Review: Muscle Imbalance Flashcards
The property of skeleton structures that employ continuous tension members and discontinuous compression members in such a way that each member operates with maximum efficiency and economy; explains how forces are dispersed through the body diffusely
Tensegrity
Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with rounded shoulders and anterior pelvic tilt?
Hypertonic pectorals
Hypertonic quadriceps, QLs, and iliopsoas
Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with posterior pelvic tilt?
Hypertonic iliopsoas and piriformis
Postural imbalance may progress to postural decompensation. What are some probable associated MSK findings with rounded shoulders and posterior pelvic tilt?
Hypertonic pectorals
Hypertonic iliopsoas and piriformis
3 planes associated with postural decompensation
Coronal plane — scoliotic changes
Horizontal plane — rotational changes
Sagittal plane — kyphotic and/or lorditic changes
[postural change in one plane modifies posture in other 2 planes]
Risk factors for muscle imbalance and/or postural decompensation
Gravitational strain
Congenital (pelvic tilt, short leg syndrome, scoliosis)
Altered proprioceptive input (trauma, sedentery lifestyle, poor exercise technique, muscle weakness)
Stress: emotional and physical
Hormonal imbalances/changes
Nutritional deficiencies
Aging — metabolic chnages
Biomechanical/pathophysiologic effects of gravitational strain
Accentuation of postural curves
Stress on postural soft tissues
Reflex muscle imbalance
Reduced diaphragmatic functions
Usual presenting symptoms are musculoskeletal
Over time can lead to multiple systemic symptoms
Sherrington’s law
When a muscle receives a nerve impulse to contract, its antagonists receive (simultaneously) an impulse to relax
Effects of pseudoparesis on postural muscles vs. movement muscles
Postural muscles — facilitation, shortening, hypertonicity
Movement muscles — inhibited, stretched, hypotonicity
Compensatory patterns in postural pseudoparesis
Common compensatory pattern (80% of people) = L/R/L/R
Uncommon compensatory pattern (20% of people) = R/L/R/L
Lower crossed syndrome involves the hip, pelvis, and low back. Associated with tight erector spinae, inhibited gluteals, weak abdominals, and tight iliopsoas. What are signs/sx of lower crossed syndrome?
Increased sacral flexion between ilia
Increased lumbar lordosis (increased loading of facet joints)
Increased flexion of the hip and knees — altered loading characteristics
Hypermobility in the sagittal and coronal planes in the L4-5, L5-S1 levels
Sitting up from supine and forward bending are dysfunctional
Hypertonic vs. hypotonic muscles in lower crossed syndrome
Hypertonic: iliopsoas, quadratus lumborum, TFL, hamstrings, rectus femoris, piriformis, adductors, gastrocnemius, soleus
Hypotonic: gluteals, abdominals, vastus medialis, anterior tibialis, peroneals
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Inability to stand straight — knee(s) flexed; L1-2 SD; pain referral to back and groin
Positive thomas test
Iliopsoas
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Pain referral to groin and hip
exhalation 12th rib SD
Diaphragm restriction
Quadratus lumborum
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Pain sitting or walking
Pain disturbs sleep
Pain referral to posterior thighs; limited straight leg raise
Hamstrings
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Pain down posterior thigh
May entrap sciatic n.; Perpetuated by SI dysfunction
Associated with pelvic floor dysfunction, dyspareunia, prostadynia
Piriformis
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Pain referred to inguinal ligament, inner thigh and medial knee
Adductors
What muscle group should be suspected to be hypertonic/spastic with the following sx/PE findings:
Nocturnal leg cramps; pain referral to upper calf, instep, and heel
GastrocSoleus complex
Symptoms and PE findings associated with inhibition of gluteal muscles
Gluteus minimus: pain when arising from a chair; pain referral to butock, lateral and/or posterior thigh, “pseudosciatica”, antalgic gait, +Trendelenberg
Gluteus medius: pain with walking; pain referred to posterior iliac crests and SI joints; +Trendelenberg
Gluteus maximus: restlessness; pain sitting or walking up hill; antalgic gait
Symptoms and PE findings associated with inhibition of vastus medialis, rectus abdominis, and tibialis anterior muscles
Vastus medialis: buckling knee, weakness going up stairs, thigh and knee pain; chondromalacia patellae
Rectus abdominis: increased lordosis; constipation
Tibialis anterior: pain referral to the great toe and anteromedial ankle; foot may drag or trip when tired
5 models dx of postural decompensation
Biomechanical: postural visual inspection and gait analysis; ROM testing
Neuro: balance and strength testing
Resp/circ: zinks patterns, lymphatic palpatory exam
Metabolic and behavior: H and P
Common diagnoses related to lower crossed syndrome
Chronic LBP Sacroiliac pain Osteoarthritis L-spine Spondylolisthesis Osteoarthritis hips/knees
Self-locking mechanism is critical for resistance against shear and is a result of form closure and force closure. What is the difference between form and force closure?
