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Muscle Imbalance
A common, often undetected cause of aches, pains and disability

PARTS 1 & 2

Dr. Phil Maffetone

One of the most common complaints in adults is discomfort, injury, or some other physical ailments causing aches and pains. Every day millions of Americans treat these symptoms with aspirin, pain-relieving creams, gels, cold and hot packs, and over-the-counter medication and NSAIDs (non-steroidal anti-inflammatory drugs), such as Advil, Tylenol and Aleve. But many people do seek help for their aches and pains, from their family doctors, chiropractors, osteopaths, physical therapists, massage therapists, and even surgery.

While sometimes the problems are remedied quickly, many patients go from one specialist to another without resolution of their complaint. Usually underlying these physical problems is muscle imbalance. And yes, there are relatively simple ways to correct it.

Your body’s muscles are a vital part of overall health and fitness. In total, the muscles are the body’s largest organ, and they aren’t just for lifting, pushing, carrying, moving, or sprinting to get out of the rain. They are responsible for other functions such as helping to pump blood through the body’s miles of blood vessels, immune function, and burning body fat.

There are three different kinds of muscle in the human body, each with different functions:

1. Smooth muscle makes up the walls of the arteries to control blood flow and surrounds the intestines from beginning to end to regulate the movement of food during digestion. These muscles are controlled to a great extent by the autonomic nervous system (the automatic or subconscious control of many body functions).

2. Cardiac muscle is unique to the heart. While influenced by the brain and nervous system, as well as hormones, the heart also contains its own intrinsic mechanism allowing it to beat independently.

3. Skeletal muscle comprises the bulky muscular images we’re so familiar with in fit looking people. Most of these muscles are comprised of a variety of different fibers, primarily the aerobic and anaerobic types. While their basic movement is under conscious control from our brain (with many other actions taking place we’re not always aware of), you can also influence skeletal muscles significantly through exercise, diet, hormones, and therapies. Skeletal muscles are the focus of this article.

Unlike heart muscle, skeletal muscles work because the brain and nervous system control them; as such, it should be referred to as a neuromuscular system, which includes the brain and spinal cord, the muscles, and the nerves that connect them.

In addition to their physical attributes, skeletal muscles influence many areas of metabolism, including fat storage, the liver, and the brain. Skeletal muscles also play a significant role in immune function because of their antioxidant capabilities; they are essentially home to much of our antioxidant protection, given a healthy diet and the intake of foods high in antioxidants. Muscles are even a major source of blood and lymph circulation. This occurs mostly in the red aerobic muscle fibers, which are well endowed with many miles of blood vessels.

The Full Spectrum of Muscle Function

A primary function of muscles is that they move bones and allow you to use your body for standing, walking, running, and every other physical action. When muscles don’t accomplish this task, it’s typically due to some type of dysfunction. In general, the full spectrum of muscle function can range from very loose muscles that are grossly weak with no perceivable contraction, to the other extreme of hypertonic or very tight, spastic muscles. Between these two extremes are a number of other important conditions. But before considering them, it’s important to know how muscles normally work.

Normal muscle function

A muscle’s normal activity is a combination of contraction and relaxation, technically referred to as facilitation and inhibition, respectively. When walking, for example, contraction and relaxation occur continuously throughout the body. When muscles contract, they get moderately tighter while working harder; when relaxed they have less force and also allow the opposite muscle to contract better.

The best way to explain normal muscle function is to feel it working. Let’s use the biceps muscle on the front of the upper arm and the triceps muscle on the back of the arm. The contraction and relaxation of these two muscles, which usually work together to move the elbow, can provide an accurate view of how muscles normally work throughout the body. So try this experiment:

- First, in a relaxed, sitting position, with your left hand feel your right biceps muscle on the front of your upper arm. Then feel the right triceps muscle on the back of your upper arm. At rest, they should both be relatively relaxed—firm but neither tight nor too loose.

- Next, place your right hand under your thigh, then pull upward as if trying to lift your thigh; in doing so you contract the biceps muscle. Now feel the biceps muscle again with your left hand, and it should feel noticeably tighter. This is how a contracted muscle (one that is normally facilitated by the brain) feels.

- While continuing to lift up on your thigh, now feel the triceps muscle on the opposite side of the arm. This should feel much looser than the biceps and even a bit looser (depending on how much you pull up on your thigh) than when at rest. This is how a muscle relaxes itself more to allow the opposing muscle to contract. The biceps muscle is contracted (or facilitated), and the triceps is in a state of inhibition. In fact, without this extra relaxation (inhibition) by the triceps, the biceps could not properly contract.

During a walk, jog or run, this same facilitation and inhibition takes place constantly in opposing muscles, just like the biceps and triceps. It occurs in the quadriceps (front of the thigh) and hamstrings (back of the thigh), the anterior tibialis muscle (front of the leg) and calf muscles (including the gastrocnemius and posterior tibialis), the pectoralis muscles (upper chest and front shoulder) and latissimus (back of shoulder and spine), and so on.

