the sense that increasing the amount of one factor leads to an increase in subsequent factors of the loop. The following diagram may help demonstrate the important components of the pain cycle and how the positive feedback effect works:
There is a lot of information packed into this diagram, but it will make more sense when each component is broken down:
- Pain: When a physical trauma occurs, such as a neck injury in a car accident, you are likely going to be confronted with pain before anything else. In this sense, you can think of pain as the catalyst in initiating the pain cycle.
- Muscle Guarding: Pain, aside from being an unpleasant sensation, acts as a signal for the body that an injury is present. Our body typically responds to this signal through the use of muscle guarding, a protective mechanism in which muscles around the site of the injury will spasm (contract involuntarily) to restrict movement. The goal of this is to prevent further injury, similar to how we might use a cast or splint in the case of a sprain or fracture.
- Restricted Range of Motion: While the purpose of muscle guarding is to minimize movement around an injured area, this can eventually become detrimental. This is because the restricted range of motion can persist after the damaged tissues have been repaired. Why this occurs is largely due to the fact that our body has already long since adapted to not using the injured area and surrounding musculature. At this point, muscle guarding is no longer serving a positive role in our body.
- For example, if your neck has been injured and has stiffened up significantly due to pain and the subsequent muscle guarding, your body will typically react to this lost range of motion by “borrowing” it from other joints in the body, also known as compensating. Instead of extending at the neck to look up, you might extend from lower in the spine. Similarly, rather than primarily rotating your neck to perform a shoulder check, you rotate more from below the neck.
- Muscle Weakness and Atrophy: Following long periods of muscle guarding and restricted movement is muscle weakness and atrophy. Our body is extremely efficient with managing its resources, and will avoid investing energy into things that are not currently serving a purpose. As such, an area that has been injured, guarded, and movement-restricted will gradually begin to weaken and suffer muscular atrophy (loss of muscle mass) over time – it simply is not being used enough to maintain a sufficient input of energy from the body.
- This is no different than why we begin to lose muscle mass if we stop working out, or why it becomes difficult to remember things if we don’t recall them for a long time. It would be wasteful for our body to continuously invest in those specific muscles or brain cell pathways if they are not something we will need in the near future.
- Decreased Function: The next stage in the pain cycle is decreased function. In reality, this has been occurring throughout the entire cycle. However, once it reaches this point, the ideal response from the body would be to start restoring function as the injured area is healed, preventing a cycle from ever being established. Of course, this is not always the case, otherwise the concept of the pain cycle would not exist.
- Psychological Stress: Various forms of psychological stress can ensue, such as: frustration, anger, depression, helplessness, and so on. Although this is not a very productive response, it is hard to blame someone for being frustrated, given the cascade of negative events that have built up to this point. Unfortunately, these various forms of stress can increase tension in our body and decrease our motivation, which eventually will lead to more pain as we continue to neglect the physical issues, such as guarding, decreased range of motion, atrophy, and loss of function.
As we can see, each component of the pain cycle feeds into the next until it meets back up with where it began, demonstrating the positive feedback effect that was mentioned earlier.
How is the Pain Cycle Broken?
In order to break the pain cycle, we need to target the factor that is fueling it the most: pain. However, there is a difference between the pain from the initial injury, and the residual pain that continues to feed into the cycle. Once the injury to the tissues (eg. contusion, fracture, sprain, strain) has healed to a functional level, the residual pain we continue to experience is actually a result of the events that took place during the dysfunctional period (refer back to the pain cycle). Thus, we should seek to rehabilitate the site as soon it is functional again.
We can employ a number of methods to deal with the residual pain. First of all are passive techniques, which can be very useful, especially in the early attempts at managing the pain cycle. The following are some examples:
- Applying heat or ice (heat is generally better for tightness/stiffness, as it promotes increased blood flow to the area, whereas ice is typically better to use on swelling/inflammation, as it will reduce the amount of blood flow to the area)
- Relaxation strategies (deep breathing, positive mental attitude, meditation, experiencing nature, and anything else that you find will help you reduce mental stress and the accompanying physical tension)
- Passive therapy (passive stretch, shockwave, massage, acupuncture, laser, percussion, and many other services that trained professionals such as physiotherapists, chiropractors, and massage therapists can provide for you)
While passive techniques can have tremendous benefits, they can also be limited in their ability to completely break the pain cycle. This is because a lot of these techniques only cause temporary relief to the problem. However, this opens the opportunity to incorporate the second major key to breaking the pain cycle: active techniques. Active techniques should be gradually incorporated once an adequate amount of function has been restored through passive rehabilitation, so the pain cycle can be broken for good.
