The physical therapy and coaching industry is vividly interested in the concept of muscle imbalances and, obviously, tests and tools to address these imbalances and, maybe even fix them.
To be fair, most speak about management. There is nothing so sexy to me about the word management to me when you are faced with limitations and that you cannot move the way you were intended to.
That being said, we have been addressing muscles imbalances as a problem relating to biomechanics. I believe this is where we are only half right. If that is the case, we are also half wrong… and in the meantime, patients are suffering.
It is true that the state of biomechanics is affected negatively by a muscle imbalance. A thorough range of motion (ROM) examination will reveal restraints in joint mobility. An assessment of movement patterns will indicate possible difficulties in recruiting chains of muscles. That being said, the observable phenomenon is with biomechanics.
The issue is when we try to improve biomechanics by actually addressing the biomechanical system.
Essentially, if we are manipulating, adjusting, activating, releasing the components of that biomechanical system (joints and soft tissues), we are not addressing the root cause of the very imbalances we observed. We are implementing our will on a system that is managed internally for a specific cause… we tend to forget that…
We tend to forget that once we have imposed our will on that body, it has to function independently.
We tend to forget that we have gained ROM of a joint while our patient is lying on a treatment table.
We tend to forget that things might change once they get back on their feet.
We tend to forget that the body’s purpose, as of the age of 1, is to resist gravity. To address it in a condition where it is not doing exactly that is like trying to heal a sick fish out of water.
When addressing biomechanics with a biomechanical approach, we tend to forget that the very tissues we are working on are hooked up to the brain.
And again, if we consider that the brains’ first and foremost purpose is to keep us upright before we even think of moving any part of our body parts, we might start including the brain in our evaluation and treatment plans.
We might be interested in neuro mechanics more so than in biomechanics when the goal is optimal patient care.
Posturology is neuro mechanics. It addresses the most fundamental of all movements… posture.
Posture is movement. Posture is stability and, from what I gather, we are all looking for stability before mobility.
Stability is tonic postural muscles. Those muscles are the closest to the joints and they are under involuntary control.
They are under the control of extra pyramidal pathways that interact with the brainstem.
Brainstem input and output is of crucial importance in the regulation of the tone of these muscles.
The brainstem is rarely considered a piece of the puzzle to assess and treat to actually fix biomechanical imbalances. This needs to change.
For muscle chain fans out there, how often do you consider eye muscles in your chains?
How often do you consider that the innervation of the upper trap or the SCM is cranial nerve XI?
How often do you consider the TMJ muscles and their impact of the head, the neck and the other muscles of the body?
How often do you consider how much compensation must take place for you to stand upright via the vestibulo spinal pathway if both feet do not contact the floor the same way?
This is why it’s time to assess the body globally.
This is why it’s time to consider the feet and the eyes for what they are: the main sensory receptors the body uses for posture and movement.
This is why a muscle imbalance is a brain imbalance.
This is why it’s time for neuro mechanics.