The human body is a miracle of adaptation. Its primary objective is survival and movement. Movement is driven by sensory input. Sensory input drives motor output. Movement changes based on the environment and given task. Muscles move bones; brains move muscles.
We tend to think of muscle imbalances as dysfunctions when we should be thinking of them as nervous-system adaptations. The brain locks the adaptations in as a strategy for survival. We call that neuroplasticity. New sensory and motor maps are formed and grooved in the brain to get you to the next destination (an alternate route in your GPS system, if you will).
Sometimes the answer to changing chronic compensations and adaptations that cause pain lies in simply showing the brain there are other options available. We can do this using sensory input to change motor output by hacking the cerebellum.
The cerebellum receives information from the sensory systems, the spinal cord and other parts of the brain, and then regulates motor movements. The cerebellum coordinates voluntary movements such as posture, balance, coordination and speech, resulting in smooth and balanced muscular activity. It is also important for learning motor behaviors. It is a relatively small portion of the brain – about 10 percent of the total weight, but it contains roughly half of the brain's neurons.
Neurons that fire together wire together; neuroplasticity. You can wire efficient patterns or maladapted patterns. Here is a common adaptation you will find and suggested interventions.
Hamstrings to Glutei
The gluteus maximus and biceps femoris are synergistic for hip extension and posterior pelvic tilt. The glutei also eccentrically control hip flexion. They slow down hip flexion. Modern humans sit on their glutei all day, falling into a pelvic tilt; modern sitting habits drive posterior pelvic tilt.
The glutei become tight and weak from neurological inhibition. The brain downregulates activation of the muscle as a protective mechanism. When the primary hip extensors become vulnerable, the nervous system relays more responsibility to the synergistic biceps femoris. The hamstring now takes over the primary role of hip extension and posterior pelvic tilt, as well as having to maintain its own responsibility of knee flexion.
The biceps femoris becomes dominant and you often end up with high hamstring pulls and forced torque on the fibular head with external rotation of the tibia, causing knee pain.
You can adjust the knee and the hip, and you should. However, then you need to hack the brain with sensory input so it can maintain the new position of joint centration after the joint manipulation. Remember, muscles move bones and brains move muscles. So, what can you do about it?
Step #1: Manually Release the Hamstrings
Any manual release technique will work. Just don't cause more pain when you do the manual release. Pain will send the brain into a sympathetic dominant fright-fright-freeze mode and learning will stop. When in survival mode, the nervous system will fall back to relying on the dysfunctional pattern. Learning shuts down to prioritize survival.
When you add more pain into an already painful adaptation, you can reinforce the painful pattern and someone can become overly sensitive to stimuli (known as central sensitization).
Step #2: Vibration Stimulation to the Glutei
You can use any type of vibration tool you feel comfortable with. If you don't have one, you can use a manual tapping technique with your fingers. Simply tap (vibrate) the glutei for 10 seconds each. Pace should be between 120-300 bpm (beats per minute). This vibration frequency activates Pacinian corpuscle nerve fibers that decrease hypotonicity, and react to vibration and shearing. Stimulation of these fibers increases tactile acuity and motor control; the ability to accurately feel and pattern movement. It doesn't take a lot of pressure to change the nervous system.
According to Diane Jacobs, "Just touching the skin in a properly prepared patient will send a cascade of novel sensory information through to the brain and to all its maps." Maps are the representation of the body in the brain and it's place in the world. The better your sensory maps, the better your predictive capabilities and the better your movement. Less prediction equals more danger for the brain. More danger equals more compensation, stiffness, tightness and pain. Decrease danger and threat, and you decrease pain and high-neurological-demand compensations.
I suggest you purchase a metronome app and use the 120-300 bpm frequency tone as a guide for your rate of stimulation. Your patients will love the novelty of the sound.
Step #3: Contract the Gluteus Maximus Muscles
Have your patient lie on their stomach and contract each gluteus maximus muscle individually (one side at a time), making sure they do not engage the quadriceps muscle in the front or extend in the lower back. Have them do four seconds of concentric activation of the glute, hold isometric for four seconds, relax eccentric control of the muscle for four seconds and repeat four times.
Step #4: Tape the Gluteus Maximus Muscles
Apply a single piece of kinesiology tape over the top and outer edge of the gluteus maximus muscle on both sides to send novel sensory input to the brain 24/7 from tactile stimulation of the tape. This helps body map representation and stimulates interoceptors of superficial cutaneous free-nerve endings beneath the skin to mitigate pain.
The primary objective with this approach is changing the nervous system, not just the tissues. That's what we do as chiropractors. It's all about the nervous system. You can get there multiple ways; not just via the spine.
What's the take-home? No system in the body ever works alone, gets injured alone ... or heals alone. Think of the bigger picture when you see common dysfunctions / adaptations that keep recurring in the body. That's the brain trying to tell you something. Pain is a request for change. Start here.
Resources
- Butler DS, et al. Explain Pain. Noigroup Publications, 2019.
- Chaitow L. Muscle Energy Techniques. Churchill Livingstone, 2013.
- Elphinston J. Stability, Sport and Performance Movement: Practical Biomechanics and Systematic Training for Movement Efficacy and Injury Prevention. Lotus Pub, 2013.
- Jacobs D. Dermo Neuro Modulating: Manual Treatment for Peripheral Nerves and Especially Cutaneous Nerves. Tellwell, 2016.
- Weinstock D. NeuroKinetic Therapy: An Innovative Approach to Manual Muscle Testing. North Atlantic Books, 2010.