I will define active techniques as anything in which you are physically engaging the musculature in and around the site of the injury. In other words, increasing your level of movement. This can include anything from going for a walk or run, lifting weights, performing stretches, or finding an active hobby (tennis, hiking, etc.). Kinesiologists can be very beneficial at developing a structured active rehabilitation program for you, as well as demonstrating the exercises and progressing the plan at a proper pace.
By performing both active and passive strategies at the same time, you will eventually see an opposite effect in the pain cycle – it will become more of a relief cycle. As pain is manage our muscles will guard less, which can help free up range of motion, allowing us to move more freely and build up our strength again, and so on. Eventually the passive rehabilitation will no longer be necessary, and we will instead remain active with the goal of maintaining our health, rather than rehabilitating our body. However, it takes a conscious effort from us to make these changes. The longer we sit around and hope for the best, the more we are fueling the pain cycle to make things worse.
Avoid Activities That Increase Pain
I was speaking with a new client today. She, like other clients we work with had suffered whiplash from a car accident. She was struggling to perform yard work such as mowing the lawn and gardening owing to her neck pain. In the conversation, she revealed how she thought she was strengthening her neck when she was continuously looking down to power wash her driveway. She mentioned the power washing caused her neck pain to worsen but she continued to do it because she believed it was aiding her recovery. I explained that she was irritating her neck by looking down for long periods of time and that it was making her condition worse. Unfortunately, this was not the first time I have had clients make this mistake. Below is a list of activities that have the potential to aggravate an existing neck or back injury. It is vitally important to be aware of body positions or activities that worsen your symptoms. If possible, avoid activities that increase your pain.
Common activities with the potential to aggravate your symptoms:
- washing the floor or a bathtub
- mowing the lawn
- prolonged texting
- washing windows
- lifting or carrying heavy groceries
- using a laptop computer or tablet
It may be impossible to avoid some of the tasks listed above. For example, if you do need to vacuum, try and break the task up. Take a rest break after every five minutes of vacuuming. During this rest break, perform stretches to ease your neck pain or low back pain. For a task such as window washing, you could pace yourself by washing a single window per day over several days.
Forget no pain, no gain
The take home message is that the “no pain, no gain” aphorism is counter productive. The bottom line is when an activity exacerbates your pain symptoms, you should stop the activity.
Dr. Karina Fuentes, Psychologist, On Chronic Pain And Anxiety Following A Car Accident
I had the pleasure of interviewing Dr. Karina Fuentes, Psychologist. Dr. Fuentes has a private practice in Port Coquitlam where she helps people with conditions such as chronic pain, anxiety and depression. She received her Ph.D in clinical psychology from the University of Victoria in 2001. She explains how therapy helps people with chronic pain and gives advice on driving anxiety after a motor vehicle accident.
What are the signs that a person who is suffering from chronic pain would benefit from seeing a Psychologist?
Some common reasons why people with chronic pain choose to work with a Psychologist include having difficulty overcoming a depressed mood, feelings of guilt about how their pain affects their family, feelings of anger, or difficulty coming to terms with how their pain limits them. Anxiety about doing things that are safe to do also suggests that support from a Psychologist could be helpful. For example, some people with chronic pain are afraid to exercise even though their doctors have said it is safe.
What advice would you give to someone who has been in a car accident and subsequently has anxiety with driving?
The least helpful thing you can do is avoid driving. Avoiding it will help you feel better in the short-term, but as more time passes it will become harder to overcome the anxiety. Having said that, you should not expect yourself to be able to immediately feel as comfortable as you did before with driving. A more helpful approach is to gradually get used to driving again. For example, you might start with short drives around your neighbourhood while practicing anxiety management techniques and then work your way up to more challenging drives.
Describe the impact that seeing a Psychologist can make in the life of someone suffering from chronic pain from an injury caused by a car accident?
