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Symmetrical Living - Reduce & Prevent Muscle / Joint Pain

Like nearly every physical therapist I know, I have a "how I got into physical therapy" story involving a personal injury. I was active in gymnastics, cheerleading, skiing, and rock climbing. I had chronic ankle sprains that I "worked through" until the one that significantly tore my anterior talofibular ligament (outside of my ankle). I would like to say I was doing something fabulous like a double back-handspring, back flip off the balance beam, but sadly no, I was jumping over a small fence. I went to physical therapy and was impressed by how restoring the muscular control in my ankle prevented me from a lifelong history of ankle instability. I went on to become a competitive runner in the Marine Corps without injury. To my ankle at least.

This inspired me to learn more. I got involved with Athletic Training in high school and went on to college for the same. I worked with hockey, football, lacrosse, swimming, and tennis teams primarily in the rehabilitation of injuries. Eventually, I became a Doctor of Physical Therapy.

So, there I was, an eager, enthusiastic therapist, ready to rehabilitate the world from their injuries, but unable to save myself. In my first year, I had severe upper back and right shoulder pain (scapulothoracic dysfunction). My second year, I dislocated my middle finger due to a ligament injury and hand tendonitis in my thumb. This progressed with sacroiliac (SI) dysfunction, neck pain, and hip pain which eventually led to a hip surgery due to degeneration. Why? I was trained in ergonomics. I had a lumbar support in my car, my office chair and set up were ergonomic, I used a headset, everything in my world was ergonomic, or so I thought. As a manual therapist, I spent my entire day mobilizing hips, knees, shoulders and spines with my right arm and standing on my left leg.

I finally got smarter about the way I practice and started utilizing both sides of my body equally and "undoing my day". The more this worked for me, the more I taught these concepts to my patients and my success rate dramatically improved with the therapy I provided. The crazy thing is, the concept is so simple, yet most of us don't employ it until we are forced to due to inability from injury.

I have since continued to develop these ideas into my practice. It started with tasks like vacuuming, snow shoveling (a favorite pastime in Colorado), sitting and sleeping. It has since expanded to include childcare, daily activities, car / airline travel, nearly every component of daily living.

Muscle Balance

Our muscles have an ideal length-tension relationship. That is to say, they perform maximally when they are at the appropriate length (not too tight or stretched out). This is because each muscle is actually hundreds of fibers that cross over each other. When we contract (or flex) a muscle, making it work, the fibers cross over more. When the same muscle is relaxed the fibers cross less.

If that muscle is tight, or shortened, it cannot cross over very well and requires more energy to perform a task. It quickly becomes fatigued due to inefficiency and will stay contracted (or crossed) and locking down because it requires less energy to do this than perform in it's shortened length. This is how we end up with "tight muscles" or "knots". Over time, the muscle becomes deprived of oxygen and weakened due to inactivity. Maintaining flexibility, or proper length-tension relation of your muscles, will prevent this from occurring.

Likewise, if a muscle is too stretched out, or lengthened, the fibers cannot adequately cross over and gain purchase for muscle contraction. It also quickly becomes fatigued and locks in its lengthened position. The result is the same with the muscle becoming weak, painful, and "knotted". By exercising correct posture with activities where these muscles can perform in their optimal length this can be prevented.

Symmetry - Unilateral Imbalance

Most of us have a dominant hand we use for the majority of activities that we established at a very young age and have continued to use because tasks are simply easier with the side that had been neuromuscularly developed. We go through everyday life without thinking of all the other muscles in our body that we recruit in order to perform basic functions. Not to bias against the left-handed population, we will explore the actions of the right-handed person simply because this is where the majority of the population falls. Let's perform a simple task of reaching with the right hand to get a glass out of the cupboard. You reach with your right hand and utilize the right shoulder, arm and hand muscles. You are also using your left back, stomach, hip, and leg muscles to stabilize your body to perform this reaching action.

This same action is performed in hundreds of everyday activities, most of which require multiple repetitions, resulting in overuse of the dominant upper spine and extremity and the opposite lower spine and extremity. This creates an entire spine and body malalignment and can eventually lead to spinal segment rotations and a multitude of overuse conditions including arthritis, bursitis, tendonitis/tendonosis and impingement. It can also contribute significantly to neck pain, headaches, upper and lower back pain.

If you performed 100 daily activities, on average 10 times each, multiply this by the average lifespan of 77.2 years. You will perform this motion 77,200 times in your lifetime! You would have to do 1000 repetitions of one exercise at the gym every single day to reach this level of frequency.

Want proof that your body is molding into this abnormal posture? Go to a mirror where you can see from your hips up. Look at your shoulders. Is your dominant side shoulder higher than your non-dominant? My money is on yes. Now place your hands on your hips (actually the boney part of the pelvis, like your mom did when she was scolding you). Is your non-dominant side higher than your dominant side? If you answered yes to one, most likely both, of these, you have structural changes that have occurred and your body is in a state of musculoskeletal imbalance.

