This article covers the nuts and bolts strategies to fix muscle dysfunction and muscle imbalances.
We will cover specific sensations that arise when fixing dysfunctional muscles and what to do about them. The strategies in this article are based on observations and experiments over thousands of client sessions at Upright Health.
There are no placebo-controlled clinical trials to point to, and there probably won't ever be any that are useful. Your body is a complex nonlinear system that requires observation and calibration on an individual basis. This article will give you understanding and tools to explore your own body's limits and to expand those limits. These are strategies that have helped people avoid allegedly "unavoidable" surgeries.
To get the most out of this article, I recommend you also read the first muscle dysfunction and imbalance article. It introduces you to the basics of Muscle Function and Muscle Balance, defines the issues, and explains helpful key concepts you should know before you get started.
Quick refresher from the first article: a muscle imbalance is when you have a clear difference in the function of muscles around one joint or when comparing the same muscle on one side of the body to the other.
The two types are joint muscle imbalances and symmetry muscle imbalances.
A joint muscle imbalance has to do with the relationship between muscles that surround one specific joint (or multiple specific joints). It is a combination of two things:
To fix a joint muscle imbalance, do exercises that target the weak and/or stiff muscles.
For example, your chest and anterior shoulder muscles are strong and can lengthen and shorten without issue. Your posterior shoulder muscles are weak and have trouble shortening. As a result, you have trouble getting out of rounded shoulder posture.
Solution: do more exercises that improve the ability of your posterior shoulder muscles to shorten against resistance. This means you're building strength and shortening ability. This would be one potential exercise.
Often people find that their hip flexors are short and weak. Their glutes are stuck in a lengthened position and are also weak. It's a classic problem of sitting all day long.
In that case, you train the hip flexors to get longer AND stronger. You train the glutes to get shorter AND stronger (without sacrificing their ability to get long as well).
In summary, you identify what specific challenges your muscles face, and then you address those challenges head-on.
A symmetry muscle balance has to do with the relative strength or extensibility of the same muscle when comparing the two sides of the body.
If you find a symmetry muscle imbalance, you pick exercises to target the specific weaknesses and/or extensibility issues.
If you have a weak butt muscle on one side, you do extra training for that weak side.
Do exercises that force the weak/stiff muscles to work independently of the other side. A simple example would be a single-leg glute bridge. With a unilateral exercise like this, you can train the weaker side to catch up.
If you have a stiffer set of hamstrings on one side, you do extra hamstring stretching and lengthened strength work on that side. Again, a simple rule is to do an extra set for the target side.
Every man I've ever met has one stiffer, shorter hamstring side (unless they've actively trained to get rid of it).
Finding and fixing muscle imbalances, however, is just the first layer of training your body.
Sometimes you’ll discover that your hip flexors are super weak on both sides of your body (see the first article on muscle imbalances here for more on this). One side just happens to be much weaker than the other side.
In that case, restoring symmetry doesn’t fully solve your problem.
Maybe your right shoulder abductors are a bit stronger than your left, but BOTH sides are quite weak and stiff. It doesn't make sense to fix the imbalance and then leave yourself weak and feeble.
That brings us to the idea of dysfunctional muscles which we covered in the previous article...
Muscle imbalances give us a quick look at where dysfunction is hiding. To become truly functional humans, we want to optimize muscle function everywhere.
Quick refresher: A dysfunctional muscle has trouble lengthening to its full range and/or producing force at any given length.
Put another way: we want muscles to have strength at every length.
For example, many men have extremely dysfunctional hamstrings. Their hamstrings are unable to lengthen enough to allow them to touch their feet, AND their hamstrings are unable to contract strongly enough to safely shorten again without the whole body contorting and compensating. These muscles can’t achieve length; they also lack strength.
Women, on the other hand, often have hamstrings that are quite extensible. But their hamstrings are often weak and unable to shorten strongly enough to safely return to a standing position without compensation (hello, hip and back pain!). These hamstrings are dysfunctional too. They can achieve length, but they lack strength through the full range of motion.
