Tuesday, April 27, 2010

Addressing Asymmetry & Compensation

In biology, humans are described as having 'bilateral symmetry'. In theory, we are symmetrical. We have two arms and two legs; one head. Most exercise training is done symmetrically, whether that is at the same time (barbell lifting), or alternating sides in a rhythmic fashion (running or cycling). The conventional approach is to work or use both sides evenly.

When we look a little closer, we find that we really are not as symmetrical as we think. Daily postures, old injuries, neuromuscular dominance, and our chosen activities all make us asymmetrical. At first, it may be a small muscular imbalance. Over time, we increasingly compensate with adjacent muscle actions and joint positions. These compensations start to feel 'normal' for us. We usually don't have a problem until we start to develop pain and weakness with added stress (a repetitive motion or the need to develop more force).

Just in this past week, I have worked with several clients with major asymmetries and compensations. They all experienced pain with some basic movements. Joint pain is a red flag and should immediately stop you. A joint may not be in proper alignment (that may be due to numerous causes, including shortened muscles, weak joint stabilizers, etc.). Usually, it is a subtle blend of relative joint flexibilty and inadequate stability. Let's look at some pictures of a client I worked with to see these issues.

Although, this client didn't experience any pain, she had limitations with he barbell push press she was trying to perform (it may be hard to see from this angle, but the right arm doesn't go back as far as the left). After taking her through several assessment tests, I was able to come to the conclusion that she was not able to fully flex (raise) her right humerus (upper arm) due to shortened muscles on the back of the right shoulder blade (Infraspinatus, and Teres Major for the anatomy nerds). With a little work (foam rolling, stretching, etc.) she saw improvements.

The shoulders and hips are notorious for asymmetries. The Lunge is a good assessment tool to see compensations.

This same client had joint pain while performing this Rear-Foot Elevated Lunge. Can you guess where she felt he joint pain? It was in her right (leg that is in the back, on the box) knee. Why? Tight/dominant left leg adductor (inner thigh) and weaker left leg abductors (outside of hip). The result was a dipping of the right side of the pelvis and twisting of the right knee at the lower range of motion. She didn't notice it until the lower range of motion. However, if she ignored these imbalance, they may evolve into pain with lesser movements (like just walking up and down stairs). We addessed these issues with appropriate hip mobility and stability exercises that she does with her warm-ups.

Asymmetries and compensations are very prevalent. Often, they are ignored until the point where they cause joint pain. The location of the joint pain usually is not the cause. It is the result. Seek functional symmetry; that is one side of your body should move (similar range of motion, joint stability, and strength) like the other side. We all have some mild differences. But, if you notice a significant asymmetry, you are at increased risk of injury (especially in vulnerable joints like the shoulder, knee and low back). Work on improving the asymmetries and make that a priority in your training. If you need more help, seek out a knowledgeable trainer or physical therapist.

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