Muscle Activation and Exercise Specialist
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Muscle balance, joiny stability and compensation in the body (Hip, Knee, Ankle)
Can my ankle injury be related to my back ache? Or vice versa?
How come I can put one shoe on easier than the other?
Can my posture affect my physical performance?
Within the field of exercise in recent years there has been an increased focus on relating posture and movement to people’s programmes. This is because:
In this article we take a brief look at how joints work and how compensation in movements can occur if optimum function is not available? Also we will discuss what the consequences of this might be and what we can do about it.
Structure dictates function! Or does it?
The above statement and question relates to the fact that the way bones form a joint, dictates the available function and range of motion at the joint e.g. a hip joint is known as a ball and socket joint and has a wide available range of motion in bending / extending, rotation, and side to side movement. Whereas the knee is referred to as a hinge joint and primarily bends and straightens although there is some minimal rotational movement available to cope with the transfer of force and motion up from the ankle and down from the hip.
The question ‘or does it?’ refers to the potential for the joint to fulfil its full range of motion or to move at all being dictated by the soft tissue i.e. muscles, tendons and ligaments and then the nervous system that tells the muscles when to pull and by how much.
Stability and Movement
If we take a look at the hip we can see that there are a number of muscles surrounding the joint. These muscles vary in shape and size i.e. short, long, wide, and thin. This by design enables muscles to have a primary role to pull in a particular direction with an advantage over others. Some work well primarily for movement where as others work well primarily in stabilising the joint.
When things are working well the muscles provide:
The above diagram shows how the line of pull of the muscles around the hip will affect the motion of the knee and the ankle. In the left picture for example if there is an equal pull of muscles to the front, in the middle and to the rear of the hip then the leg can be pulled directly to the side. If however the muscle towards the front of the hip were to dominate it could be pulled out and to the front, also affecting the position of the knee and the foot. The arrows point in both directions to signify how movement and force can be transferred up and down the body so likewise the movement of the foot on the ground can affect the motion of the knee and the hip. (Although we are focusing on the hip this principle applies throughout the body i.e. motion above can affect below and motion below can affect above)
The continuous balance of the pull of the muscles around the joints allows us an orchestration of optimal stability and movement.
Compensation in movement and dysfunction
We mentioned earlier how the muscles have primary roles regarding their shape, size and direction of pull. Due to the number of muscles around the joint and their varying alignment they can also play a secondary role and help out other muscles e.g. in contributing to movement or in stabilisation.
This can be seen in the above pictures of both an outer and deeper layer of muscles around the hip. For example the gluteus maximus is a large muscle that plays a role in hip extension, rotation of the femur (thigh bone) and also stabilising the hip. It is assisted in this role by a smaller muscle called the piriformis.
The beauty of this system is that if one muscle becomes inhibited in some way due to fatigue or injury then another can work harder and help out to keep us going.
There are a number of reasons why this need for compensation may occur e.g. poor posture, movement habits, injury, fatigue and it is definitely a good thing. In days gone by it would be essential for survival to be able to keep moving to find food and shelter.
However because the body is continuously adapting, if it picks up that this is now the way to move with most ease it will continue to do so without being able to recognise the affect long term. The long term effects being altered stress patterns wear and tear in the body and a decrease in strength and mobility.
Examples of causes of compensation in the body:
Injury – A twisted ankle will automatically cause the body to produce a limp. This alteration in movement will now put an increased load on the other leg and hip.
Posture – Many of us have an overuse of a slumped position due to the amount of hours sitting at home, at work or driving. This is also an adopted position at the shoulders when feeling stressed.
Movement – A mother may carry her baby to one side more than the other. A sports person may be more dominant on one side than the other.
With the continuing adaptation due to these circumstances the joints are not moving or being loaded optimally so we gradually start to lose the potential for movement as the body adapts accordingly i.e. bone wear and tear and muscle tightness. We will notice this with loss of muscular suppleness, endurance, control and power. Due to this process it may be years before we start suffering form aches and pains from an injury to an entirely unrelated part of the body!
Consequence of fatigue, injury, posture habit etc
Examples of altered muscle balance in action:
In these pictures we can see a demonstration of a squat. This motion is used daily whether standing from a chair or picking up an object in front of us. In this appraisal the arms are held in the air to help in identifying imbalances not discussed in this article. In the first picture we can see someone performing what would be deemed as a ‘good squat with a concertina effect at the ankles knees and hips. In the second picture the person is demonstrating a lack of motion at the ankles (either through habit or restriction) which means motion is increased at the hips in a forward lean to sink as low.