If you find a dysfunctional muscle, you want to train it back to full function.
You want strength at every length.
If your hamstrings are chronically shortened and weak, you want to train the hamstrings to lengthen. You ALSO want to strengthen them in the short and long positions.
That means you want your hamstrings to be able to contract when they’re short and long (and also in various angles). That means you’ll perform exercises and movements that challenge the hamstrings when they’re short and when they’re long (and at various positions).
To strengthen them when they’re short, you might do something like this:
To strengthen them when they’re long, you’ll need to teach them to lengthen AND strengthen when long. This video demonstrates how you can do this using contract/relax techniques for your hamstrings.
Dysfunctional muscles need to be given a variety of challenges to recover their full function. Constantly training your hamstrings in a shortened position will make them chronically short. Constantly stretching your hamstrings and making them relax (as some flexibility-focused practices do) will leave them weak and your hip joint unstable. You want to optimize strength AND length.
The same idea is true anywhere you look in your body. You don't want to haphazardly stretch out all your shoulder muscles without training them to produce force. Doing so would result in an unstable (and likely painful) shoulder.
Conversely, focusing on training the front of your shoulder to be short and strong without also being strong when long will make it hard for you to reach overhead, swing a tennis racket, or do a pain-free push-up!
Stretching your back muscles without training them to be strong will leave you feeling loose and limber, but picking up a heavy bag of groceries will become a difficult, sometimes scary proposition.
On the other hand, doing a lot of back muscle strengthening in a shortened position (like constant deadlifting) will leave you feeling like the Tin Man from the Wizard of Oz.
You want me to touch my toes???
To feel strong, flexible, AND confident, you need your muscles to be able to lengthen AND produce force in every position.
In summary, to fix muscle dysfunctions:
When you start corrective exercises to fix dysfunctional muscles, you will experience a range of sensations. Some of them may worry you.
Here are several key signs of muscle imbalance/dysfunction and strategies to help you deal with them.
This is usually the one that scares people the most.
Let’s say you do an exercise that activates your inner thigh muscles. As soon as you start the exercise, you feel a sharp, intense sensation in the inner thigh muscles!
Or maybe you notice that your legs and thighs are shaking and twitching uncontrollably.
You panic and tell yourself, “OH THAT’S DEFINITELY WRONG! I must be hurting myself. SOMETHING IS WRONG.”
Sharp sensations are usually the clearest means that bodies have of telling us that we are deeply and profoundly weak in that position. Shakes and jitters tell us the same thing (though it feels a lot less threatening).
Sharp sensations can occur in the middle of the muscle (known as the muscle belly) and/or near tendinous attachments at the joint. It can be a small section or a large section.
Sharp pains at the tendinous attachments tend to elicit the most panic. People often interpret these sensations as “joint pain,” when in fact they are simply getting alert signals from atrophied bits of muscle fibers around the joint.
The jitters and shakes will generally be the entire limb or portion of the body. It could be your leg bobbing out of control or your arm shaking as you try to put it out to the side. The jitters and shakes tell you that your brain and muscles don't know how to efficiently handle the position. You're like a newborn calf trying to figure out how to fire muscles for the first time.
To fix this problem, stay calm.
You will need to learn how to activate the weak muscle(s).
Two things can help you here.
One is self-massage. Using a foam roller, lacrosse ball, or another handy semi-stiff implement, knead the target muscle. This helps relax and lengthen the muscle which will also help it function better.
Do not think of massage as a permanent fix, though.
Massage may help you feel and recruit the muscle better, but massage ALONE will rarely be the long-term solution. It’s a good way to manage soreness and stiffness that happens after exertion. It’s not a long-term solution for weakness or chronic lack of extensibility. For more detail on massage and dysfunctional muscles, check out this article.
Once you’ve massaged the muscle for 1-2 minutes, you should start to actually USE the muscle. But when you do that, don't go at it with 110% effort. Instead...
