In muscular imbalance, there is an imbalance between the agonist and antagonist muscle involved in a particular movement. Dysbalances of this type often present themselves due to lack of movement, after trauma, or as a result of neurogenic disease. The therapy of choice is physiotherapy, with exercise sessions combined with electrical stimulation in certain circumstances.
What is muscular imbalance?
To perform movements, humans rely on the interaction of opposing muscles that are connected to the central nervous system via efferent motor innervation. Muscles never work alone when they contract. The agonist that realizes the movement is always dependent on a counterpart or antagonist that enables the movement in the opposite direction. If these are not equally strong, a muscular imbalance exists. When an agonist flexor flexes, the antagonist extensor must simultaneously extend. The return to the initial position is made possible by the flexion of the extensor, which in turn has the original flexor as an antagonist. For example, abdominal muscles are the antagonists of back muscles and vice versa. Agonist and antagonist muscles should be approximately equal in strength. If they are not, there is a muscular imbalance. Poor posture, pain and irreversible damage can be the late consequences of such imbalances. In the context of rehabilitative and physiotherapeutic exercises, for example, balanced training for agonists and antagonists is therefore considered the overriding goal. The sometimes most common imbalances concern like abdominal muscles, which are usually much less developed than the antagonistic back muscles.
Causes
The cause of muscular imbalance is essentially muscle shortening or muscle weakening of either agonist or antagonist. Underlying these phenomena may be unilateral force development concomitant with neglect of stretching ability. The most important trigger for this phenomenon is lack of or complete lack of strain on the affected muscle. However, one-sided strain during sports and in everyday life can also be a cause. Muscular imbalance can also occur as a symptom of an overriding disease or as a result of trauma. Associated diseases are usually diseases of the central nervous system, such as the autoimmune disease multiple sclerosis. When motor nerve tissue is damaged by such diseases, fewer movement commands reach a muscle from the central nervous system. As a result, the affected muscle can no longer be trained or strained to the same extent as its antagonist. This phenomenon can also occur with motor nerve damage to the periphery of the body, for example in the context of neuropathy. If the muscular imbalance occurs as a result of trauma to the musculoskeletal system, insufficient regeneration or pain-related incorrect loading is usually the cause.
Symptoms, complaints and signs
Symptoms of muscular imbalances depend greatly on the primary cause. In muscular imbalances caused by muscle shortening, a muscle adapts to a specific stimulus by increasing tension, while its counterpart has not been exposed to any stimulus and thus maintains its previous tension. Thus, the shortening relationship between the two is disturbed. Muscular imbalances due to muscle lengthening, on the other hand, are present when one muscle adapts to a specific stimulus by lowering its tension. The tension of the other muscle again remains constant, thus changing the shortening ratio. If there is an unfavorable load distribution between muscles and joints over the long term, arthro-muscular imbalances develop with painful muscle tension, tendon overload and muscular coordination or functional disorders. Increased wear and tear of the articular cartilage can result. In neurogenic imbalance causes in the peripheral nervous system, sensitivity of the affected area is often impaired in addition to motor function. In central nervous causes, the same may be the case.
Diagnosis and course
A pronounced muscular imbalance can be diagnosed by physicians and especially physiotherapists just by visual diagnosis.In the medical history, previous trauma or known neurogenic diseases may be indicative of a dysbalance. Symptoms such as a hunchback also indicate an imbalance. Slice radiographs of the muscles, which allow an assessment of muscle expression, are diagnostic. The patient’s prognosis depends on the primary cause. In principle, any imbalance can be improved by means of targeted training. However, a generally poorer chance of full muscle recovery is associated with central nervous causes than with other causes.
Complications
Muscular imbalances are common. In fact, everyone is affected to at least a small degree because certain muscles or muscle groups are always used less than others. Minor imbalances do not cause discomfort. Stronger muscular imbalances lead to chronic pain. Usually, by doing some exercises, the muscles can be trained evenly, so that the complaints also disappear. However, if nothing is done, complications develop over time, often characterized by irreversible changes. What complications can occur? The most important complications include muscle tension, tendopathies and arthrosis. Muscle strains develop in the context of prolonged poor posture. They can be painless. However, pain often occurs with pressure or movement. The muscle tissue hardens. Muscle tension can still be reversed through various therapeutic measures. Tendopathies are micro tears in the tendons of strong muscles. Sometimes these cannot heal completely. Therefore, degenerative changes can occur as a result. The tendon attachments show ossification and calcification. It is true that these changes are not primarily inflammatory. However, mechanical irritation can lead to secondary inflammation, which further accelerates the degeneration process. Sometimes relief of the symptoms is only possible through surgery. In the worst cases, muscular imbalance can also lead to arthrosis with subsequent joint deformity and severe limitation of movement.
When should you see a doctor?
