What do we mean when we talk of facilitated and inhibited muscles?

Comment

Comment by Jeff Sims on October 6, 2009 at 3:27am

i'm surprised there's no discusion of reciprocal inhibition, sensory motor amnesia related to stabilizers (e.g., transverse abdominus, multifidus, etc.) and antagonist co-contraction. i have found understanding & applying these concepts (i.e., strengthening stabilizers) to be very helpful in rehabilitating upper & lower crossed syndrome cases.

Comment by Erik Dalton on October 5, 2009 at 8:44pm

Love to see you in class. We discuss lots of neurology but keep it simple and practical while relating it to the hands-on technique being discussed.

Comment by SC on October 5, 2009 at 8:35pm

So, that's what I have been missing out on!
Got to take one of your classes Erik, so I might actually be able to answer something here!
Thanks for your "pretty" responses.

Comment by Erik Dalton on October 5, 2009 at 8:14pm

This is a reply to Serge's first post:

Rather than further discussing the neurology of how bombardment of afferent stimuli can up-regulate neuron excitability causing facilitation, I think it's easier to discuss the resultant muscle imbalances, i.e., upper & lower cross syndromes.

Muscular imbalances may result from abnormal afferent information due to (1) faulty posture, (2) joint blockage, (3) CNS malregulation, (4) painful stimuli, (5) excessive physical demands, (6) habitual movement patterns, and (7) psychological stressors.

Overloading the musculoskeletal system seems to facilitate the postural muscles (pecs, upper traps, etc.) causing hypertonicity and shortening…especially when the person is fatigued. Dynamic muscles (rhomboids, lower traps, etc.), become inhibited from overload causing substitution by the postural muscles during principle movement patterns which reinforces and perpetuates the imbalances.

Janda believed our sedentary society’s lack of variety of movement patterns also facilitates the postural muscle system. We’ve all seen how prolonged sitting in flexed positions allows gravity to pull the heavy head forward on the shoulder girdle and the shoulders forward on the rib cage which perpetuates the upper cross syndrome (see www.erikdalton.com/articles.htm )

When developing a treatment program, it’s important to know which muscles behave as postural or dynamic muscles and to investigate (via clinical reasoning) the possible causes for abnormal afferent information. This allows the therapist to treat not only the muscular imbalances but also correct the cause of the aberrant stimuli.

Some muscles tighten from fascial adhesions and some from facilitation. It's important to include techniques that address both the neurologic as well as the fascial contracture issues. But what about fascial myofibroblasts? Are they stretch receptors? How do you treat 'em?

Comment by Erik Dalton on October 5, 2009 at 8:11pm

Deviations from ideal alignment predispose the person to muscle imbalances to maintain an upright posture and a mechanical response to a change in the center of gravity. Faulty alignment may give rise to what Kendall and McCreary call "stretch weakness" or adaptive shortness of muscles and their fascial bags. Conversely, muscle weakness or shortness may cause faulty postural alignment.

It is impossible to distinguish a cause-and-effect relationship when dealing with established postural faults. Perpetuation of the faulty posture only serves to further perpetuate the muscular imbalances that contribute to faulty movement patterns.

Comment by SC on October 5, 2009 at 8:09pm

Some of your first post theory goes a bit over my head, first because I have not studied for a while, second, when I try to analyze complicated things, I feel like a dog biting its own tail, third most theories are someday proven wrong or incomplete. But hey, it's all good questions.
Personally, I don't think the CNS ever stops firing signals to the rhombs. Pain is there speaks for itself.
I am in physical therapy for this exact problem pec/rhombs battle and I am waiting for my epiphany!
My sense is that the Rhombs are trying to fight back but they are to weak and they give in to the pecs. At this point exercise to strengthen the rhombs is creating more pain and trigger points in them and paraspinals (and probably more joint subluxation in my case). On the other hand, if I regularly stretch my pecs only, I am able to keep the pain in the rhombs at bay.
I have to carefully self-monitor my exercises to make sure I don't recruit other muscles to "help out". Ultimately, this the problem, it's not just about Rhombs and Pecs. They don't operate in a vacuum. When pain is involved many other muscles become involved too.
The outcome of PT is very discouraging at the moment (X 1 week).