Reduce the difficulty of the exercise down to its easiest conceivable level. Practice the exercise, contracting the muscle with only enough effort to barely elicit the sharp sensation or quivers.
Once you feel the sharp sensation or quivers, maintain the same level of contraction for 30 seconds or more. If you can't do 30 seconds, aim for as long as you can. You may notice the muscle itself start to quiver or shake more. Relax and rest. Then do it again. Be careful to stay just below the level where your internal alarm bells go off.
If you get the shakes in a specific position, maintain that position and see if you can contract the muscles HARDER in that position while you hold it for 30 seconds. This will stabilize things as the brain and muscles get better at producing force there.
Holding the leg off the ground for 30 seconds forces the inner thigh muscles to get used to working. Your brain gets used to sending the "FIRE" command for a longer period.
Holding a difficult position for longer periods gives your brain and body time to figure out what to do.
You should feel the muscle working and sharp sensations will transform from an alarming pinpoint sensation to a more diffuse sense of fatigue.
This transformation may take a few sets (if you’re lucky). It may take a few weeks. It may even take a few months if your body has deeply atrophied.
The key is to keep doing it. This normalizes work in the muscle. Your brain gets used to giving commands and receiving feedback from the muscle fibers. This process builds a connection between the brain and the muscle. It also builds contractile elements within the muscle over time.
When you do any exercise, it’s important to know what muscles you should feel working. Once you know that, you can use the exercise as a solid test.
Here’s an example.
Let’s say you’re lying on your side. You are trying to lift the top leg toward the ceiling. You feel your inner thigh muscles working. You feel the hamstrings working. You feel the muscles of the front of your hip working. But you don't really feel the side of your butt working...
You're using the wrong muscles!
The muscles best positioned to lift your leg are the ones that are facing up. Why? Because gravity is pulling your leg down. You’re fighting against gravity.
If you imagine your muscles as rubber bands, you’ll see that the only ones that can lift your leg are the ones that are facing up to the sky. Your muscles act by pulling their ends together. They shorten to do work. You may find this video on super basic hip anatomy helpful.
The other muscles that attach to your leg pull your leg in the wrong direction. The muscles on the front of the hip pull the leg forward. The muscles on the back pull the leg back. The muscles of the inner thigh pull the leg down toward the floor!
You must use the outer hip muscles (the ones facing up toward the ceiling) if you want to do this exercise properly.
But let’s say you do the exercise and instead of feeling the muscles on the outer hip activate, you feel your low back and inner thigh fire up and cramp up!
Or let's say that you notice your leg keeps wanting to drift off course every time you lift it.
These are signs that you’ve got your wires crossed! Your brain is telling the wrong muscles to fire.
Misfiring muscles can be bad news. If you are walking and suddenly find yourself slipping on ice (or a banana peel), you need to be able to recruit the right muscles quickly to right the ship and stop yourself from falling.
If your brain defaults to firing the back muscles and inner thigh instead of the outer hip muscles, you’ll be slip-sliding your way home with a bruised butt or broken hip.
I guess I should've strengthened my outer hip last month!
First, massage the “wrong” muscles to get them to relax. This will make it easier to get the right muscles fire. If that doesn't help, try massaging the right muscles to get them to relax. This sometimes helps them fire better.
Pay attention to the result of massaging each muscle group. It will help you decide what to do in future training sessions. If you find that massaging one set of muscles makes your ability to recruit muscles worse or increases your pain levels, you know those muscles need to be strengthened more and not relaxed!
Sometimes the only thing you need is to concentrate on feeling the right place and then do the exercise over and over again. Often you’ll feel the wrong muscles fatigue out after 15-25 reps. Then you’ll feel confused. You'll say, "hmm...now I don't feel anything..." Keep going! Then you’ll feel fatigue creep into the target muscle(s).
Congratulations! Take a rest until you feel ready to go again. The next set, do the same thing. Over the course of a week or two, you’ll be activating the right muscles without having to think about it so much.
