1. Muscle imbalance As. PhDr. Kamila Řasová, Ph.D.
Department of rehabilitation
3rd Medical Faculty, Charles University in Prague

2. Back and Neck Pain 95% of back pain has no diagnosable cause
within 1 – 2 years, a minimum of 50% of such cases would go on to develop further recurrent pain episodes.
Studies have show that a high percentage of people with back pain have nothing more than tight (semi-contracted) back muscles.
It can be the cause of any number of muscle, fascia, metabolic and mechanical postural dysfunctions and syndromes.
Untreated imbalances can lead to “degenerative spinal conditions” that causes excessive forces on the spine’s joints, ligaments and discs from overactive (hypertonic, semi-contracted) muscles and underactive (hypotonic, overly stretched) muscles.

3. Skeletal muscles work together to allow movement.
3. month

4. 3 months model in verticalisation Stabile posture as a whole
Segmental level: co-contraction of antagonists
Spinal level: reflex under brainstem level

5. Segmental level: co-contraction of antagonists
Two groups of muscles based on their phylogenetic development (Janda, 1987)
The tonic system consists of the “flexors”, and is phylogenetically older and dominant. These muscles are involved in repetitive or rhythmic activity (Umphred, 2001), and are activated in flexor synergies.
They are prone to tightness or shortness.
The phasic system consists of the “extensors”, and emerges shortly after birth. These muscles work eccentrically against the force of gravity and emerge in extensor synergies (Umphred, 2001).
They are prone to weakness or inhibition.

7. Spinal level: reflex under brainstem level
Vertical chain to punctum fixum: sole-knee-pelvis-thorax-scapula-head

8. Chain of deep stabile system:
multifidi - transversus abdominis –diaphragm-pelvic floor
The role of diaphragm: – connection between respiration and posture, in co-contraction with m. transversus abdominis stabilizes chest, in dysfunction leads to hyperfunction of neck.
The role of planta pedis

9. Crossed Syndromes
Upper Crossed Syndrome” (UCS) cervical crossed syndrome
Lower Crossed Syndrome” (LCS) pelvic crossed syndrome
alternating sides of inhibition and facilitation in the upper quarter and lower quarter

10. Layer Syndrome (LS) stratification syndrome
- combination of UCS and LCS
- characterized by alternating patterns of tightness and weakness, indicating long-standing muscle imbalance pathology.
Janda, 1987, 1988

11. What Causes Muscle Imbalances?
1. A lifetime of poor posture 2. Jobs or activities that require a lot of forward bending (flexing) and/or lifting/twisting from that forward bend. 3. Jobs or activities requiring long or excessive use of extension (bending backwards) 4. Jobs that require static position or repetitive motion – like computer work, cashiering, etc, 5. A lack of exercise. Over exercise, and Incorrect exercising. 6. Repetitive Stress - Both Physical and Emotional - Just think about defensive attitudes, confidence, shyness and aggression. These immediately affect our musculature and it all shows up in our body’s posture. 7. Lack of restorative sleep 8. an accident injury 9. Once injured, the pain and physical reactions to that injury can create further imbalanced muscle problems if not properly treated.

12. Why to treat muscle imbalances?
A muscle that is chronically semi-contracted causes metabolic dysfunction within the muscle tissues. It also squeezes blood vessels and nerves running through the muscle. This interferes with healthy blood supply and proper nerve signaling.
Muscle imbalance and poor muscular coordination often result to injury.

13. An examination

14. TrP
Limit of movement
Role in blockage of join in „antagonists“ at vertical chiens causes punctum fixum
Mainly in deep stabile system

15. Treatment Post Isometric Relaxation Technique (PIR)
one of the simplest and most effective Muscle Release Techniques
release spasms, Hypertonicity and reflex compensations in muscles
lengthens fascia and allows the muscles to return to their proper resting length
increase range of motion
reduce chronic pain and myofascial restrictions
restore normal biomechanical function.

16. PIR is the basis for other forms of muscle therapy
Muscle Energy Therapy (MET) utilizes neurophysiologic muscle reflexes to improve functional mobility of the joints. MET uses active muscle contractions (controlled isometric contraction-release) followed by complete relaxation and subsequent passive stretching to increase range of motion (ROM) of the related joints. “Passive stretching” means the therapist does the stretch for you. (Hanna) Somatic Education is based upon a whole body therapy that helps to improve muscular function, control and teaches you the ability to “feel” your muscles (mind-body awareness). There are Hanna Somatic practitioners who can provide assisted therapy and once you understand and can perform the techniques properly you can do them at home on your own – a minimum of twice a day. If there are no practitioners in your area there are video tapes, CDs, and books available that provide detailed instructions on how to perform these exercises and help raise the awareness of how your own body/muscles are performing for you. Myofascial Release (MFR) This technique coaxes muscles in spasm to relax, and breaks down adhesions in the fascia. Bodies respond to this therapy by releasing tension that has been stored in the fascia, thus allowing more functional flexibility and mobility of the muscles, fascia and associated structures. This technique is more useful for those with long standing muscle imbalances that have developed dysfunctional fascia problems as well.
Cranio-Sacral is a very gentle process, using less pressure than the weight of a quarter. Make no mistake this is an extremely powerful whole body, muscle and spinal adjustment. Patients’ often think nothing much is being done while treatment is underway, but they soon change their minds when the treatment is over. Global Postural Re-education (GPR) The technique is known as Souchard's Global Postural Re-education and it employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse. Developed in France, 25 years ago, GPR is only now being introduced in the United States.

17. Janda principles Normalize the periphery
normalizing afferent information entering the sensorimotor system.
providing an optimal environment for healing (by reducing effusion and protection of healing tissues)
restoring proper postural alignment (through postural and ergonomic education)
correcting the biomechanics of a peripheral joint (through manual therapy techniques).

18. 2. Restore Muscle Balance
Techniques to decrease tone must be specific to the cause of the hypertonicity. These include post-isometric relaxation (PIR) (Lewit, 1994) and post-facilitation stretch (PFS) (Janda, 1988).
isolated muscle strengthening is not emphasized in the Janda approach. Instead, muscles are facilitated to contract at the proper time during coordinated movement patterns to provide reflexive joint stabilization.

19. 3. Increase afferent input to facilitate reflexive stabilization.
increasing proprioceptive input into the CNS with a specific exercise program, “Sensorimotor Training” (SMT) (Janda & Vavrova, 1996). This program increases afferent information entering the subcortical pathways (including spinocerebellar, spinothalamic, and vestibulocerebellar pathways) to facilitate automatic coordinated movements.

20. 4. Increase endurance in coordinated movement patterns.
Endurance is increased through repetitive, coordinated movement patterns. Since fatigue is a predisposing factor to compensated movement patterns, endurance is also more important than absolute strength.
Exercises are performed at low intensities and high volumes to simulate activities of daily living.

21. Lewit approach Relaxation of TrP, mobilization of joint blockage
Activation of co-activation: Diaphragm and deep abdominal muscles

23. Therapy models Neurotherapeutic facilitation Task oriented approach
Vojta reflex locomotion
Therapy by Bobath concept
Rasova K. archive
Body is stabilized enough to allow elicitation of the swing movement.
Therapist practices abilities to achieve specific task, in this case mopping the floor.

24. Motorické programy aktivující terapie