Normal muscle function is the optimal state of the neuromuscular system. It provides the best balance of the physical body—with the right combinations of inhibition and facilitation to produce the most effective physical activity.

Abnormal Muscle Function—Neuromuscular Imbalance

Understanding the normal function of muscles can also give you a better idea of the abnormal. The most common abnormal muscle condition in active and inactive people alike is muscle imbalance, which occurs when two or more muscles don’t contract and relax as they should. This type of problem is referred to as neuromuscular imbalance.

Using the example above when you contracted the biceps and the triceps got looser, imagine if the biceps remained tight and the triceps remained loose even after you released your grip on your thigh. This is very much like the condition of muscle imbalance—except both muscles are in an abnormal state.

A muscle that stays too relaxed is referred to as abnormal inhibition and sometimes called “weak” (although this is not true weakness, which refers to the lack of power). This part of a muscle imbalance can be relatively minor causing minimal impairment, or in some cases extreme to the point of causing severe pain in a joint controlled by that muscle. In most cases, this inhibition causes an opposite muscle to become too tight, a condition called abnormal facilitation. Together, these abnormal muscles—muscle imbalance—can adversely affect the joint(s) they control, the tendons they’re attached to, and other muscles, ligaments, bones, and body areas (such as the pelvic, spine, or head) all over. This will also cause an imbalance in posture and an irregular gait.

The full spectrum of muscle function ranges from extreme weakness to extreme tightness, with normal in the middle. The extremes are usually due to a brain or spinal cord injury; those with cerebral palsy, multiple sclerosis, or who’ve had a stroke typically have this type of muscle weakness and tightness.

The development of muscle imbalance may occur as follows:

The abnormally inhibited muscle is lengthened, and is often the starting point for many common physical ailments that are not induced by trauma such as falling or twisting your ankle. This muscle weakness itself is often silent. However, you might feel the lack of function produced by it, such as something not right in the knee joint while moving. And, when the muscle doesn’t properly control the movement of a nearby joint, it eventually causes that body part to become inflamed.

Trauma—from a minor, seemingly innocuous muscle strain, or a major hit or fall that directly injures the muscle—can result in the same abnormal muscle inhibition.

The other side of abnormal muscle inhibition is tightness (abnormal facilitation). It often occurs as the body compensates to an abnormal inhibition that recently occurred. This tight muscle is often noticeably uncomfortable and sometimes painful, and it can impair movement by restricting flexibility. Tight muscles are shortened, making them candidates for mild, slow stretching; however, in most cases this would be treating the secondary problem as the cause is usually the weak (inhibited) muscle. In addition, in attempting to loosen the tight muscles through stretching (which is not recommended), you risk weakening the inhibited muscle more (because it’s already over-stretched).

Two Types of Muscle Imbalance

Today, health-care professionals, sports coaches, and athletes often use the term muscle imbalance. Unfortunately, there is no consensus about how muscle imbalance is defined.

There are at least two different types of muscle imbalance:

- Neuromuscular imbalance was discussed above, and involves the whole spectrum from brain and nervous system to the muscle itself.

- Exercise imbalance is generally a localized muscle problem, typically due to working one muscle or group much more than another; or using one muscle or group much less than another in daily life. (This is not to say that the brain and nervous system don’t play a role in exercising a muscle, but the term “neuromuscular” differentiates the two types of muscle imbalance for convenience.)

Exercise Imbalance

It’s not unusual for some individuals to define muscle balance and imbalance in terms of strength, making it more a local phenomenon because it reflects muscular exercise. In this case, the problem is too much or too little strength development in one muscle or muscle group compared to another. As an example, this can occur with lifting weights if the biceps muscle is used more than triceps exercises. The result is that the biceps becomes much stronger relative to the triceps. This could make the elbow or shoulder joint vulnerable to injury.

The cause of exercise imbalance can occur from improper weight workouts, performing one-sided-type sports such as tennis, or having a job that requires a high level of physical activity in only one muscle or muscle group. These are examples of using one while reducing the action of another muscle or muscle group causing imbalance. The lack of strength, typically from neglect or disuse, can also contribute to muscle imbalance.

Measuring Muscle Imbalance

Muscle imbalances can’t be easily evaluated using X-rays, CAT scans, or other high-tech devices. But it’s possible to measure the problem in other ways. In general, the “strong” muscle is measured against the “weaker” one:

- For neuromuscular imbalances, evaluations include testing a single muscle or muscle group to determine general contractibility.

- For exercise imbalances, specific measures of strength can be made.

Differentiating between normal deviations is important. The human body is not perfectly symmetrical, and therefore normal variations exist in muscle function and strength. The most common example is the expected difference between muscle strength on the left and right sides of the body—a right-handed person usually has more strength on the right side.

Observing posture and gait, and considering the health and fitness history are two ways of observing both types of muscle imbalance.

Strength versus Power

It should be noted that strength and power are two terms often used together but should be defined differently:

- Strength is defined as the maximum force a muscle or muscle group can generate, such as in lifting a weight. Athlete A can bench press 200 pounds and has twice the strength of athlete B who can bench press 100 pounds.

