Chronic pain plagues millions of Americans as we speak. We know this, we diagnose this, and we try to treat this; but still the pain remains. If this is the case, what could we possibly do differently to curb chronic musculoskeletal pain? Shouldn’t the diagnosis of the pain be enough to guide treatment approaches? Experts warn of the contradictions associated with this approach.
“The medical diagnosis will help us with healing times, movement constraints and specific restrictions to the rehabilitation process, but will not help us to specifically prescribe manual therapy and exercise,” said Dr. Michael Voight, co-founder and lead instructor of the Scrape, Tape and Move course. “The motor system functions as an entity. It is principally a wrong approach to try to understand impairments of different parts of the motor system separately without understanding the function of the motor system as a whole.”
The Janda approach to chronic pain syndromes
“Dr. Vladimir Janda was a pioneer in assessing and treating musculoskeletal pain by viewing movement patterns and the neuromuscular system as a whole,” noted Dr. Phil Page, co-founder and instructor for Scrape, Tape and Move. Instead of using typical structural approaches (x-ray and MRI scans) that work for traditional acute injuries, he urged clinicians to use a functional approach and recognize the function of all processes and systems within the body. To break down his unique approach, we must analyze his two clinical philosophies:
- Tonic and phasic muscle systems
- Muscle imbalance syndromes
Tonic and phasic muscle systems
Dr. Janda preached that the musculoskeletal and central nervous system cannot be separated functionally; therefore, the term “sensorimotor system” is used to define the system of movement. Dr. Page noted, “Changes within one part of the system will cause the body to attempt homeostasis, resulting in a compensations or adaptations elsewhere within the system.” To begin diving into this concept, Janda suggested there were two groups of muscles:
- The tonic muscle system consists of the “flexors”, which are prone to tightness and soreness.
- The phasic muscle system consists of the “extensors,” which are prone to weakness and inhibition
You can learn more about these systems at www.JandaApproach.com.
Based on Janda’s clinical observations, this neurological predisposition to tightness or weakness can also be influenced by structural changes. To further explore how this results in muscle imbalances, he outlined his two famous “crossed syndromes.
Upper and lower-crossed muscle imbalance syndromes and how they associate with chronic pain
If you are working with a patient with chronic neck pain, checking for upper-crossed syndrome should be one of the first approaches to pain relief. This muscle imbalance is characterized by two sets of muscles: those that are tight and those that are weak:
- Tight upper trapezius and levator scapula on the dorsal side crosses with tight pectoralis major and minor.
- Weak deep cervical flexors cross with weak middle and lower trapezius.
If your patient presents characteristics of upper-crossed syndrome, you will notice postural issues like:
- Forward head posture
- Increased cervical lordosis and thoracic kyphosis
- Elevated and protracted shoulders
- Rotation or abduction and winging of the scapulae
Patients with low back pain are perfect candidates for an assessment of lower-crossed syndrome this muscle imbalance syndrome is characterized once again by two sets of tight and weak muscles:
- Tight thoracolumbar extensors on the dorsal side cross with tight iliopsoas and rectus femoris
- Weak deep abdominal muscles cross with weak gluteus maximus and medius.
Postural changes associated with lower-crossed syndrome will be identified as:
- Anterior pelvic tilt
- Increased lumbar lordosis
- If lordosis is deep and short, the imbalance is predominantly in the pelvic muscles. If the lordosis is shallow and extends into the thoracic area, then imbalance predominates in the trunk muscles
- Lateral lumbar shift
- Lateral leg rotation
- Knee hyperextension
How to counteract a crossed muscle imbalance syndrome
Treating a chronic pain patient with an upper or lower-crossed muscle imbalance syndrome dives into the intricacies of facilitating weak muscles and lengthening tight muscles. To learn how to integrate instrument assisted soft tissue mobilization, kinesiology tape and elastic resistance into your treatment plans, sign up for a Scrape, Tape and Move course in your area and learn from the experts!