The implications of this coupled with a rounding of the back would mean the hips and more problematic the back will be taking a greater load or stress in this motion to get back up or lift an object.
In the third picture we see a view of the lower body from the front whereby the knees and ankles are roughly in line. In the fourth picture we see another or alternative compensatory movement for lack of motion at the ankles (either through habit or restriction) whereby the hips allow the knees to fall inward and the ankles to roll in.
The implications of this will be an increased stress or load on the inside of the knees in lowering and then with the pressure of standing back up.
What we can do!
Conventionally there are a number of options available to us in terms of therapies if we are in pain e.g.
Or self help via exercise strengthening and stretching protocols e.g.
These methodologies have been around for a long time and work on the basis of identifying postural and movement abnormalities in how you hold yourself and areas of immobility and tightness in the body.
Where there is a lack of mobility you can be clicked, massaged and stretched back into place. Where there is weakness you can do isolated and integrated exercises specifically aimed at that joint and that range of motion to emphasize certain groups of muscles e.g. core muscles.
Referring back to the squat pictures we have a variety of options available.
1) Although the body is designed to be able to move into these alternative positions, the movement in picture 1 is more desirable because it represents the position of most stability and strength. This is unless altered by habit, muscle tightness, or injury e.g. if someone’s knee hurts they are more likely lean forward from the hips than bend and stress the knee. So first of all we need to determine why someone may move this way.
2) If it is an acute injury then the first port of call is therapeutic intervention to address the inflammation and need for healing at the joint.
3) If it is a formed habit then simple re-education of how to squat for optimal strength is all that is necessary. If it is a chronic problem and the person has joint restriction through muscle tightness then a massage and stretch protocol is used followed by direct strengthening of the muscles around the joint before integrating back into the full movement.
This system is based on years of experience in terms of practice and research into how the body moves and where common weakness and compensations arise. However sometimes progress can be limited or may not work as simply as it suggests because there is not a true understanding of why the restriction may exist in the first place and why the muscles may be tight e.g. what job are the muscles doing? As a step forward in this process of rehabilitation and creating strength in movement a new system has evolved in an attempt to answer this question.
Muscle Activation Techniques™ (MAT)
Muscle Activation Techniques™ works with the process of how compensation occurs i.e. muscles become inhibited causing other muscles to overwork and tighten, triggering the compensation.
Instead of just working on the symptom MAT works on the underlying inhibited muscles and weakness in the body that are causing it to compensate or that now exist because of the compensation or injury. Once this strength and control is restored the body can release the muscles that have tightened in order to add stability to the joint. You will now feel that you have more mobility, strength, control and ease of movement throughout your body.
For example in reference to our ability to squat, a restriction at the ankles may be due to instability at the ankle at the knee at the hip or all three.
Muscle Activation Techniques™ can work on its own to restore strength and mobility or be used in conjunction with other therapy and exercise modalities. Whereby other therapies produce mobility the checks and balances used in MAT ensure that the joint is also stable so mobility will be maintained.
In terms of exercise, the weakness that MAT addresses is slightly different from that addressed through conventional exercise; where you may end up simply strengthening your compensation and the strong muscles get stronger whilst the weak remain weak! MAT tests for and addresses the body’s ability to regulate tension i.e. when you reach down to pick up a pen and your back spasms, it will not be because you do not have the strength to pick up the pen. It will be because you do not have the ability to regulate tension to give you enough support in the body as it changes position and adjusts to the change in load (whether a pen or heavier object).
With the additional stability MAT provides you will be able to make faster progressions in your exercise programmes. It is also often the case that you can focus more on exercise and sport that you enjoy doing rather than getting stuck with the same corrective exercises and re-occurring problems.
Owen Hedicker was the first UK Certified MAT Specialist and practices in and around the Southampton area Hampshire. He is also available for personal training.
Anatomy pictures produced by Primal Pictures @ www.primalpictures.com
Exercise picture produced by personal training on the net @ www.ptonthenet.com
Pictures of squat compensation from NAMS / CES programme @ www.nasm.org