In many cases, this disease is diagnosed relatively late, as the symptoms are not particularly characteristic and can be confused with other diseases. In general, therefore, the affected person should see a doctor if there is discomfort and pain in the muscles without a particular reason. These complaints may indicate another underlying disease that should be treated. In any case, a doctor must be consulted if the pain leads to restricted movement, which usually does not disappear on its own and lasts for a long period of time. This can also lead to infections and inflammations. To prevent these from spreading further, treatment by a doctor should be sought. It is not uncommon for the permanent pain and restriction of movement to cause psychological discomfort. In this case, treatment by a psychologist should also take place. In the first instance, a general practitioner can be consulted to diagnose the disease. In the further course, the treatment must then be carried out by a specialist.
Treatment and therapy
The treatment of choice for patients with muscular imbalance is physical therapy. For neurogenic causes, referral to a neurologically trained physical therapist is indicated. During physiotherapy care, antagonists and agonists are trained in equal measure to restore balance. Especially in the case of diseases of the central nervous system, this turns out to be a lofty goal. When nerve tissue in the spinal cord or brain is damaged, contraction commands no longer reach the muscles adequately, making training significantly more difficult. This relationship can also interfere with training sessions in peripheral nerve disorders. In such cases, physiotherapy can be combined with electrostimulation. Direct stimulation stimulates the muscle to contract independently of nerve impulses and accordingly trains it without the involvement of nerve conduction pathways. During the physiotherapy sessions, attention is paid primarily to muscle tremors. As soon as the muscles begin to tremble, a break is taken.
Outlook and prognosis
The further course of the imbalance depends relatively strongly on the cause of the disease, which is why no universal prediction is possible. However, there is a rapid irritation and overload of the muscles. Muscle tension or dysfunction of the muscles also occurs. In severe cases, these can also restrict the patient’s movement. If the imbalance is the result of an accident or trauma, it is not uncommon for patients to also suffer from psychological complaints and require support from a psychologist. If the muscle imbalance becomes severe, pain sets in. These can restrict the daily life of the affected person. Not infrequently, however, the pain disappears on its own. If tears in tendons and muscles do not heal properly, deformities and inflammations can occur. These also lead to restricted movement. In most cases, the treatment of the imbalance takes the form of therapy. This is primarily based on the cause of the imbalance. If nerves have been damaged, it may not be possible to heal all restrictions again.
Prevention
Muscular imbalances can be prevented in everyday life by proper movement, sufficient exercise, and equal stress on agonists and antagonists. Because posture also contributes to proper movement control, attending a posture school may be useful. After trauma, dysbalance can be prevented in the form of professionally supervised rehabilitation that is as complete as possible.
Aftercare
Therapy for a muscular imbalance can only have a lasting effect if consistent aftercare is provided. This can be well implemented by the patient with a physiotherapist or sports instructor for rehabilitation, but also in the gym. The goal is basically to compensate for the muscular imbalance or to prevent it in advance by strengthening weak muscles and stretching shortened muscles. An example is stretching shortened chest muscles and strengthening the upper back in people who work daily at a PC in a bent-over posture. Strengthening of muscles is done with targeted strength training, for which the patient can also have an individual plan drawn up by the physiotherapist or rehabilitation sports instructor. It is also important during aftercare to make this training efficient with correct exercise execution and regular sessions as well as the individually optimal load dosage. Stretching shortened muscles is just as important as strengthening when it comes to muscular imbalance. Stretching is not only an important element before and after training. It can also be effectively incorporated again and again in everyday life, for example during breaks at work. Special stretching courses are also often helpful, as is yoga, which is ideal for whole-body strengthening and does not neglect stretching muscles. Those who tend to shorten certain muscles should also pay attention to an ergonomic design of the workplace.
This is what you can do yourself
To counteract muscular imbalances, proper sitting is elementary. It is recommended to sit ergonomically and dynamically on the office chair. A combination with a height-adjustable desk makes sense. The sitting position should be changed as often as possible, and working while standing and actively walking around is also recommended in everyday office life. Muscular imbalances are often caused by a lack of movement. It is therefore important to integrate more movement into everyday life. It makes sense to ride a bike to work or park a little distance away to walk a few more minutes. Instead of the elevator, it is better to use the stairs and the printer should not be located directly at the workplace to get up every now and then. Since muscular imbalances can be caused by one-sided training and a lack of stretching during sports, care should be taken to always warm up and also to always train opponents. It is also important to wear appropriate footwear. During sports, ill-considered increases in load, falls, running on uneven surfaces and muscular overloads should be avoided. This can also prevent muscular imbalances. In the case of muscular imbalances, sports in which many muscle groups are used in a balanced way and at the same time, such as dancing, gymnastics or martial arts, are helpful.A varied training program with strengthening, coordination, balance and stretching exercises is also useful. If improvements do not occur through self-help measures, sports therapy is advisable; targeted exercises under guidance will correct deficits in the musculature.