Form closure — due to how joint fits together
Force closure — due to gravity and loading forces (muscles, fascia, ligaments)
With the sacrum as the “keystone”, postural muscles may affect SI joint stability. What muscles are associated with the SI joints posteriorly and ventrally?
Posteriorly: Lats, thoracolumbar fascia, gluteus maximus, and ITB
Ventrally: abdominal obliques, linea alba, and transverse abdominals
3 Medial compression points applied in pseudoparesis perception test
The iliac crests (multifidus, lat dorsi, levator scapulae, lumbar vertebrae, lumbosacral junction)
Midway between iliac crests and greater trochanters (gluteals, SI joints, sacrum, innominate)
The greater trochanters (pelvic diaphragm, hamstrings, STL, and structures below the pelvic diaphragm)
Interpretation of pseudoparesis perception test with SI joint stabilization
In a balanced system, there will be no signs of pseudoparesis
In an unbalance system, external stabilization is necessary to eradicate the signs of pseudoparesis
What should the firing pattern be for LE extension?
- Ipsilateral hamstring
- Ipsilateral glut max
- Contralateral e.spinae
- Ipsilateral e.spinae
What should the firing pattern be for LE abduction?
- Ipsilateral glut medius
- Ipsilateral TFL
- Ipsilateral QL
- Ipsilateral e.spinae
A 26 y/o male presents to your office w/ complaints of lower back pain after a triathalon. PE reveals left hip flexors with 4/5 strength. All other neurologic findings are negative. Which of the following diagnostic findings confirms pseudoparesis common to a lower crossed syndrome?
A. Left paracentral disc herniation at L3 B. Left torsion on a left oblique axis C. Left hypertonic rectus femoris D. L3-5 N RL SR E. Left hypertonic QL
C. Left hypertonic rectus femoris
Signs of upper crossed syndrome
Forward head posture
Increased lordosis of upper and mid C-spine
Increased kyphosis at cervicothoracic junction
Protraction of shoulders
Internal rotation of humerus
Tends to stress C4-5, cervicocranial and cervicothoracic junctions
Hypertonic vs. weak muscles in shoulder region pseudoparesis
Hypertonic postural mm: levator, upper trap, pectorals, lats, SCM, scalenes, subscapularis, UE flexors
Weak movement muscles: deep neck flexors, serratus anterior, deltoid, UE extensors, rhomboids, supraspinatus, infraspinatus, mid and lower trap
5 models treatment plan for muscle imbalance
Biomechanical: protect osteoarticular system and reduce strain placed on joint capsules and ligaments by restoring ROM
Neuro: Restore neurologic balance by addressing SD induced pseudoparesis
Resp/circ: optimize fluid flow
Metabolic: improve functional capacity with OMT, proper nutrition, hydration, sleep
Behavioral: empower pts with responsibility by giving them specific exercise Rx
One study of a hamstring stretching protocol found greatest improvement during initial ____ weeks, but still improving at ___ weeks
8; 12
How long to hold stretches
Either 10s for 9 reps or 30s for 3 reps
[total stretch time of 90s; in this study, each group stretched 6d/week x6weeks]
Exercise Rx for stretching in general
Perform exercises 2-3x on each side, 2-3x/day
Stretch each side for 12 seconds or 3 deep breaths, unless otherwise prescribed
Once feeling of stretch is no longer appreciated, you can cut down on frequency (must re-asses every week)
Exercise Rx for retraining
Perform after stretching 2-3x/day
Cervical flexion test and positive vs. negative result
Supine pt instructed to “flex chin to chest”
Positive test = immediate recruitment of SCM and scalenes with absence of chin nod
Negative test = longus colli activation causes chin nod with SCM and scalenes firing late
What does a positive cervical flexion test indicate?
Facilitated SCM and scalenes
Inhibition of the deep neck flexors (longus colli)
Substitution by the SCM and scalene muscles
Scapular stabilization test
Patient in table-top position and lifts one hand from table causing other arm to support all upper body weight
Positive test = scapula on weight bearing UE protrudes away from body —indicates weakness of lower trap, serratus anterior, and rhomboids
Negative vs. positive bilateral shoulder flexion test
Negative: allows full overhead flexion of b/l UEs at shoulders with minimal influence on thoracic and lumbar spine
Positive: U/l or b/l restriction of overhead flexion with noticeable influence on T and L spine
CS position for scalenes
F St Rt
Levator scapulae CS
Grasp pts ipsilateral wrist and extend arm and place under traction or compression, depending on which one relieves TP
Hold x90 seconds
Levator scapulae “still-ish” technique
Abduction of UE to 180 degrees
Distraction, adduction to 90 degrees and finally to 0 degrees
Hold to back of chair, flex head to opposite knee
3 deep breaths and follow fascial release
SCM counterstrain
F St Ra
CS positions for AC1-8
AC-1 = RA
AC2-6 = F SaRa
AC7 = F St Ra
AC8 = F SaRa
Pectorals counterstrain
Adduct arm across midline