Whenever we try new exercises, there is a temptation to try SUPER HARD. When I try a new exercise, I often try to do it as high, far, and fast as I can. This enthusiasm, while laudable, means my brain tries to recruit anything and everything to get the job done so that I can impress myself (or anyone else who happens to be looking). The result is inefficient and incorrect movement patterns.
Trying super hard is counterproductive.
If you don't feel the right muscles firing, you are doing the exercise WRONG.
If you find yourself doing this, STOP. Instead, do the movement slower and with LESS range of motion. Hold the end position for 20-30 seconds or more, waiting for the correct muscles to give you a sensation of fatigue. Over a few days, weeks, or months, you should notice that your range of motion gradually increases. This strategy is slow-going but is reliable.
Hammering away with poor form and the wrong muscles firing is likely to lead to WORSE pain and dysfunction. So don't do it. Make sure you get the right muscles firing.
Angles matter a great deal when you’re targeting muscles. Sometimes shifting or rotating your limb or torso by five degrees in one direction will help you turn on the right muscles. For example, in a glute bridge, if you don’t feel the right glutes firing, changing the amount of knee bend can make a big difference. Making sure the low back is flat enough to keep the spinal muscles quiet also helps.
This is the least intuitive for most people. If an exercise is hard to do properly, how would adding weight/resistance help???
The simplest explanation is this: Adding weight gives sensory feedback that tells the body: “WE NEED TO PRODUCE SOME REAL FORCE OR WE’RE GOING TO FAIL.”
Resistance forces the body to recruit the muscle fibers that are most effective at producing the desired motion. It trains the right neurons and muscles to fire.
With no resistance, your body can produce some semblance of the desired motion with the wrong muscles. So it will.
By adding weight, you have increased the demand. Ineffective muscles can no longer do the job. The right muscles must work to produce more force. It’s a bit like the story of the grandma who lifted a car off her grandchild. With the right motivation, your muscles (and you) rise to the challenge.
Can-can / Standing hip flexion This exercise gets a lot harder when you add an ankle weight.
For example, hockey players often find it hard to perform hip extension without hip abduction. They’ve trained their hip muscles to do this constantly. This can and does lead to weakness in the inner thighs.
When trying to perform pure hip extension, their hips bias to hip abduction. No matter how much a hockey player tries to slow things down and mentally keep the movement in the pure sagittal plane, the leg moves out to the side.
Hockey players spend a lot of time in hip abduction or creating forceful hip abduction as part of the skating stride. This reinforces a pattern of abduction in many motions.
One way to clean up the movement is to train the inner thighs to fire while moving through the hip extension arc. This teaches all the hip muscles what to do when attempting to achieve hip extension.
This can come in both static and dynamic flavors. For a static example, it could mean putting the leg in different positions and firing the adductors by pushing into a stationary object.
By slowing things down, getting into controlled positions, and then asking the right muscles to fire, you can retrain movement patterns.
Generally, it's a good idea to use more static exercises in the beginning. This gives you a chance to feel the right stuff firing FIRST. Then you can increase the challenge by introducing a more dynamic exercise with more range of motion. This is an example of a more dynamic exercise that targets similar muscles.
We all end up with unique muscle dysfunctions and imbalances. Our childhoods, our hobbies, and our work lives influence the kinds of movement patterns we have. That means it's impossible to pick out magic exercises that will solve every individual's problem.
Experiment with all these strategies and you'll find yourself improving your ability to activate and feel the right muscles.
Pinching sensations are common at the shoulder joint, hip joint, and in the low back. I believe pinching and jamming sensations have one interpretation that yields three productive strategies that should all be applied and tested concurrently.
The interpretation is simple: the muscles aren't doing their jobs properly. Some muscles are not achieving the right length and/or do not have the strength to enable smooth and pain-free range of motion.
Here are the strategies for joint jamming:
Strategy 1 for pinching or jamming is the simplest to apply from the “dysfunctional muscle” perspective. You work on the strength and extensibility of that muscle. This has been helpful for people with “jamming" in their hip flexors. You train the muscles to lengthen and strengthen throughout their full range.