- Power incorporates a speed factor with strength. Athlete A and B can both lift 350 pounds, but athlete A has more power because he can lift this weight much quicker than athlete B.

The general terms “weak” and “strong” are usually associated with strength. However, these are vague meanings unless related to a previous muscle condition—For example, Athlete A’s leg muscles are stronger now that he is consistently exercising.

Observing posture and gait

When working with patients to assess their muscle function, I would study their standing posture and gait. In fact, just moving around during a walk from the waiting area to my exam room, including the act of standing and sitting provided valuable information about specific muscle dysfunction. Muscle imbalances are represented by excessive deviations in posture—curving of the spine, tilting of the head or pelvis, one-sided rotation of the upper body, or other distortions, some very subtle, others not. Expressing pain in a certain physical position also provides information about a muscle or muscles not supporting the body.

Irregularities in movement are more common with higher levels of activity, especially during exercise and in particular with running which relies on more muscles. One just has to watch athletes on TV or the runners at the end of a marathon or long bike event to see the more exaggerated forms of imbalance: irregular movements, and, in runners, even the erratic sounds of shoes hitting the pavement.

I recall my days as a student, learning about muscle imbalance and which muscles perform specific movements, and the imbalances that cause slight irregularities in gait. Some of my classmates and I would go to an indoor mall and watch people walk by, assessing them with our newfound understanding of human anatomy.

History

I found that the history of a person’s pain or injury usually provides a significant amount of information regarding which muscles are imbalanced. In today’s health-care environment, however, taking down a patient’s full history is a lost art. This is unfortunate since people knowingly and unknowingly provide many key clues by talking about their symptoms, and a good question and answer session may be the best assessment process that can uncover a hidden cause of a problem and lead to an effective therapy.

A person with knee pain who states he or she twisted an ankle a week before the onset of the problem is making an obvious statement about which muscles might be weak. In this case, one or more of the muscles that supports the ankle that can also influence knee movement, such as the posterior tibialis, could be the cause of the knee pain.

Asking a patient a question such as, “what movement causes pain” can provide important clues about which muscles are at fault. Difficulty with specific movements, for example, such as getting up from a chair, placing a hand on the low back area, or combing hair, are associated with particular muscle weakness.

Other assessment procedures are applicable to one type of muscle imbalance or the other as discussed next.

Testing muscle strength

Exercise imbalance can be measured various ways. The simplest method is through observation. By comparing the bulk of the left and right sides of the thigh, one could sometimes see large differences in muscle mass. This might also include obtaining a measurement of muscle bulk, such as the size difference between left and right lower thigh just above the knee. While muscle bulk does not necessary directly relate to strength, this provides a general measure of imbalance potentially caused by exercise or lifestyle factors—such as too much development in one muscle or muscle group compared to another. Left-right differences in the body usually exist but should not be significant. An example of a normal difference might be a right thigh measurement of 15? inches and the left 15 inches.

Testing a muscle’s strength is a simple way to measure individual muscles or muscle groups. If you can lift a 50-pound weight 15 times with your right biceps and seven times with your left, it shows you’re much stronger on the right compared to the left. In this case, the difference is probably not within the normal variation of being right-handed. Using your left arm more in the course of daily living could eventually make up the deficit.

Examples of sports medicine measurements

Comparing the strength of certain flexor and extensor muscle groups is common in athletes. An example is the relative strength of the hamstrings on the back of the thigh in comparison to the quadriceps on the front can be measured. This hamstrings:quadriceps (H:Q) ratio is a common assessment. An H:Q ratio less than 0.6 is thought to be abnormal, and this imbalance in strength between the quadriceps and the hamstrings could potentially contribute to knee joint or hip injury.

Likewise, the ratio of biceps to triceps strength has also been used. Studies show that a ratio greater than 0.76 may predict elbow injuries, although this particular study was done observing baseball pitchers.

Information about muscle balance is sometimes evaluated on an electromyographic (EMG) device. This equipment measures the electrical activity of muscles at rest and during contraction. Studies using EMG are commonly used in research and by clinicians to treat various types of muscle problems. Like most other muscle evaluations, there are no clear standards for gathering and assessing different types of EMG findings. However, comparing before and after treatment measurements can be very useful to determine whether improvements are being made and which therapies may be most successful.

Testing neuromuscular function

Generally speaking, muscles involved in neuromuscular imbalance can sometimes be measured using some of the same methods as above. This includes posture and gait, and a history. And, more subtle neuromuscular imbalances are not as easy to observe compared to the significant weakness found in stroke patients.

The size of the muscle in relation to the body’s left and right, or front and back, is not as relevant in the case of neuromuscular imbalances. In fact, strength and neuromuscular function in the same muscle sometimes don’t correspond. A frail elderly person could have poor muscle strength but good neuromuscular function, and a person who regularly lifts at the gym could have neuromuscular imbalance contributing to an injury.

