Musculoskeletal conditions are the costliest and most rapidly growing group of diseases (1) The number one cause of disability and the number two reason for office visits to doctors in the US is joint pain. 18% of the US adult population will have disabling joint pain at some point in their life. Direct and indirect costs of musculo-skeletal conditions account for over 149 billion or 2.5% of the gross domestic product (1992). Knee pain specifically is the third most common reason for physician visits and accounts for 14 million office visits in 2009.
Osteoarthritis, the wear and tear form of arthritis, is the most common diagnosis for joint pain with muscle imbalances being a contributing factor in the vast majority of cases. 70% of all people visiting physician however, receive drugs (anti-inflammatories and analgesics) as the primary treatment but these therapies do not address underlying causes.
Joint misalignment is an independent risk factor for osteoarthritis progression and specific exercises can prevent or delay osteoarthritis. The questions that need to be answered are: which muscles need to be exercised and; which exercises should be avoided?
The good news! The Diagnosis Foundation (DxF) is offering corporations a way to reduce their medical and workers compensation expenses by addressing this issue. The DxF can come to your facility and:
Screen personnel for imbalanced muscle strength in either the legs, ankles, arms or wrists
Refer personnel with abnormal muscle strength balance to your company physicians or other doctors who specialize in these conditions
The Screening Examiner is a volunteer position with the Diagnosis Foundation (DxF) for people who have passed the certification examination of the testing procedures involved in each particular screening event. Part of the certification and continuing education requirements for each certification is participation in X number of screening events and examining x number of participants.
Screening examiners coordinate the days and times they participate in DxF sponsored screening events with the Volunteer Coordinator. Additional information about screening event team members is located here. A brief outline of ‘Screening Examiner’ responsibilities are:
1) Screening activities
Review pre-screening questionnaire for contra-indications to performing any test
Examine each participant
Record results (for screening events without an Assistant Manager)
Review findings with each participant immediately after
2) Post-screening activities
Participate in Lessons Learned review
Solicit, collect & enter in Membership DB new research members
Recruit additional Screening Examiners
3) Accomplishments to become Screening Examiner
Passed the certification exam for the testing procedures involved in each particular screening event
The Screening Manager team member is a mid level volunteer position with the Diagnosis Foundation (DxF). Volunteers coordinate the days and times they participate in DxF sponsored screening events with the Volunteer Coordinator. Additional information about screening event team members is located here. A brief outline of ‘Screening Manager’ responsibilities are:
1) Pre-screening activities
Establish tentative dates
Verify availability of all required personnel, equipment, etc.
Confirmations of scheduled dates for screenings
Point of contact for communications between existing: venues, Asst. Mngrs., diagnosticians
Reminders to all staff & venue for pre-screening deadlines
Weekly updates with screening supervisor
Materials / Supplies – Organize, gather, produce, deliver, etc. all materials, supplies, equipment, furniture, amplification, tents, signage, etc.
Marketing of screens
Assist venue with internal & external marketing
Implement DxF internal marketing
New venue development
Site visit – Evaluate logistics requirements at new venue
2) Screening activities – Exit processing
Follow up – Any abnormal findings, fill out and discuss with screening participants the Follow Up Form
Obtain participant initials on Research Membership Agreement
Q & A Cards – Collect cards for DxF responses
Solicit: newsletter / general memberships / donations
3) Post-screening activities
Participate in Lessons Learned review
Inform supervisor of fundraising & new venue leads
Recruit & train additional Screening Mngrs. with approval of Screening Supervisor
Intern with Screening Supervisor
4) Accomplishments to become Screening Mngr.
Pass quiz on Screening Mngr. activities
Participate as Asst Mngr. in 3 screenings
Recruit & Train 2 of Asst. Mngrs.
Solicit, collect & enter in Membership DB 50 Research Members
The Screening Assistant Manager team member is an early level volunteer position with the Diagnosis Foundation (DxF). Volunteers coordinate the days and times they participate in DxF sponsored screening events with the Volunteer Coordinator. Additional information about screening event team members is located here. A brief outline of ‘Screening Assistant Manager’ responsibilities are:
Record Screening Results – onto form or database (if available)
Assist with intake or out take as needed
Participate in Lessons Learned review
Solicit, collect & enter in Membership DB new research members
Recruit & train additional Asst Mngrs. with approval of Screening Mngr.
Accomplishments to become Asst Mngr.
