Muscle Imbalance

Muscle Imbalance

Many biomechanical problems that we treat are the result of muscle imbalance. This is especially true of the shoulder and the kneecap, which are predominantly stabilised by muscles rather than ligaments.

Joints move when activated by muscles, which pull them in a specific direction. Most joints have a combination of muscles applying forces in different directions at the same time. This gives the joint a new direction of movement. A problem occurs when one of the muscles in the group becomes weak compared to the others (ie: as a result of injury, overuse, under use, or postural mal-alignments). The joint then moves in a dysfunctional way causing pain, swelling, muscle spasm and possible tissue damage.

In this situation, the physiotherapist treats the joint locally to decrease pain, swelling and spasm and then assesses the muscle balance (length/tension relationship) to ensure that the cause of the problem is addressed.

An example is the kneecap, which runs up and down ‘tram-lines’ as the knee flexes and extends. The kneecap is held in position by the Quadriceps muscle which is divided into medial and lateral. If the knee is injured the medial muscle is inhibited from working. This means effectively that the medial structures are not working to counterbalance the pull. The patient then experiences knee pain due to kneecap mal-tracking.

The symptoms of this are:

  • Pain under the kneecap (especially when bending down or descending stairs).
  • ‘Creaking’ knee; the need to straighten the knee from a bent position and ‘crack it’
  • A build up of pain when the knee is bent for any length of time (eg when driving or sitting in a cinema).

The problem is resolved by taping the knee and specific exercises helping to redress the muscle imbalance.

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