Common Tasks that Promote a Unilateral Imbalance

  • Brushing your teeth
  • Grooming your hair
  • Applying make-up
  • Showering with a loofah or washcloth
  • Eating
  • Putting away dishes
  • Pouring a cup of coffee, milk, juice
  • Pouring cereal into a bowl
  • Turning a doorknob
  • Using a key to open car / front door
  • Using a security key pad / keyless entry
  • Putting on your jacket
  • Picking up the newspaper
  • Operating a can opener
  • Vacuuming
  • Sweeping
  • Mopping
  • Cleaning the sink, bathtub, toilet
  • Shoveling
  • Raking leaves
  • Edging the lawn
  • Pruning bushes
  • Planting / weeding the garden
  • Watering the garden
  • Carrying an infant on your hip
  • Carrying an infant carrier
  • Feeding an infant
  • Watering the plants
  • Grocery shopping
  • Filling/Hanging a birdfeeder
  • Carrying a purse, briefcase, diaper bag
  • Carrying a backpack on one shoulder
  • Carrying a stack of books or papers
  • Loading/Unloading your car
  • Folding/Unfolding stroller
  • Hanging clothes
  • Painting
  • Hammering
  • Using a screwdriver
  • Drilling
  • Turning on/off a light switch
  • Operating a remote control
  • Wiping the counter
  • Cleaning windows/mirrors
  • Dusting
  • Holding a phone with your shoulder
  • Operating a mouse on a computer
  • Writing
  • Walking your dog
  • Feeding the dog
  • Throwing a ball with your dog
  • Holding a small child's hand
  • Loading/Unloading the dishwasher
  • Washing your car
  • Washing the dog
  • Bathing a child
  • Loading/Unloading the washer/dryer
  • Carrying sports equipment
  • Throwing / kicking / hitting sports

Static Positions that Promote a Unilateral Imbalance

Okay, so that pretty much includes almost everything you do in a given day. So what is the solution - quit taking care of yourself, your house, your children and working? That is one option, but probably not the most feasible. The other is to start living your life symmetrically. You are probably saying "but I can only do these things with my dominant hand," right? Wrong! That is only because that is what you have neuromuscularly trained your body to do. With practice and time, you can perform almost any activity with both sides of your body equally well. This will be difficult at first and you may only accomplish one tenth of the activity with your non-dominant side, but with practice, that should gradually improve to 50% for most activities. Some fine motor activities (such as writing, working a computer mouse or sewing) and dangerous ones (such as cutting with a knife or operating a chainsaw) may be better saved for your dominant hand.

This is a process which requires retraining of the connection between your brain and muscles and the development of these underutilized muscles. Start small. Try vacuuming with your non-dominant arm a few strokes and then switch back to your dominant arm, gradually increasing the amount you do with your non-dominant arm as you build up a tolerance for the activity. The same applies to raking, shoveling, sweeping and mopping. If you are cleaning a mirror or window, try doing the right side with your right arm and the left side with your left arm. If you hold an infant on your hip, try switching sides so that you are doing equal amounts on each side. Your brain and body can learn to perform nearly every activity on this list ambidextrously, or equally with either arm.

You can also develop symmetry by performing tasks bilaterally, with both arms or legs at the same time. Instead of carrying an infant on your hip or holding your books in one arm, try using both arms and holding the child or books in the middle of your body. Keep in mind this can also lead to a flexion imbalance, discussed later, from always placing the weight in front of your body. You can balance this by utilizing a backpack on both shoulders or child carrier on your back.

It has taken your body a lifetime to become strong, coordinated and efficient at performing everyday tasks in the manner which you are accustomed. This will not change overnight or even within a few weeks. Neuromuscular recruitment, the activation of the muscle fibers in a coordinated fashion and communication with the brain, occurs within the first few weeks. Hyypertrophy, gain in muscle mass, takes twelve weeks of specific training. A habit can be formed in 21 days. Theoretically, given these time frames, a person should be able to perform most tasks ambidextrously in three months; however, due to the difficulty of coordination of multiple muscle groups in a coordinated manner and the complexity of fine motor control, this process may take several years to fully integrate. You may also note some muscle soreness as you begin to use the opposite side of your body. These muscles have effectively become very weakened from disuse and will fatigue easily. It will take some time to develop them. I encourage you again to start small and develop a little each day.

Static, non-moving postures, can be just as damaging. Consider that you spend a greater amount of time performing activities such as sitting or sleeping than active motions. This allows the muscles on the shortened side to contract more and the lengthened side to stretch. Common positions with sitting that rotate the pelvis are sitting with a wallet in your pocket, crossing your legs, turning to work on a computer, or driving with your right side forward. Simply focus on either a neutral pelvis when doing these or perform the same motions equally on both sides. To perform them neutrally, remove the wallet from your pocket, position your computer directly in front of you, sit all the way back in your car seat with your right buttock and cross your ankles instead of your knees. If you must put your wallet in your back pocket or cross your legs, switch sides so that you are performing the same task equally on each side. If you are a right side sleeper, try going to bed on your left side. You will most likely migrate back to your preferred sleeping side, but over time, will develop a greater comfort with the opposite side and be able to stay there longer, and, eventually, be able to sleep on both sides equally.

Sometimes we are limited in our ability to perform activities in this manner due to time, practicality, or not quite having our muscles developed to perform the activity this way. In this case, we generally end up with stiffness or soreness of our dominant upper body/spine and non-dominant lower spine/hip. What to do? Undo your day. This means whatever posture you repetitively performed, stretch your body in the exact opposite position. For example if you were reaching forward with your right arm, stretch by reaching backward with your right spine and arm.

Everyday activities can become balancing activities, just by making simple modifications to how you do them.