Some examples of how a Psychologist can help people include finding different ways of managing their pain, overcoming anxiety about driving or being a passenger, rebuilding confidence, finding hope for the future, and focusing on abilities instead of limitations. Psychologists can teach specific skills for improving sleep, overcoming anxiety and negative thinking, resolving trauma, and learning how to relax.
Will ICBC cover the cost of treatment with a Psychologist?
It is up to your adjuster about whether or not they will provide funds for treatment. If you have a lawyer, you may wish to ask your lawyer to speak with your adjuster about the possibility of funding. Some Psychologists’ fees exceed what ICBC pays, so in that event you may be asked to pay for the difference.
When ICBC provides funding they typically will approve a set number of treatment sessions. Depending on what you and your Psychologist think is best, your Psychologist may submit a request for additional sessions. It is then up to ICBC whether or not additional funding will be provided.
How can family and friends support an individual suffering from chronic pain?
Be aware that although your loved one may look perfectly fine they may be struggling with pain. People with chronic pain are sometimes afraid of burdening friends and family, and they may try to hide how they are really feeling. Planning shorter activities or making sure your loved one can take breaks can be helpful in managing household tasks and social commitments. People with chronic pain usually don’t know how they are going to feel from one day to the next, so patience and understanding are key.
Is Your Mattress And Pillow Working For You?
Do you experiencing significantly more neck and back pain upon waking than you do later the day? This could be a sign that your mattress and pillow are not doing their job.
It’s your mattresses role to support the curves of your spine, thereby, allowing your tired spinal muscles to relax and recover at night. If your mattress is on the hard side, so much that is resembles a plank of wood, there will be gaps where your spine doesn’t come in contact with the mattress (because of your spinal curves). The muscles that run down your spine will have to continue working at night to maintain the natural curves where the gaps are. In contrast, a proper mattress supports the spinal curves allowing your back to rest. It’s a good idea to replace your mattress at least every ten years if not sooner as mattress wear out.
Do you spend the first part of your day stretching out the tension in your neck? Your pillow makes all the difference. I speak from experience. Have you every gone on a holiday and forgot to bring your pillow? You wake in the morning and your neck muscles are tense after using a luxury pillow which is more like two pillows stuck together. The pillow I recommend is a water pillow. The outer plush material of a water pillow resembles a traditional pillow; however, there is a badder inside the pillow. It’s recommended you fill the pillow with two or more litres of water by opening the valve and using a funnel that comes with the water pillow. For a better night sleep and less neck discomfort in the morning, try using a water pillow.
Whether you are recovering from soft tissue injuries or suffering from chronic pain, determine if your mattress and pillow are working for you.
Core of Back Pain
Back pain is one of the leading causes for lost work days. Approximately 80 percent of people will suffer from back pain at some point in their lives. You can stretch or perform strength exercises religiously, but if your core stability muscles are not working properly, your low back pain may persist or reoccur. Some lower back pain coping strategies that were commonly used in the past, such as using a back belt, are not the solution. Currently, people are encouraged to turn in their back belts for core stabilization exercises for treating or preventing lower back pain.
Core training is a buzz phrase in the world of fitness and rehabilitation. Core training or core stabilization describes exercises that focus on improving the function of the muscles responsible for supporting the lower back and pelvis. The core stability muscles act like an internal back belt for the lower back and pelvis. They are muscles that play a role in creating stability at various joints throughout the body, not just the core. Lack of stability at a joint can result in pain and movement dysfunction. Core stabilization exercises are commonly prescribed to people who have disc problems (disc bulges or herniations), lower back pain, a weak back, sacro-iliac joint problems or pelvis instability.
Learning how to properly train core stability muscles is not a task that can be done by using a weight machine in the gym. A Kinesiologist can teach you how to train your core muscles. Core stabilization is not achieved solely by using a rehab ball or a balance board. In fact, having this equipment available is not crucial to performing core exercises. One needs to be consciously contracting their core muscles in order to get the full benefits of using the ball or balance board as a piece of rehabilitation equipment. A Kinesiologist can show you how to use the rehabilitation equipment to perform core exercises.
From a sports perspective, adding core stability exercises to your routine would be beneficial, regardless of whether you suffer from low back pain. Properly trained stability muscles will make your movement more efficient. Your body will compensate for the lack of core stability by distributing stress on the muscles of the extremities. This scenario will set you up for an injury with repetitive movements that occur when playing a sport or performing a physical job.
A healthy back begins with a well trained core.