As part of an assessment process, EMG may be useful in evaluating neuromuscular imbalance. Some practitioners, however, also use it as part of their therapy and is an example of biofeedback, defined here as a method of improving muscle function and correcting imbalance by consciously responding to the stimulation of pressure resistance by another person (such as a therapist) against a muscle.

Another form of biofeedback, manual muscle testing, is sometimes used with EMG but often performed separately as an assessment, and at times part of the treatment. Muscle testing is often used before and after therapies such as muscle stimulation, manipulation and massage, to evaluate their efficacies.

Manual muscle testing

As a form of biofeedback, manual muscle testing is commonly used for the evaluation of muscle imbalance, most often employed to evaluate neuromuscular imbalance. It can also be used as therapy.

The first textbook on manual muscle testing appeared in 1949 to assess muscle weakness in polio patients, and gradually, muscle-testing techniques were improved for the evaluation of a full range of muscle dysfunction in all types of individuals. Today, various forms of manual muscle testing are used by tens of thousands of health-care professionals worldwide. Manual muscle testing is also recommended by the American Medical Association’s guidelines for physical impairment.

The objective of muscle testing differs considerably among its users. For example:

Neurologists perform muscle testing to help evaluate brain and spinal cord function.

A physical therapist may use muscle testing to rate a patient’s level of disability.

An athletic trainer may use muscle testing to assess a particular athletic injury.

Chiropractors, osteopaths, and other medical doctors may use manual muscle testing as a form of assessment for neuromuscular imbalance.

Manual muscle testing involves physically evaluating individual muscles. This is accomplished by first positioning an arm, leg, or other body part associated with a particular muscle’s action. In this position, the practitioner applies force against the patient’s force from that particular muscle. Weakness due to abnormal inhibition may exist if the resistive force cannot properly be maintained, or sometimes if there is excessive pain.

Properly done, manual muscle testing can help differentiate between neuromuscular imbalance, and exercise imbalance. And, it can eliminate the need for EMG and other tests, many of which are much more expensive.

Ten Common Causes of Muscle Imbalance

1. Poor muscle development
This can arise from chronic exercise imbalance (such as lifting weight with certain muscles and neglecting others), poor running gait (which can develop certain muscles more than others), or overtraining (too much workout time and or too much workout intensity).

2. Poor lifestyle habits
This includes performing physical work requiring the use of certain muscles while neglecting others. Being overly right-handed while not using the left hand, and being generally inactive (the couch potato) are two common examples.

3. Micro-trauma
These injuries may be less obvious, such as regularly wearing bad shoes, sitting at your desk or in your car too much, or chronic repetitive stresses such as typing.

4. Acute or chronic localized injury
These injuries are more obvious and include the common muscle strain, a twisted ankle, or traumatizing a muscle from a fall or whiplash-type injury in a car accident.

5. Chronic and acute illness
Including diabetes (reduces neuromuscular function), sarcopenia (reduced muscle bulk with aging), chronic inflammation and related conditions (arthritis, obesity, and many illnesses resulting in significantly reduced physical activity).

6. Neurological disorders
These include brain injuries (such as Parkinson’s disease, stroke, birth trauma, head trauma), and spinal cord injuries (serious trauma that damages the spine affecting the spinal cord such as an auto, bike, or swimming accident).

7. Nutritional factors
Such as low dietary protein, dehydration, anemia, low blood sugar, and general malnutrition.

8. Pain
Whether from unknown sources, or chronic or acute pain from an injury or illness, the presence of pain itself can produce muscle imbalance maintaining a vicious cycle of cause and effect.

9. Aerobic deficiency syndrome (ADS)
Reduced aerobic muscle development can lower overall muscle function causing an imbalance.

10. Stress
Excess physical, chemical and mental stress can directly and indirectly cause muscle imbalance through mechanical and chemical means.

The above items are discussed in more detail in my books and other articles.

Muscles attach to bones through tendons. So when a muscle is not functioning properly, the tendons don’t either. Most tendon problems are secondary to muscles that don’t work well. Likewise, ligaments connect bones to other bones. And muscles have an important support relationship with both ligaments and bones, directly and indirectly. So when a ligament or bone problem exists, there is usually an associated muscle imbalance as well.

The cause of muscle imbalance must be addressed if normal muscle function is to be restored. Often, the body can accomplish this on its own, especially when it’s fit and healthy. Being barefoot is a powerful physical activity that can help the body correct muscle imbalance.

In fact, the body is always self-correcting problems. Even without knowing it, the body is always working to restore muscle balance. During the process of correcting its own problems, the body may show relatively minor symptoms, and often none at all. When your body can’t fix a particular problem, that’s when symptoms appear and an injury develops.

END OF PART 1

Dr. Phil explains how to test the tensor fascia lata muscle
(From the Manual Biofeedback DVD)


Muscle Imbalance: PART 2

A long history surrounds the concepts, theories, and practices that employ muscle imbalance. In brief, here are some of them:

- In 1741, French physician Nicolas Andre was one of the first to discuss muscle imbalance in his writings. He coined the term “orthopedia” which means “straight child” and advanced the notion that scoliosis, abnormal curvatures of the spine, was due to muscle imbalance.