My repsonse to your Q "Do the pecs win because they are stronger or do they win because reciprocal inhibition has priority over proper positioning of the joint?"
is yes to the 1st and no to the 2nd because to it's to scary to think it would.
In chronic issues, after a period of time the CNS registers some dysfunction as non priority and stops sending pain signals so I heard. That's probably how discs can degenerate without causing symptoms. I don't beleive that reciprocal inhibition has priority per se but maybe that the CNS registers the situation and new joint position as normal because it is chronic.
If that is true, I have no idea how long it takes for the CNS to adapt but I have been in pain for years so I am guessing reciprocal inhibition does not get priority overnight if it does at all.

I hope my answer makes some sense, but hey if it contradicts itself
at any point, just blame it on my foggy brain function. :))

Comment by Serge Rivest on October 4, 2009 at 6:22pm

From talking with an osteopath, he mentioned this: Some muscles pull and some muscles are being pulled. When you palpate a muscle and it feels tight it could be either. Though, this means a totally different treatment for each. If it is being pulled, you have to relax what is pulling it.

I'm wondering if this would make sense:

UCS

1. The persons start a new career in IT and sit a desk all day long. Hands and head forward as he gets tired, gravity wins.
2. After a few months, even a few years, the body adapt and since the pecs are always in a shortened position and the rhomboids are always stretched, they adapt to the task and keep that shape permanently.
3. When the person stands up though, the pecs and rhomboids are not happy about the standing straight posture and are not really adapted to maintain the shoulder in the straight position anymore. The person tries to stand straight but has to contract the rhomboids harder, which pulls the shortened pecs. The pecs spindles are not happy about being overstretched so the pecs start the contract back (stretch reflex), there is a fight between the pecs and the rhomboids. The pecs win and the rhomboids become tired. Do the pecs win because they are stronger or do they win because reciprocal inhibition has priority over proper positioning of the joint? ... interesting anyway.

Comment by Serge Rivest on October 4, 2009 at 6:05pm

Background
Looking at the Erik Dalton's DVDs we come across the Upper and Lover crossed syndrome first presented by Vladimir Janda. These syndromes have two major components: 1. Tight, Facilitated muscles that create imbalance and 2. Weak, Inhibited muscles that allow that imbalance to happen.

Discussion
I don't know about you but this Facilitated and Inhibited concepts where not covered in massage school and I got great difficulty at finding a good description of what they are and how they are created. I've spent many hours searching the web and books through google books and found partial and sometimes contradictory answers, especially between the physios and the osteopaths books. I would like to get an answer from someone who clearly understand how it works. Yes, that would be you Erik ;)

Questions
1. Muscle facilitation and inhibition, what does it really mean? How does that phenomenon occur?
2. What are the symptoms? Is it muscle tightness? Is it jerky motor control? Is it loss of strength?
3. How can the bodyworker find out if a muscle is facilitated or inhibited? Is there a special test?
4. What can we do about it?


Even though I don't clearly understand the concepts yet, I've developed my own theory which I can use practically. I've decided to associate a tight muscle (higher tone) with a facilitated motor nerve and a weak muscle (reduced tone) with an inhibited motor nerve. I'm pretty sure that this is not the complete picture but that's enough to be usable. The second part of the theory would be that a series of impulses from the nervous system would reach the motor neuron. When there is enough impulses to pass the firing "threshold", the motor neuron would fire and the muscle fiber would start to increase in tone or contract. So there would be two variables here: 1. The amount of impulses going to the motor neuron and 2. The threshold in the motor neuron that could be high or low.Since some of these impulses can be controlled by the bodyworker (decompressing a joint, relaxing the person, shortening a muscle) this allows us to control the amount of input going to the motor neuron and eventually affect the tonicity. Same with spindle work, as mentioned by Erik, this could increase the amount of impulses going to the CNS and it might just make the decision of sending more impulse back to the motor neuron of that same muscle.

Examples:

Shortening muscle -> Decrease firing of receptors (spindles, golgi, etc) -> CNS (decision) -> Decrease firing to motor nerve -> Decrease tone.

Spindle work -> Increase firing of spindles -> CNS (decision) -> Increase firing of motor nerve -> Increased tone.

That's the way I understand facilitation / inhibition. The problem here is that I don't understand why, in the upper crossed syndrome, the pecs get facilitated when they should stop pulling and rhomboids inhibited when they should be pulling. I would expect the CNS to make the decision of sending lots of impulses to the motor neurons of the rhomboids so they would contract like mad and bring the shoulders back. Something is wrong somewhere in that principle and I hope it's my understanding.

Thanks for clarifying this.

Cheers

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