This video shows you exercises to build hip flexor strength in a shortened position.
This shows you one potential exercise to build hip flexor strength in a lengthened position. | From the Foot Pain Fix
Strategy 2 is approaching the problem from the “muscle balance” perspective. Say you have pinching and jamming in the hip flexors, but training the hip flexors directly fails to create any improvement after several weeks or months. Strategy 2 would mean you train the muscles that create opposing motions (like the glutes, hamstrings, and even adductors).
As with training any muscle, this involves strength in a shortened position, lengthened position, and any weak points in between.
Strategy 3 is a more global application of the muscle balance perspective. You look at other structures that affect the area of complaint. For example, a pelvis that is constantly stuck in anterior tilt can lead to jamming sensations in the front of the hip. If you have shoulder pain and hunchback posture, you need often need to deal with the hunchback first to before you can fix the shoulder pain.
With Strategy 3, you zoom out and look at the whole body. Ask yourself what else could be offsetting the body and creating undesirable, inefficient, and ineffective motion? Then go at it.
When you experience joint jamming, you should test all three of these strategies. Observe their effects over the short, medium, and long term.
Sometimes you will only need one or two of the three. Sometimes one of the three will actively worsen the situation.
You must observe how different stimuli affect the overall comfort, strength, and mobility of the joint (and the rest of the body).
When you first start learning to “listen” for feedback from your body, it can be challenging. Over time, you will be more skillful at hearing the feedback and identifying cause and effect.
And you will become a human who moves right and feels right.
Let’s look at an example of this. Say you cannot lift your arm out to the side. You experience pinching, jamming, and a hard stop sensation at the acromion process.
You apply strategy 1 and train the motion over and over again. The range of motion never improves. The pain remains about the same or potentially gets worse.
You apply strategy 2 and train the adductors of your shoulder joint. You try shortened and lengthened positions. This yields some slight benefit after a month. But you're still frustrated.
You apply strategy 3 and look at the relationship of the shoulder blade to the spine and rib cage (and their relationship to the neck, head, and pelvis). You train the muscles around your torso to restore a more ideal pelvis-spine-rib cage relationship AND continue to train the muscles around the shoulder joint itself. Boom. After two months of this, your shoulder feels GOOD.
Though a full “fix” may take a few months of experimentation (or longer), this is a very reliable approach. It's the approach I take in the Shoulder Fix.
I’ve actually been in this exact shoulder pain situation. I was unable to lift my arm to the side fully for years. The solution was not to keep jamming harder into the pinch (believe me, I tried). It was to develop better control of my spine and shoulder blades. This required training muscles that moved the spine, shoulder blades, and pelvis!
I’ve also seen this with a man in his mid-fifties with a recalcitrant case of “frozen shoulder.” Injections only provided short-lived moderate pain relief. They did almost nothing for his range of motion. He worked to free his thoracic spine and then improved control over scapular positioning. Over the course of three months, thoughts of steroid injections or surgery gave way. He basically forgot that he ever had “frozen shoulder.”
Strategy 3 is a strong reminder that you must maintain a local and global view of the body. The human body is an intricate machine.
Parts may appear to be malfunctioning in isolation, but the entire system is interdependent in complex ways.
The function of the knee joint is dependent on the function of the ankle and hip joints. The hip joints are dependent on the knee joints and ankle joints as well as the spine above! And the spine is affected by the rib cage, shoulder blades, and arms relative to those shoulder blades.
Your hands and wrists rely on the muscles of your elbows, shoulders, and scapulae (and therefore also the spine and hips).
You might feel the strain at the knees, but the feet, ankles, legs, hips, abs, and even neck all play a role in making this safe (DO NOT TRY THIS WITHOUT PROGRESSIVE TRAINING).
A sprained ankle can cause a limp and offset your entire body so much that your shoulder and neck start to hurt.