- In 1890 French scientist étienne-Jules Marey made the first recording of a muscle’s electrical activity, and coined the term electromyography. This would become a common instrument to measure muscle imbalance.

- In 1900, Nobel laureate Sir Charles Scott Sherrington, an English neurophysiologist, proposed his law of reciprocal innervation, which stated that muscle inhibition usually generates tightness in opposite (antagonist) muscles. Despite this notion, most of the therapies associated with muscle imbalance were directed at tight and painful muscles, which, within the tight/weak model of muscle imbalance, were the most symptomatic and easiest to detect. This involved using braces and surgery by many practitioners.

- In 1949, American physical therapists Henry and Florence Kendall’s first textbook on manual muscle testing appeared, which evaluated weakness in polio patients. This marked a change in approach in treating muscle problems as both tight and weak muscles were observed and measured.

- In the early 1960s, clinical pioneers Dr. George Goodheart from the U.S., and Czechoslovakian Dr. Vladimir Janda took different paths in their pursuit of treating patients with muscle imbalance. Goodheart, influenced by Kendall’s work, promoted the idea that muscle inhibition (weakness) was the primary cause of muscle imbalance associated with everyday aches and pain, along with more serious disabilities. This triggered a muscle-testing revolution among many clinicians seeking to find and fix mechanical dysfunction. Janda took the tight muscle road like some of his predecessors, directing therapy at the tight side of muscle imbalance. Both clinicians developed huge multidisciplinary followings that continue today.

- As the jogging and fitness boom of the 1970s evolved, strength exercises such as weight lifting and various workout machines became popular. One result is that many people developed muscle imbalance by creating too much strength in one muscle in relation to another.

Today, there is usually a clear division among the many types of therapists who treat muscle imbalance. Some see the primary cause, and therefore direct their treatment, to the tight side while others focus on the weak muscles to correct the problem. On one hand, there are chiropractors, osteopaths, physical therapist, medical doctors, and massage therapists (to name a few) who evaluate and treat the tight part of muscle imbalance. While others in these same professions evaluate and treat weakness as the primary cause of muscle imbalance. I have always considered the weak muscle to be the primary problem in most cases, with the tightness a secondary problem.

Self-Care of Muscle Imbalance

While treatment by a health-care professional is sometimes necessary, many people are able to correct their own muscle imbalances. There are a number of ways you can accomplish this. Furthermore, the following approaches to correcting muscle imbalance can also prevent a recurrence.

- First and foremost is to address the cause or causes of muscle imbalance (discussed in Part 1).

- Second, allow your body to do the work. Muscle imbalance will often correct itself naturally in a body that’s most fit and healthy. This included the right exercise routine, a healthy diet, and proper management of stress.

- One powerful way to correct muscle problems is by developing a great aerobic system. In particular, the process of warming up before a workout and cooling down afterwards can immediately correct many dysfunctional muscles.

- Spending more time being barefoot can encourage many muscles to function optimally, correcting imbalance. Since the muscles in the foot significantly influence body-wide posture, being barefoot can help all skeletal muscles.

- Eliminating chronic inflammation can correct muscle imbalance—as the body’s natural anti-inflammatory chemicals are also powerful regulators of muscle function.

- Since pain can cause muscle imbalance, finding the source of pain, and eliminating it, also can correct muscle problems.

- The application of cold (cryotherapy) can also help correct muscle imbalance. But extended, continued use of ice placed directly against the body must be pursued with discretion to prevent muscle damage.

NSAIDs and Inflammation Can Cause Muscle Imbalance

Many people use NSAIDs when they have aches and pains, including aspirin, ibuprofen, Advil, Motrin, Nuprin, Naprosyn and other prescription and over-the-counter drugs. But these can weaken muscles as one of their side effects. They can even worsen the problem despite providing symptomatic (and temporary) relief.

The balance of dietary fats control inflammation, and conversion of the omega fats to inflammatory and anti-inflammatory chemicals relies on an important enzyme called cyclooxygenase, or COX. There are actually two COX enzymes, and many people are familiar with the term “COX-2 inhibitors.” Aspirin and other NSAIDs temporarily block the COX enzymes so much less of the inflammatory chemicals are formed. While this reduces the inflammatory chemicals, it also lowers the beneficial anti-inflammatory ones. In addition, the cause of the problem—fat imbalance—goes untreated. So, if taking NSAIDs makes you feel better, it usually indicates that your fats are not balanced. Here’s a quick review on how to improve the balance of fats to control inflammation:

1. First, eat approximately equal amounts of omega-6 and -3 fats. It does not necessarily have to be at each meal, but in the course of a day or week, strive for an overall balance. While this 1:1 ratio of -6 and -3 is ideal, the typical Western diet is often 5, 10, or even 20:1. It’s no wonder there’s an epidemic of chronic inflammation, pain, and muscle imbalance. One reason for this is the high intakes of omega-6 vegetable oils such as corn, soy, safflower, canola and peanut, and the low consumption of omega-3 fats, especially from wild fish, which is the best source, with beans, flax seeds and vegetables contain much smaller amounts.

