Have you ever been told your pain is because one group of muscles have been over exercised? Many of my patients are told this. Therefore they are told that the solution for their pain is that they need to exercise the “weak” muscles to balance out the muscles. Many patients I see go to physical therapists and trainers believing that there will be a “magical” exercise that once they do will rid them of all pain. According to this theory once this balance is restored, then one’s pain should disappear. Although this occasionally works and I do believe exercising is great, this muscle imbalance theory is incomplete at best. This post discusses why muscle weakness is an effect of the pain, not the cause, and why exercising will not work to resolve pain in these cases.
If muscle imbalances did indeed cause pain and exercising would work, then athletes as a population should have less pain than the general population. The reality is they do not so the justification is that certain sports exercise certain groups of muscles “too much” causing an imbalance. Strengthening is appropriate when tissues are in a deconditioned state or have become debilitated. However, when someone who exercises their legs everyday and is much stronger than I is told that they have “weak calves” or “weak thighs,” then this idea is no longer logical or valid. Why don’t I then have their pain if I my muscles are weaker?
In a previous post titled “Why Do We Get Knots In Our Muscles?,” I discuss how tense knots in our muscles happen because the muscles are responding to anatomical dysfunctions. Briefly, muscles reflexively contract with associated hypersensitivity when there are structural dysfunctions over the joints they are involved with. The muscles will not relax and the hypersensitivity will not be resolved until the structural dysfunction is corrected, no matter how slight it may be. Let’s discuss two reasons why a muscle or certain group of muscles may become “weak” and why exercising will not help in these scenarios:
- Partial Contraction: When a joint becomes dysfunctional and a muscle or group of muscles associated with that joint contract to protect the joint, they stay partially contracted. These muscles by definition cannot be as strong as muscles that are completely relaxed. When a muscle contracts, it shortens. How much a muscle can shorten is limited. A muscle that should be at rest that is partially contracted is weak because the muscles fibers cannot shorten as much as a muscle that was previously fully relaxed. So a partially contracted muscles will be weak. However, this weakness is not caused by a lack of exercise. Therefore, exercising will not cause this muscle or group of muscles to strengthen. It in some cases, may make the problem worse. In this case, the answer is to figure out what structural dysfunctions the muscle or muscle are responding to and restoring normality to the area. As soon as this takes place, the partially contracted muscles can relax and will immediately be stronger if tested.
- Structural Change: In the simplest cases, a muscle has two points of attachment and the muscle crosses over a joint. In most cases, muscles are attached to bone via tendons. A contraction or shortening of a muscle or group of muscles produces motion over a particular joint or sometimes multiple joints. Therefore if there is a structural change at the joint where a bone shifts or torques from it’s ideal anatomical position even slightly, then the distance between the two attachment points changes. This structural dysfunction will produce pain over the area even if the pain is only tender to touch. The two points of attachment for a particular muscle or group of muscles may be shortened or lengthened in these cases. If the attachment points (called the origin and insertion) are shortened, then the muscle(s) becomes slack. A muscle that is slack will then have a harder time producing movement over its corresponding joint than if it did not have the slack. Simultaneously, the attachments of the muscle(s) that produce the opposite motion will be lengthened. These muscles will appear stronger. The end result is the muscle imbalance that many practitioners promote exercise to resolve. Exercising the muscles that are “weak” however will not necessarily resolve the structural dysfunctions. In these cases, exercising the “weak” muscle(s) will not work because it does not resolve the structural problem and in some cases can make the pain worse by further intensifying the structural problem. The answer in these cases is to restore the structure to normal so the muscles and corresponding tissues can work as designed.
The above examples are two reasons why muscles may be weakened for reasons that are different than simply over exercising or under exercising a group of muscles based on the anatomy or physiology of the muscles. Until we stop assuming that pain is caused by muscle imbalances and that the answer is “strengthening” the weak muscles, many musculoskeletal pains will not be resolved. Pain is not as simple as one group of muscles being too strong while their countering muscles being to weak. This does occur but the associated structural dysfunctions need to be addressed as well or pain will simply continue. These are not solved by strengthening exercises and often times exercises are not necessary. Instead of looking for the “magical” exercise, we should consider approaching these problems in a different unique way. A big component of Osteopathy is restoring the structure to as close to ideal as the body allows.