Narrowing your sights to only where you feel pain blinds you to the true causes and true abilities of your body. Remember to maintain a global view of your body. That’s how you become a human who moves right and feels right.
The next logical question is: "okay, how long does all this take?"
The answer is in the backyard.
Last year I planted potatoes in my backyard. I took a couple of store-bought potatoes that were sprouting and buried them in some dirt.
I watered them regularly. I gave them good soil to grow in.
I waited. And I waited.
I stuck my fingers in the dirt to check if they were ready. And then I waited some more.
One day, I stuck my fingers in the dirt, and they were ready to pull out of the ground! After several months, it was like magic!
When growing potatoes (or any plant, vegetable, animal, human, etc.), there is a timeline that is not in our control. No matter how much I wanted the potatoes to grow in three weeks, I could not drastically change the timeline. I could control the basic inputs. But I could not control the growth timeline.
The same is true for your body. You can control the inputs. You SHOULD control the inputs. Constantly train your body in the direction you want it to go.
But also accept that things will not always be fixed or get stronger as quickly as you hope.
Some issues seem like they resolve in a matter of days. Others can take months or years to fully resolve.
For any given area of concern, the reality is this: it will take as long as it needs to take (and that can be a while).
Sometimes that means you'll need to be doing the same few exercises for weeks. Sometimes it's for months. Sometimes you'll need to cycle different exercises to get the effect you're looking for. Remember that your muscles need to be trained in a variety of ways to maximize function and balance.
And you can't rush that.
If you've ever raised a child, you know that some things happen at their own pace. You may want your newborn to tell you when it wants to poo so you can put it on the toilet, but that's probably not gonna happen for a while. You may want your six-year-old to hit three-pointers on the court while under pressure, but you may have to wait until she's a little stronger (and taller).
People often get caught in an urgency trap. They think, "this problem must get fixed in [1 month/2 months/6 months] or it's a problem that I can't fix myself." They then seek out increasingly drastic quick fixes. The path starts with mundane quick fixes like more intense massages, chiropractic adjustments and then progresses to medical quackery like steroid injections, PRP injections, stem cell injections, or untested orthopedic surgeries.
The problem is with our willingness to take responsibility for our own muscles.
We need to recognize that the muscle dysfunctions that we have in the present are the result of all of our movement choices in the past.
If you have spent twenty-five years never raising your arms overhead, what is a reasonable amount of time for you to be able to do it comfortably? If you have spent thirty-five years spending 85% of your waking hours in a sitting position, what is a reasonable amount of time for you to balance out the hips? If your lifestyle stays the same and you continue to sit for the vast majority of your day, what effect will that have on the speed of your progress?
Having watched people improve their bodies over months and years, I can say this: the time it takes to fix long-standing muscle dysfunction is surprisingly short when compared to the amount of time spent creating the dysfunctions and imbalances. If it takes you forty years to create a problem and two years to fix it, that's a reasonable trade in my opinion.
The sooner you start training your body and making lifestyle changes that build you instead of breaking you, the better.
You've now learned some straightforward strategies to fix your short, stiff, and weak muscles. It's important to remember that this process involves experimentation with different movements and exercises.
You will run into roadblocks. You'll run into challenges. As long as you listen to your body, you'll make progress. Be consistent about the challenges you present to your muscles, and your muscles will rise to the challenge.
We've discussed some of the sensations you'll get when fixing muscle dysfunction. We've discussed how to address muscle imbalances. And, in a follow-up article, we'll discuss what to do about the dreaded pain flare-ups that sometimes happen when you're fixing your muscle dysfunctions. Stay tuned for that.
If you haven't already, be sure to read the first article in this series to understand the basics of Muscle Imbalances and Muscle Dysfunction.
You may end up with pain flare-ups when fixing your muscle imbalances muscle dysfunctions. Understand and fix pain flare-ups.
If you're in chronic pain, learn about the philosophy that helped me heal in Why am I in Chronic Pain?