2. By eliminating vegetable oils (substitute olive or coconut) and taking fish oil capsules, which are high in the most potent omega-3 fat, EPA, the balance of fats can significantly improve. (The omega-3 flax oil is less effective.)

3. Avoid refined carbohydrates, including sugar, which can increase the conversion of omega-6 oils to inflammatory chemicals.

4. A number of other dietary factors can impair the production of anti-inflammatory hormones, thereby increasing the inflammatory ones: low levels of vitamins B6, C, E, niacin, and the minerals magnesium, calcium, and zinc (these should come from a healthy diet); trans fat; low protein intake; excess stress; and aging, which increases the risk of more inflammatory chemicals.

A Note About Other Types of Pain Drugs

In addition to NSAIDs, a second type of over-the-counter drug used for pain relief includes acetaminophen. The most popular non-prescription one is Tylenol, which doesn’t act by reducing inflammation, and therefore is less likely to interfere with healing and recovery. In fact, it’s not entirely clear how it works, but liver stress is among the side effects; the body needs to break down these drugs in the liver, which requires large amounts of the amino acid cysteine (best obtained in the diet from whey consumption).

Narcotics, such as opiates, are another type of pain reliever. These act in the brain to reduce the sensation of pain and also don’t affect inflammation. However, they are easily addictive, and their use as a pain reliever wears off as the brain cells become desensitized. Common narcotics prescribed for pain include morphine and other opioid drugs such as codeine and oxycodone (OxyContin).

Yet another pain-relieving drug is THC, the active component in marijuana, which controls pain by stimulating certain receptors in the brain, similar to those that opiates act upon. THC can stimulate the brain’s natural opiates, like endorphins. The only prescription form is the product Marinol, although many states now have medical marijuana laws.

Manual Biofeedback

Among the many tools I used in private practice to help correct muscle imbalance was manual biofeedback. It’s a safe and effective, and relatively easy approach for use by most healthcare professionals, with its basic techniques used by many lay people as well.

Manual biofeedback helps the brain and body restore and balance muscle function. It addresses the problem of muscle imbalance that’s due to a wide range of problems. It can be used in children and adults of all ages who have suffered minor local muscle injury to more serious brain and spinal cord injuries. This therapy helps restore muscle balance by strengthening weak muscles and relaxing tight ones. It’s a simple hands-on system that requires no equipment.

Most people who have injuries associated with muscle imbalance fall into at least one of two categories:

Local muscle injury is the most common cause of physical problems, and is often associated with trauma to the muscle itself, such as the result of a fall, a so-called pulled muscle, a twisted ankle, or other injury. Micro-trauma is even more widespread; it’s the accumulation of minor physical stress in a muscle or joint, often unnoticed while it’s happening, eventually causing a more obvious muscle problem. Daily living produces significant wear and tear on the body’s mechanics—a stress that most people should adapt to well. But often, this stress is not compensated for and muscle imbalance develops. In addition to exercise, too much sitting, repetitive motion injury, or walking in poor-fitting shoes often leads to micro-trauma, which in turn ultimately causes muscle problems. Local muscle injuries can result in anything from minor annoying ache to a serious or chronic debilitating condition.

Brain or spinal cord injury can occur at any age, even before birth, and usually milder forms can be found in many individuals who don’t realize they have a relatively minor problem that still causes muscle imbalance. Trauma, infection, or reduced nutrient supply can easily cause brain or spinal cord damage resulting in poor muscle function. Many people are also involved in an auto accident or other trauma that can often sustain a brain or spinal cord injury—sometimes so apparently minor that many doctors or hospitals say you’re fine, even after an MRI or CT scan.

Manual biofeedback can help promote and restore muscle balance; it not only helps locomotion and posture, but can improve brain function as well, including speech, vision, balance, memory, and even intellect. And because muscles have other important functions, such as energy production, circulation, and immune activity, increasing physical movement can improve overall health.

Manual Biofeedback Can Be Used by Anyone

While healthcare professionals regularly apply the art and science of manual muscle testing, biofeedback and other hands-on assessment and therapeutic activities, there are tens of thousands of other individuals who learn to use these important techniques everyday. Almost everyone has used tweezers to take out a deep splinter (minor surgery), bandage an abrasion (emergency first aid) or in some instances even save a life by learning CPR (cardiopulmonary resuscitation). And it’s not uncommon to see, in many public areas, including airplanes, restaurants and malls, automatic cardiac resuscitators for emergency treatment in cases where a person’s heart stops—complete with instructions for the average person to use to save a life.

Manual biofeedback is just as practical, if not easier, than some of these techniques, and its successful application to the majority of physical aches and pains can be surprisingly simple once a bit of experience is attained. Manual biofeedback can be used in the young and old, including children, athletes, and everyone else.

