What is Muscle Dysfunction?
Athletes and dancers have to contend with tight muscles on a daily basis, often simply as a result of the high impact of intense training. However, if a muscle remains cramped over a longer period of time, this can be a sign of more complex underlying causes. The increased tension is most likely based on a pathological change in nerve stimuli, which is referred to as muscle dysfunction.
Muscle dysfunction can take the form of muscle tightness (contraction) or weakness (inhibition). In either case, the affected muscles will not be able to work at their normal capacity, and their individual functions will be impaired. This condition may extend to entire groups of muscles, causing muscle dysbalance, and can even interfere with motor patterns in the central nervous system. A motor pattern is like the “software” the brain uses to perform motion, so severe muscle dysfunction can have a significant impact on bodily movement as a whole.
Muscle dysfunction can also be a direct cause of overuse symptoms, such as joint pain or inflamed tendons (insertional tendinopathies), or it may cause joints to be less stable, thus increasing the risk of injury.
Chronic muscle dysfunction and muscle imbalance can ultimately cause restricted (i.e. cramped or shortened) fascia. Fascia is a connective tissue that attaches and stabilizes our muscles and internal organs. Such restriction of the fascia can put enormous pressure on bones and joints and limit their movement. This is often found to be the cause of chronic overuse symptoms.
Clinical Relevance of Muscle Dysfunction
Muscle dysfunction, muscle imbalance and fascial restriction are at the root of almost all overuse issues, and are significant factors in many sports and dance accidents.
Muscle dysfunction can take various forms and cause pain in almost all areas of the body – back, groin, knee or foot pain are just some of the most common symptoms. Tight muscles or recurrent muscle strains are often the early warning signs of muscle dysfunction.
This can lead to clinical problems in two different ways: increased myofascial tension has its own direct impact, or the reduced strength and capacity of an affected muscle group can result in instability-related symptoms or injuries. Increased tension of muscles and fascia (fascial restriction) can place significant stress on bones, joints and tendons, thus reflecting the cause of joint pain or any kind of insertional tendinopathy (inflammation of the tendon where it connects to the bone).
Patella tendinopathy (jumper´s knee syndrome) is a common example of an overuse issue that relates to muscle dysfunction. The patella tendon is the common tendon of the four muscles that make up the quadriceps. In an overuse situation, the vastus lateralis and rectus femoris muscles typically become tight, while the vastus medialis becomes weak. This dysbalance places an uneven stress on the patella tendon, which can lead to local inflammation and mechanical wear, and may even result in a partial rupture of the tendon.
Instability related to muscle dysfunction is most commonly found on the foot and ankle. Proper foot stabilization relies on the well-balanced performance of different muscle groups working in harmony: namely, the peroneal muscles and the tibialis posterior. The two peroneal muscles are prone to muscle dysfunction, either as a result of direct trauma (ankle sprain) or as part of a complex muscle dysfunction of the entire lower extremity.
Dysfunction of the peroneal muscles (typically tightness) causes the heel bone to turn slightly inwards and the foot arch to flatten. This may result in pain and swelling of the ankle due to the increased pressure on the joint, or inflammation and pain of the Achilles tendon or the plantar fascia. Dancers typically have a high arch in their feet and are therefore especially affected by these kinds of instability problems.
Underlying Causes of Muscle Dysfunction
Muscles contract according to information they receive via a nerve called the motoneuron. This determines the tone of a muscle in relaxation, as well as how strongly a muscle contracts. In a normal muscle contraction, not all muscle fibers are involved; some will contract while others will stay relaxed. The muscle fibers are activated in this way via a mechanism called neural recruitment.
Muscle dysfunction relates to a change in the pattern of this neural recruitment. When the nerve stimuli are altered in some way, the muscle will not work at its normal strength and capacity, and will also have a noticeably more contracted or more relaxed tone in rest. This modified innervation – which causes muscle dysfunction – often results from overuse and is probably the body’s way of trying to protect the muscle from further damage.
Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. They can therefore be referred to as “functional dysbalances”. As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.
Joint dysfunctions – commonly known as “blocked joints” – often go hand in hand with muscle dysfunction. Tightness of a muscle causes a reflex reaction of its opposing muscle, and this local imbalance can cause joint dysfunction. As the body then tries to compensate for such restricted or unstable movement, this may lead to muscle dysfunction itself.
Treatment of Muscle Dysfunction
For successful treatment, muscle dysfunction demands a complex approach. Sadly, the treatment of overuse issues often only focuses on local pain and inflammation or joint dysfunction. However, without addressing the underlying causes, there is a high risk of incomplete rehabilitation and it is likely that these issues will flare up again.
Deep myofascial release treatment (dMRT) is a highly effective way of treating muscle dysfunction and restriction of the fascia, targeting the root causes of an overuse issue rather than just treating the symptoms. It is a variation on more traditional myofascial release treatments, but tailored to the particularities of treating the highly trained bodies of athletes and dancers. dMRT can deliver fast and – crucially – sustainable results. Dancers who have been treated on a regular basis learn to be more in tune with their bodies and to know when they need to be treated again, and this greater awareness plays a vital role in preventing overuse and injury.
Strength and flexibility training, with individual corrective exercises, are another important element of the complex treatment plans necessary to treat muscle dysfunction. Dancers should get a fascial roller and tailored exercise program in their first consultation, and be encouraged to work on their specific problems intensely and regularly.