According to Janda, the coordination of the agonists and antagonists muscle is more important than the overall strength of muscles. A strong muscle that cannot contract in coordination with other muscles is not useful for the body (Page and Frank, 2002). Thus, the best way to treat a muscular imbalance is by organizing the treatment in three major stages.
Central indirect technique focuses more on the central nervous system, to have a stronger and more general response.
Vojta approach: Positions and specific reflex points are used to influence the afferent input to the central nervous system.
Primal reflex release technique.
Feldenkrais method: Verbal instructions to change movements pattern as well as manual manipulations are used.
Local direct technique focuses on a local response.
Soft tissue techniques to manage scars, adhesions, contractures and any other soft-tissue impairment. Neural tension techniques.
Joint mobility techniques to restore mobility and reducing the pain perception by manipulation.
Lymphatic technique as the lymph flow is important in restoring normal physiological functions.
Orthotic techniques that has been proved to positively affect posture and muscle function by neural inputs.
After having normalized the peripheral structures, the muscles balance of shortened and lengthened muscles should be restored.
Muscle tightness can be also due to several factors, therefore consequent techniques should be applied.
- Tightness due to pain can be eliminated with cryotherapy, manipulation or traction.
- Joint dysfunctions that can cause spasm can be treated by joint manipulation.
- Trigger points spasm can be resolved by different techniques such as dry needling, spray and stretch or pressure points.
- Limbic spasm generates a general tension due to overactivity of the limbic system, and is mostly treated by general relaxation, massage and stress reduction techniques.
- Tightness spasm resolves by facilitation-stretching treatment.
- Other possible treatment choices are post-isometric relaxation, proprioceptive neuromuscular facilitation (PNF), post-facilitation stretching, static stretching and yoga (Page et al, 1967).
As for tightness, there are several types of reason of weakness and several different treatments.
- Tightness due to weakness is better resolved with stretching.
- Trigger points weakness can be resolved similarly to the tightness trigger point.
- Weakness due to stretch or prolonged postures can be treated by relaxation and stretching.
- Reciprocal inhibition, in which inhibition of an antagonist muscle due to overreaction of the agonist is present, relaxation and inhibitory techniques of the antagonist are applied.
- Other techniques can involve: vibration, oscillation, acupuncture, PNF proprioceptive neuromuscular facilitation, Brugger, exercises and kinesio taping (Page et al, 1967).
Once the restoration of muscle tone and length are achieved, the training to regain optimal coordination and mechanical loading can start. The use of sensorimotor training is best to achieve that. It facilitates the afferent motor pathways by progressive stimulation exercises (Page and Frank, 2002).
Particularly regarding lower crossed syndrome:
- Tight hip flexors and thoracolumbar erector spinae are being stretched and relaxed with the appropriate technique.
- Abdominal and gluteals muscles are strengthened.
- Facilitation and coordination exercises are used to restore their balance and coordination.
- All the muscles will be involved in “synergistic balanced activities for stabilization and improved muscle balance”(Page et al, 1967).
Changing habitual postures, movements and activities are necessary to achieve a balanced and coordinated motor function (Page et al, 1967).