While traditional EMG biofeedback uses computer equipment, including mechanical sensors and electrodes attached to the skin, manual biofeedback does not use any equipment. Instead, it relies on the neurological sense of the person using manual biofeedback. This personal approach also allows for the recruitment of more brain-body stimulation with verbal, visual, tactile, and other sensory cues that further enlists the patient’s participation and motivation. Like many forms of biofeedback, manual biofeedback relies on basic manual muscle testing.

While it takes another person to use manual muscle testing and the basic biofeedback therapies, with respiratory biofeedback, you can do it on yourself without assistance from others.

The Family Hope Center, which is based in Philadelphia, helps brain-injured children and teaches their parents how to apply many home therapies. A couple of years ago, the Center asked me to make an instructional DVD on manual biofeedback. I was happy to be of assistance. The DVD and users manual that I created contains an introduction to the concepts of muscle imbalance and how to remedy it, respiratory biofeedback and proper breathing techniques. It also includes the detailed use of manual biofeedback, and a library that demonstrates how to test and perform manual biofeedback on all the body's major muscles.

This DVD is now used by virtually all types of individuals dealing with sports injuries, common aches and pains, as well as improving brain function. (For more information, visit the manual biofeedback pages.)

Breathing Muscles

Of all the vital muscles necessary for optimal health and fitness, one of the most important is the diaphragm. This breathing muscle is located on top of your abdomen and under your lungs. The large flat muscle allows you to breathe by pulling in oxygenated air and expelling unwanted carbon dioxide. In many people, the breathing mechanism may be the weak link to improved overall function.

Poor diaphragm muscle function—muscle weakness—can lead to various problems such as general fatigue or poor function of many body areas due to reduced oxygenation. In this case, less air enters the lungs and the blood does not receive the proper amount of oxygen. Moreover, poor exhalation does not eliminate the necessary amount of carbon dioxide. Correcting diaphragm muscle weakness can allow the body to improve the function of many other muscles.

Everyone can incorporate the actions of normal breathing into their day—not necessarily only during exercise, but also during rest or down time. This can help improve one’s health, but also repair muscle imbalance.

Normal Breathing

It’s natural to take breathing for granted, until you experience a breathing difficulty. But some people breathe improperly and don’t even realize it, while many others could improve their breathing by controlling stress. Normal breathing is associated with proper muscle movement—the most important being the abdominal muscles in the front and sides of your abdomen and the diaphragm muscle. These muscles work together allowing us to efficiently breathe in and out. Without normal breathing, the abdominal and diaphragm muscles may work improperly, and even cause other muscles to not work. In this scenario, body movement—posture and gait, for example—can become impaired, oxygen can be reduced, and other problems can occur.

The abdominal muscles also help physically support your body structure—the spine, the low back, pelvis, shoulders, and even the neck. The abdominals not only help you walk, jog, play any sport like tennis or golf more efficiently, but also sit, stand and even sleep properly. In some cases, improper breathing is the beginning of a complex set of imbalances causing an injury to the low or middle back, hip, and shoulder.

Given the importance of the abdominal and diaphragm muscles, let’s look more closely at the two components of normal breathing—inhalation and exhalation:

1. During inhalation the abdominal muscles relax and extend outward, while the diaphragm muscle moves downward. This movement allows air to enter the lungs more easily and is accompanied by a slight whole-body backward extension, especially of the spine.

2. During exhalation the abdominal muscles contract and tighten, and are gently pulled inward; the diaphragm muscle “relaxes” with an upward movement. This helps push air out of the lungs, with a slight whole-body flexion.

By watching another person’s breathing, especially the belly moving out on inhalation and in on exhalation, one can often tell if it’s correct. You can also evaluate your own breathing by feeling the muscles move. So try this quick experiment:

Place the palm of one or both hands on the abdomen (over your belly button).

Slowly breathe in and feel the abdominal muscles expand outward. Your belly should get bigger during inhalation.

Slowly exhale and feel the abdominal muscles tighten and be pulled inward. The belly is more flat on exhalation.

During normal breathing, most movement occurs in the abdominal areas, and only slightly in the chest, which expands more with much deeper breathing.

Those who breathe improperly often move their muscles opposite that of normal—for example, they sometime pull their belly inward on inhalation. In other cases, the chest is quickly and fully expanded and the abdominal area doesn’t get a chance to move properly. These poor patterns of breathing can be caused from stress, the stigma of not showing their belly during inhalation. The use of so-called slimming garments that wrap around the belly can actually cause the abdominal muscle to weaken and therefore should be avoided. Even over-exercising the abdominal muscles—typically with sit-ups or crunches—making them too tight to relax. In a real sense, poor breathing is the result of muscle imbalance—weak diaphragm and tight abdominal muscles are a common example.

It’s particularly important to be aware of your breathing during times of stress, which is often when breathing can switch from normal to abnormal as you hold more tension in your abdominal and pelvic muscles.

If your breathing is abnormal or irregular it’s important to immediately retrain the breathing mechanism. This can be done using respiratory biofeedback (see the 5-Minute Power Break). The procedure is simple using the steps just outlined above for normal inhalation and exhalation.

