How do you know what exercises to do?


Sit up - TestingThere are thousands of different exercises available.  Which ones should you do?  Will it help me be faster, stronger, have more endurance, etc.  Will it improve my muscle balance, help me recover from surgery or prevent injuries?  The most common reason people stop working out is because of pain while exercising.  This frequently is because the exercise is the wrong one for that person.

In order to determine which exercises you should be doing, there are the general phases of care which must be considered first.  By this I mean, are you repairing from a major injury or surgery, training to develop a new skill or working to improve some already perfected skill?  These 3 phases of care can be summarized as: Integrity, Capability and Extent (I.C.E.) and will each involve different types of testing and exercises.

  1. The integrity of your musculoskeletal system needs to be working correctly.  This means the bones, ligaments, nerves, arteries and basic muscle functions need to be intact.  If there is an issue in this area, you will usually be under the care of some type of physician (medical, osteopathic, chiropractic).  
  2. The Capability of your systems needs to be correct. This means the techniques are correct, you engage the muscles for each activity in the right sequence, at the right time and intensity.  Think of a baseball pitcher.  A fast throw will involve using muscles from the toes through fingers and they each need to be working the right amount at the right time to get a good pitch.
  3. The Extent of your capabilities is what most people think of when exercising.  They already have good form, good muscle balances, their technique for whatever activities are polished.  This is where you are looking for more power, speed or endurance. 

One of the major problems of choosing which exercises to do that won’t cause pain is somebody skipping phases.  They might be trying to improve speed or endurance while they still have muscle imbalances or damaged ligaments.  This topic of which exercises to do is quite large and would take a good size book to describe.  This article will take a closer look at a frequently overlooked component that can apply to each of the three major phases of care. 

Joint balance
All of the muscles around any given joint need the correct amount of strength pulling in each direction. For example, the muscles that move your thigh backward, need similar strength compared to the ones that move your thigh forward, to the outside, to the inside, rotating the thigh inward and outward.

There are nuances to what the exact balance of all the muscles in the body should be. For example, some research indicates that the quadriceps should be 20% stronger than the hamstrings to minimize chances of injury. This article however, is not focused on the exact balance that is required to maximize performance. Here we focus instead on major differences in strength for all the muscles that cross any given joint.

Why is balanced muscle strength important?


Vintage Balance ScaleIf one muscle around a joint is stronger or weaker than the rest, the bones of that joint will:

  • Not remain centered properly throughout the range of motion, this causes…
  • A fulcrum shift and muscular inefficiency
  • This results in a loss of athletic performance – decreased power, speed & endurance
  • Over time you get soft tissue damage & pain
  • Eventually resulting in: joint damage & disease

A muscle strength imbalance can manifest in many ways. In some cases, early stage muscle strength imbalance might result in one of your joints buckling in a particular direction when you are lifting close to your maximum weight. If every muscle except one that is required to lift a weight, is strong enough to do the job, the one weak muscle will be the limiting factor for how much you can lift. It will literally become your weakest link.

In other situations, you might experience that one muscle always fatigues first during a particular repetitive activity. Perhaps you notice this more on one side of your body compared to the other. This can come about sometimes because all of the muscles involved in the motion are not contributing their fair share.

How does a muscle imbalance come about?

Glute Med - anterior view - half bodyWhen you do high performance activities, the body recruits the necessary muscles and muscle fibers to get the job done. This activity gives the most stress to the muscles closest to the lines of force and less to those on the periphery of the action. This results in greater stimulus to growth on the muscles central to the action and less on the neighboring fibers. In addition, each muscle shape and type (fusiform, pinnate, bipennate, etc) grows at a different rate when subjected to the same stress. Doing the same exercises over time eventually results in some muscles involved in those motions getting stronger than others.

There are lots of other causes of muscle imbalances. Perhaps you miss certain activities more often than others. Perhaps you work a little harder on some motions than other. Other factors to take into account that are unrelated to how much you exercise could include: how much you work each individual muscle with the rest of your daily activities; old injuries; surgery; nerve or artery damage; etc.

How often does this happen?

Cross training programs are designed to minimize muscle imbalances, but they still occur. The Diagnosis Foundation has been doing a Balanced Muscle Strength screening program in the Metro NY area for months now. Groups that are being tested include: the public at large, yoga enthusiasts, CrossFit athletes, 5K runners, etc. Overall, statistics are showing that a very high percentage of people being tested have muscle imbalances. While the number of muscle imbalances are fewer among those who cross train than with other exercise programs and the population at large, they are still pronounced enough to be a significant factor affecting strength, performance and susceptibility to injury.

How do you know if you have any muscle imbalances and which muscles are involved?


Getting tested for individual muscle strength is a good way to find any imbalances in your muscle strength. This involves strength testing that isolates individual muscles.

To accomplish this, subjects are placed in very specific starting positions and asked to do a very specific motion that puts most of the work load on one group of muscle fibers, and minimizes the contributions from others.

For general strength purposes, a 1 rep max test is typically performed. Other testing protocols are involved when testing for endurance or speed, etc.

State of the art testing where documentation is required for insurance or legal cases typically involves sophisticated equipment (i.e. Cybex, Biodex). While muscle strength testing with this type of equipment can be extremely accurate, it tends to be limited in the number of different muscles that can be measured and takes a relatively large amount of time and money to perform.

Manual muscle testing, with or without measurement or recording devices, offers a much broader range of muscles that can be measured and can be done in a much quicker time frame and lower cost. Accuracy will not be as good with manual testing, but it is still considered to be of good quality with “good internal and external validity” (1). In a balanced muscle strength screening, a skilled examiner can test ten to twenty muscles on both limbs in less than 10 minutes.

Follow up & Results

When muscle imbalances are discovered through testing, the next step is to determine the cause.

  • Are you missing some muscles in your exercise program?
  • Are your daily activities working some muscles more than others?
  • Do you have an injury or history of surgery?
  • Nerve problem?
  • Artery issue?
  • Some other cause?

Once you have determined what the cause of the muscle imbalance is, corrective steps can be taken. In most cases, specific exercises to strengthen the weak muscles will be the core of the treatment program. Sometime, stretches are recommended for over strong muscles which have become shorter in length.

For many, modifying your training routines to include exercises for the weak links, can have dramatic results. Exercising the weak muscles will not only improve the muscle you are specifically targeting with the new work out, but it can also have dramatic effects on improving other activities that use this muscle as a synergist or stabilizer. You might just find that you get results in activities that at first glance seem totally unrelated. These improvements can also come about much faster than you would have thought possible.

Want to know more about FREE balanced muscle strength screenings?

See our online course in Balanced Muscle Strength

Author: Dr. John Wallman is a chiropractic physician with 30 years experience specializing in nutrition and exercise. He is currently president of the Diagnosis Foundation and formerly Director of Academic Affairs for the International Space University.

1) On the reliability and validity of manual muscle testing: a literature review, Cuthbert & Goodheart, Chiropractic & Osteopathy, 2007, retrieved from