Participate in 2 DxF sponsored screenings Or previous experience with anatomy & / muscle strength testing
Recruit & train at least 1 DxF Screening Staff member
The Screening Staff team member is an entry level volunteer position with the Diagnosis Foundation (DxF). Volunteers work at screening events helping people to learn about balanced muscle strength and how it can prevent arthritis and / or improve their physical performance in athletic activities. Shifts last for 2-8 hours based upon your schedule and DxF needs. The days and times that you participate in DxF sponsored screening events is arranged with the Volunteer Coordinator. Additional information about screening event team members is located here. A brief outline of ‘Screening Staff’ responsibilities are:
Screening activities – Intake Processing
Screening Schedule – Maintain the appointment sheet and participant flow into screenings.
Forms – Distribute forms for participants to fill out in advance of testing
Verify Forms – That they are filled out completely and legibly.
Verify Membership – All screening participants must be either a Research Member or General Member
Participate in Lessons Learned review
Recruit & train additional Screening Staff with approval of Screening Mngr.
Accomplishments to become Screening Staff
Pass quiz on screening procedures & Screening Staff activities
There 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.
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).
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.
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.
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?
If 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?
When 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?
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.
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 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847521/
The Diagnosis Foundation (DxF) is working hard to improve people’s health and we need people to help! Have you got 5 minutes? a few hours? Here’s some of the types of volunteer help we need:
New venues for Balanced Muscle Strength screening – Do you have inside access to someplace that might want a Balanced Muscle Strength (BMS) screening? This could be a sporting event,
The Diagnosis Foundation (DxF) is working hard to improve people’s health and we need your help! Have you got 5 minutes? A few hours? Here’s some of the types of volunteer help we need:
New venues for Balanced Muscle Strength screening – Do you have inside access to someplace that might want a Balanced Muscle Strength (BMS) screening? This could be a sporting event, health club, business wellness program, clinic, health expo, sports team, etc. Can you contact them, and if you get a positive response, let us know? We can do screening events in the Long Island, Metro NY region for free (currently there are charges for other areas). For additional info on the BMS screens, click here and here.
Screening Events – Can you spare a few hours to help out at screening events? We need people to hand out forms, check paperwork, manage the screening appointment book and record results. This is a great way to find out 1st hand about muscle strength testing.
Web site development – Do you know HTML? Help is needed on a few small projects to improve the look of the web site.
The Diagnosis Foundation (DxF) will be exhibiting and performing muscle strength & balance screenings at the NBC NY Giants Health & Fitness Expo. Muscle strength imbalances can play a key role in many different conditions such as:
This free event will be taking place June 22 & 23 in MetLife Stadium in Rutherford, NJ between the hours of 11 am and 6 pm. As a follow on to this expo, you can take courses offered by the Diagnosis Foundation in muscle strength testing.
What is a Balanced Muscle Strength Screening? The DxF tests 12 individual muscles on each of your legs for strength. We are looking for any muscles that are too strong or weak compared to their neighbors. The testing process is simple, is done manually, it takes 10 minutes to do and involves no equipment. You can learn how to test for muscle strength through one of our educational or certification courses in as little as 2 weeks.
Why test for muscle strength balance? When one or more muscles is too strong or too weak compared to its’ neighbors, your joints will not remain centered properly. This will result in decreased athletic performance. That joint will not have all the strength, endurance or speed that it should. When imbalances are more severe or long lasting, you will be prone to injuries, accelerated damage in that joint and eventually osteoarthritis.
The NBC4, NY Giants Health & Fitness Expo will be held concurrently with the NJ state Fair. This is a perfect venue for people to learn about Balanced Muscle Strength. This type of strength & balance testing has been a standard procedure for major league teams and Olympic sports for many decades. Now, the Diagnosis Foundation is introducing this important athletic and health improvement technique to the public. Attendance is estimated to be between 30,000 and 50,000 over the 2 days of this event. Activities at the Expo include:
Over 12 different health and wellness tests and screenings in the categories of muscle strength & balance, cholesterol, diabetes, osteoporosis, blood pressure, prostate, kidney disease, breast cancer, glaucoma, vision and hearing, and body fat
fitness activities including dance demonstrations, Zumba and yoga lessons, and kicking and passing demonstrations on the field with The Giants
family activities including a meet and greet with Giants Players and NBC Talent, healthy cooking demos with food sampling, Virtual Tour through Human Body, Giant Rock wall
Here’s what we at the Diagnosis Foundation (DxF) have been doing to improve health care quality and simultaneously bring down costs. We have initiated a series of public health care screens that attempts to address early stage causes of diseases. The current screening program is looking at the balance of muscle strength in either the arm or leg regions. We test 12 muscles in each limb semi-quantitatively using manual muscle strength testing (1 rep max). People with abnormal results are counseled to follow up with a provider skilled in differential diagnosis of muscle strength imbalance causes (i.e. activity imbalances, neurological causes, vascular, bio-chemical, etc.) who can also provide treatment. Continue reading “Health care quality vs. costs”