Muscle Balance and Bone Health

In general, by maintaining proper muscle balance and by being healthy and fit, you can significantly reduce the risk of bone problems, including fractures and osteoporosis—injuries that occur in both men and women.

There are a number of other factors that significantly influence bone strength, in particular, the proper mineralization of bone. This is referred to as bone density. Your bones are not unlike muscles, intestines, skin and other tissues throughout the body. They are full of life—living parts of us. As such, bones are always metabolically active. This means there is always an ongoing influx and output of nutrients—calcium, sodium, magnesium, zinc, protein and others—which provides us with our level of bone density. If your bones lose more calcium, for example, than they take in, you risk weak bones vulnerable to injury and disease. Combine this with even minor muscle imbalance and the risk of bone injury is high.

In addition to muscle balance, here are some other key factors that greatly influence bone health:

- Aerobic fitness: this helps maintain support of bones.

- Gravity stress: this is associated with physical activity that improves bone density. For example, someone who only bikes for exercise might add walking or jogging to their workout routine.

- Hormone balance: both estrogen and testosterone in particular help regulate bone mineralization, as do adrenal hormones that regulate sodium.

- Adequate calorie intake: low-calorie diets can weaken bones.

- Proper fat and protein intake: both are necessary for bone health.

- Avoiding chronic inflammation: this problem can reduce bone density.

- Sun exposure: your main source of vitamin D, which regulates calcium.

When a bone is stressed, whether from physical strain, dietary or hormonal inadequacy, too little vitamin D, or disease, at least three types of injuries can result.

- A stress reaction is a subtle bone injury, microscopic in nature. It causes vague discomfort following physical activity, even just walking around. This problem can’t be seen on an X-ray or other scan, making it somewhat elusive.

- A stress fracture, which is more painful and usually restricts activity, can occur if more stress affects the bone. It can often, but not always, be diagnosed with an X-ray. It is also an example of a microscopic bone injury.

- A bone fracture or break can occur with higher levels of stress. There are many different classifications of fractures depending on how extensive it is and where the break is located. While more serious fractures can require surgical repair, many others are capable of healing with just a cast, or little or no support. In some cases, poor health is associated with bone injury, such as osteoporosis where reduced bone density contributes to a compression fracture (collapsed vertebrae). Fractures are more obvious on X-ray.

If you experience trauma—a severe twisted ankle, a hard fall, or drop a heavy weight on your foot—and injure a bone, healing occurs much more rapidly if you have better muscle balance and are healthier overall. This is true even for an extreme case where surgical repair is necessary. Most importantly, whether a stress fracture from exercise or a more serious bone injury such as a broken hip from a fall, there are usually key causes of more severe health problems that need to be addressed.

Stress fractures

The most common bone problem in active people is stress fracture. They can occur without obvious trauma, and are often due to muscle imbalance interfering with weight bearing, gait, and other movement. While the bones in the legs (tibia and fibula) are common sites of stress fractures, they can also occur in the foot’s metatarsal and navicular bones, the pelvis, and wrist.

Pain from a stress fracture typically improves with rest and worsens with activity. There is often some swelling in the area, but sometimes it’s not noticeable. The swelling around the site of fracture may prevent a proper diagnosis by X-ray if taken within the first two weeks of injury. Only after some healing has taken place will the X-ray show the problem. In these situations, a bone scan may help locate the stress fracture when the X-ray can’t.

Most stress fractures will heal well in a healthy person without major therapy. Rest, cooling the site of fracture, cessation of weight-bearing exercise, and hard-soled flat shoes are often sufficient, but each case must be treated individually. Aspirin and other NSAIDs must be avoided as they can delay bone healing.

Just as important is the fact that something caused a stress fracture to occur; and that something—some imbalance in muscles, hormones, diet, or often a combination of problems—must be found and corrected. If this does not happen, you are vulnerable to future fractures.

A low-fat diet may be associated with a higher incidence of stress fractures—statistically more in physically active females. Fats are important for many aspects of health, with certain fats helping to carry calcium into bones and muscles.

The importance of optimal muscle function for bone health is often not addressed by health-care professionals. However, this may be the most important contributing factor in stress fractures. Three muscle problems can exist in this context:

- Muscle imbalance can cause reduced support and increased stress on specific areas of the skeleton.

- Poor aerobic function, as seen in the aerobic deficiency syndrome, can result in the daily loss of bone support.

- Low muscle mass, such as that seen in sarcopenia, is associated with poor strength, loss of bone support, and increased vulnerability to falls and other injury.

Muscle balance is a key part of physical health and fitness. An imbalance of two or more muscles typically results in one being weaker, and often not symptomatic, and another too tight. This imbalance can be a primary cause of various aches and pains, some minor and merely annoying but others debilitating. Correcting muscle imbalance is something you can do—it’s one of the jobs of a health and fit body. In some cases, finding a healthcare professional may be necessary to accomplish this task.
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