Muscular Imbalances, Adhesions, Trigger Points and Pain

I very commonly hear the phrase “I have bad knees”. Typically this phrase is used to describe pain someone experiences in their knees when performing certain activities. When I think of bad knees I think of the actual issues that create pain… not the pain itself. Why not the pain itself? Because pain does not necessarily indicate an injury or damage. Pain is an alarm. The question is, what is the alarm telling us? Pain can be an indication of fatigue, it can be an indication of damage occurring or has occurred (injuring vs injured), it can be an indication of irritation or malfunction.

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Pain is Our Check Engine Light

We can liken pain to the gauge lights on the dashboard of our car. Perhaps we’re driving and the check engine light comes on. This tells us there’s something that requires our attention so we go and get it checked. It may just be letting us know we need to change the spark plugs. However, there could be a larger issue. Figuring out what it’s telling us is crucial to prevent potentially harming the motor permanently. If we ignore the light, whatever the issue is will likely get worse. This issue may also put strain on other areas of the vehicle and cause other mechanical issues. Pain is the same way. It is our check engine light. It could be a muscle imbalance, a knot (adhesion) or trigger point or it could be something more serious. However we need to investigate it to know.

When someone tells me they have bad knees, I encourage them to tell me more about it.I like to know if they have been diagnosed with a condition, or if they have spoken to a physician or sports medicine professional and any outcome that resulted. I ask them to describe the pain to me, when they notice it most and any protocols they may use to resolve it. I ask these questions because depending on the answers it may not be “bad knees” as much as it is tight tissue, a muscle imbalance or a trigger point.

What is Tight Tissue?

Let’s talk about tight tissue. What does this mean? Well it is not uncommon when we are in certain postures for a prolonged period of time that our muscles and fascia (collagen based tissue fibers running throughout the body) become stiff. Someone might for example, find that after a long car ride when they first get out and move around they are experiencing some pain in the knee. They may also then find when they move around or stretch a bit the pain begins to reduce. However when the tissue becomes especially tight it’ll start creating little nodules. We call these adhesions, more commonly called knots. In this case when you get out of the car you may find that moving around does not resolve the issue and you just continually feel knee pain. Sometimes stretching is enough to pull the tissue apart, sometimes massaging or foam rolling the area prior to stretching is required. 

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Let’s Discuss Muscular Imbalances

Returning to knee pain as an example, let’s say for example, you find knee dominant movements (i.e. squats, lunges etc) consistently cause pain. You may have an actual knee problem but you may be dealing with a muscular imbalance. A muscular imbalance is when one muscle on one side of the joint is tight (also referred to as chronically shortened) and the muscle on the opposite side of the joint is overly lax (also referred to as chronically lengthened). An imbalance can cause pain because muscles apply tension to joints. If they didn’t human movement couldn’t occur. When there is an imbalance the tension applied to the joint is applied incorrectly causing the joint to move in a way it was not intended. This isn’t an injury… not yet. It is the malfunction that will lead to an injury if left uncorrected. I like to use the hinge on the door analogy. When a hinge on a door is on correctly the door swings open and closed seamlessly. We don’t even think about the hinges when we’re using the door. However if the hinge gets bent or is on crooked, the door squeaks. You can hear it each time you open the door and you notice the sound and may notice it coming from the hinge. If you correct the placements of the hinge and rehang the door the problem will be solved and you likely won’t give it another thought. If the hinge is left alone, over time you’ll notice that squeaking will get louder and louder until eventually the hinge or one of its connections breaks. Our joints are the same way. If we have a muscular imbalance we may notice pain. Each time you use the joint for certain activities you’ll feel it… over time you may notice the pain becomes worse. If left unchecked something will “break”. 

Treatment for a muscular imbalance typically involves some massage/foam rolling, stretching and various exercises. Over time and with consistency you’ll notice the pain will become less and may eventually disappear altogether. It won’t happen overnight as the muscles have been trained into these postures and improper movements for a long time. So while you can treat the tight and lax muscles you also have to be careful to treat the movement or static postures you’ve been performing that created them. Over time your central nervous system will become retrained (this is called motor learning) and the problem will disappear. 

Let’s Discuss Trigger Points

These are controversial and debate among physicians and researchers continue. However the logic is sound and looks a little something like this. A trigger point is where an activated motor neuron is connected to a knot. The difference between a regular knot and a trigger point is found in how pain is expressed.

If you press on a knot you will feel pain in the area of the knot. If you press on a trigger point you will experience pain radiating to another area of the body. Ever dealt with a knot on your upper back and when pressure is applied you feel it in the temple? That’s an example of a trigger point. Again trigger points are not injuries, but they are malfunctions. These trigger points and knots if left unchecked will continue to pester you with pain and muscle tightness. This can lead to altered body movements, increased sitting and various other pain avoidance activities. Over time our central nervous system will learn and make these movement deviations second nature leading to muscular imbalances. 

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Conclusion

As you may have noticed there is a relationship between muscular imbalances, trigger points,  muscle adhesions, and pain. Our natural response is to avoid pain but we better serve ourselves if we get to the bottom of the pain and address it. If we do not and we just accept we have a bad knee or bad back etc and avoid certain exercises, or movements we may be doing so prematurely and causing more harm than good. If we identify what’s causing the pain we can quickly figure out if there are movements that should be avoided, or if it’s something that can be resolved. Good resources for identifying pain are professionals such as an exercise professional, massage therapist, or sports medicine/medical professional. If an avoidance of pain strategy is your strategy and you’ve not identified the cause of pain, you will likely find more and more movements trigger pain. This will likely progress until an actual injury occurs, making the interventions to fix the problem more difficult, painful, costly and time consuming than if it was simply resolved at the beginning. Remember if we don’t make time to maintain our health now, we will be forced to make time for our illness later.