A good number of people we see present with muscle imbalance.

So what is a muscle imbalance?

Simply put some muscles are tight and other muscles are weak. But it is not that simple.

Last week I treated a runner with hip pain. When I mentioned his gluteals were weak, he boasted that he could break the theraband with side leg lifts. However when I asked him to do a single leg squat he had no control.

So more accurately: are the right muscles working at the right time, in the right way?

Efficient movement requires coordinated action of multiple muscle groups. If a muscle doesn’t do its job, others will compensate. An imbalance leads to uneven loading on joints, resulting in pain and loss of performance. A runner with poor gluteal control will have increased loading on the outside of the hip, which could lead to tendinitis or bursitis, or the increased twisting in the knee may lead to patellofemoral pain or early osteoarthritis.

How do we get unbalanced?

None of us are completely symmetrical. We all have a dominant hand or foot, and this affects our habitual movement patterns. Certain sports exaggerate this. A previous injury may lead to altered movement patterns, e.g. an ankle sprain may cause a limp which will affect the muscles in the hip leading to secondary hip pain.

Chicken and the egg?

Research on the deep abdominal muscles found that in people with low back pain the muscles are delayed or don’t switch on at all. Injury of a joint results in muscle inhibition of the surrounding muscles. This can be seen after knee surgery when there is marked wasting of the quadriceps. The muscles affected the most are the antigravity/stability muscles, this is a serious design flaw, with the resulting weakness putting the joint at more risk of injury. So does the weakness cause injury, or is it a result of injury?

So we have a muscle imbalance after injury, from pain inhibition and compensatory patterns. Do these recover on their own? Not necessarily. The body tends to take the path of least resistance, so you will automatically use the muscles that are already working, reinforcing the muscle imbalance, so retraining is necessary. Which is why physiotherapists will always have work.

Strength training vs. motor retraining.

When doing exercises, we must think about what we are trying to achieve. If we are looking to get muscle hypertrophy, i.e. bigger and therefore able to produce more force, we use high load and low repetitions. To retrain motor patterns, low load with lots of repetitions is needed. We need to learn to activate the correct muscles first with specific exercises, then progress to functional retraining. This is a long process, with lots of practice and repetition. Think about how long it takes to learn to drive a car. How many hours of practice does it take before the process is automatic?

Pain is the last thing to appear and the first thing to go. Often these imbalances have been around well before you notice any pain, which is usually what prompts people to seek treatment. The pain may have resolved, but that doesn’t mean the imbalance has. So it is important not to stop the exercises just because you no longer have pain. A maintenance program may even be required.