What are we really doing as sports acupuncturists when treating injury and helping an athlete prepare their body efficiently, effectively, and wholistically for peak performance? How do we help regain that fine balance, the yin-yang tuning of the tissues and ultimately the athlete?
There are many things to consider, but what it really boils down to is joint mobility and stability through muscle inhibition and muscle activation; essentially, correcting muscle imbalances. Treating long, short, underactive, and overactive muscles is a staple of sports acupuncture therapy. The best tools to do this is with our needles, electric stimulation, our hands, and exercise. The trick is to identify those dysfunctional muscles.
This article is an overview of the common overactive synergist muscles I often see in my clinic. Every inhibited prime mover muscle will result in its synergist “buddy” muscles becoming dominant. These ancillary synergists have disrupted the recruitment patterns by taking a more active role and trying to perform as the primary mover muscle during a joint action. This is known as synergistic dominance.
Synergists and Agonists
As we know, the role of the synergist muscles is to assist the primary mover or agonist's muscle for a specific joint action in its most efficient and fluid manner. When there is a muscle somewhere in the body that becomes habitually overactive, it will reciprocally inhibit the antagonist, the muscle on the opposing side of the body. The body will then compensate by replacing that now-inhibited muscle with its synergists to keep that joint in action and keep us moving.
Now that these synergists have taken on a new role that wasn’t meant for them, they must adopt a new, compensatory level of tonicity (overactivity). Our bodies, like the flow of water, will move along the path of least resistance. As we know, this can eventually lead to injury. Let’s identify those common muscles based on predictive patterns of dysfunction that are often seen in the clinic – again, those tissues that need to be activated and those that need to be inhibited.
Assessing Your Athlete Patients
Along with a good understanding of your patient’s static posture, it’s important to create a biomechanical flowchart of your athlete; a detailed analysis of how that athlete functions and moves. A thorough assessment of the athlete through functional movement screening assessment, and overhead squat assessment should be performed.
After you have a good tally of the five kinetic chain checkpoints (feet, knees, hips, shoulders, and head), then you can selectively identify these points of the patient’s body to further scrutinize the dysfunction and prioritize your treatment strategy. You will create a checklist of all the mobility, asymmetries, and motor control dysfunctions. If any of these areas are out of alignment and exhibit dysfunction, there is a good chance overactive and underactive muscles will be found.
One of the important details to take into consideration during your exam is to identify if the joint is working properly by using joint-play palpation. It’s that little accessory or micro-movements (using light force) to assess the freedom of movement in all three planes. Then using active palpation of the soft tissues to distinguish whether there is actually a joint dysfunction or if it’s a tissue problem affecting the joint.
It’s important to palpate the front of the joint and the back of the joint while the patient moves the joint through the full range of motion during your assessment.
When figuring through this menagerie of long and short, overactive, and underactive muscles, there is often a misconception of what is going on. The sensation a patient has with muscle tightness doesn’t necessarily mean there is a tissue extensibility issue.
What’s happening here is that our nervous system is signaling to us that something is out of whack. If we have poor posture or functional movement compensations due to injury – new, old or from poor movement habits, our bodies conform to the poor mobility and motor patterns, resulting in these abnormal and dysfunctional muscle-length and tension idiosyncrasies.
The nervous system is in a constant battle to find homeostasis. The principal proprioceptors that are in this tug of war are the Golgi tendon organ (GTO) and the muscle spindle fibers. Together, they reflexively work to regulate the muscle length-tension relationship or muscle stiffness.
Remember Your Anatomy & Physiology
From Pysio-pedia.com: “The Golgi tendon organ (GTO) and muscle spindle are proprioceptors, or sensory receptors, that detect changes in muscle length, posture, and motion of body parts. The GTO is located at the interface between a muscle and its tendon. It senses changes in muscle tension and responds to increased muscle tension by inhibiting further muscle contraction. The muscle spindle, on the other hand, senses changes in muscle length and the rate of lengthening. The GTO and muscle spindle work together reflexively to regulate muscle stiffness.” https://www.physio-pedia.com/Muscle_Spindles
The other issue, as stated by Shirley Sahrmann (2002), is that when the muscle is stretched long or short, it disrupts or deforms the muscle's capability to generate force. It has lost its length-to-tension relationship in its normal resting state. Basically, the muscle filament proteins, actin, and myosin, either have too much overlap (as in an adaptively short muscle), or not enough overlap (as with an adaptively long muscle). In both cases, this deformation will render the muscles weak.
Finally, it's important to note that muscle imbalances do not always mean there is a movement dysfunction; however, these imbalances put a consistent and abnormal strain on the related fascia, tendons, and ligaments, subjecting them to a higher risk for overuse injuries. Just because a muscle is overactive does not mean it has become strong or tight. The nervous system has increased its neural drive to a chronically hypertonic state. So, while short muscles are weak, they are activated too easily and often prematurely.
Below is a list of commonly inhibited or underactive muscles and their overactive synergists. The following list was taken fro: Overactive Synergists Cheat Sheet by Dr. Brent Brookbush: https://brookbushinstitute.com/articles/overactive-synergists-cheat-sheet.
Upper-Body Dysfunction (upper-cross syndrome, protracted shoulder girdle):
External Rotator Activation
Child's pose is an effective stretch for both muscles.
Trapezius Activation
Deep Cervical Flexor Activation (usually just the activation exercises will release the SCMs and Scalenes by default)
Note: Improving cervical mechanics is essential to the optimal function of the scapular stabilizers, and the following mobility techniques may be beneficial to improving cervical dysfunction:
Dr. Brookbush Notes: For individuals with upper-body dysfunction, isolated activation is best performed in the following sequence:
Lumbopelvic Hip Complex (LPHC) Dysfunction (anterior pelvic tilt, lower cross syndrome)
Transverse Abdominus Activation
Gluteus Medius Activation
Gluteus Maximus Activation
Dr. Brookbush Notes: For individuals with LPHC dysfunction, isolated activation is best performed in the following sequence:
Lower-Leg Dysfunction (pronation distortion)
Gluteus Medius Activation
Vastus Medialis Obliquus (VMO) Activation
Tibial Internal Rotator Activation
Posterior Tibialis Activation & Tibialis Anterior Activation
Dr. Brookbush Notes: Although practice has shown that the order of activation in lower leg dysfunction is less critical, the following sequence is likely optimal:
This wonderful list is referenced by my friend and teacher, Dr. Brent Brookbush. He is the founder and owner of the online school The Brookbush Institute of Human Movement Science. I highly recommend you check out the school. It has greatly elevated my skills and knowledge as a practitioner. He has certified me in integrative manual Therapy and as a human movement specialist.
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