Ask Leonard a Muscle Testing Question
My students email me questions all the time. Even if we don’t personally know each other, you’re welcome to ask a question of your own, and I’ll try to answer it or tell you why you should be asking a different question.
Because these questions and answers are searchable, be specific so that your key words will show up in someone else’s search. Also, please do your own search of this blog to ensure someone else hasn’t already asked your question. If I don’t answer your post, it will be because I’ve already answered it for someone else on this site.
Hi Leonard ,
I have a client with a really pronounced permanent thoracic rotation.
It’s obvious he has scholiosis too…
But what’s your feedback ?
Thanks !!!
Hi Flo, there are two separate issues at play here:
1. Thoracic rotation, and 2. Thoracic side-flexion. I’ll give you the answer but I’ll warn you that its not going to be a simple answer:
1. Thoracic rotation: unless there is an organ/nutritional issue directly causing the rotation, you’re going to want to look somewhere else–eg, the pelvis or the arches. Your training focus should be to the activate everything below the thoracic vertebrae (so, tib post, toe flexors, may need to stretch the gastroc or toe extensors to get these working; then any other major pelvic players like gluteus maximus or illio-psoas, one of which will need to be stretched and the other recruited during Gait Cycle; and finally a quick look at Iliocostalis lumborum, the QL and multifidus lumborum to ensure they’re not in spasm on one side and holding the pelvis out of alignment – something that may also ultimately be Gait Cycle related). See if those things balance the pelvis. If they do, problem solved. If not, it may be organ-related or it may very well be referring down from the mid-back as is the case with scoliosis. I often see cervical misalignment referring all the way down, and there’s a way of therapy-localizing the cervical vertebrae to see if any of them are “out” – if so its now a question of what is causing what (top-down or bottom-up) and you can chase your tail for quite a while on this one.
2. Thoracic side-flexion. Scoliosis can be tricky. Any time there’s side-flexion, nerves are being pinched and there is decreased innervation to numerous muscles and compensation during stance, gait and lifting. When its fully a skeletal deformity you need to work with it, not against it. Here are two practices I’ve found effective:
a) isometrics to activate all the thoracic muscles before each workout: illiocostalis lumborum & thoracis, Multifidus lumborum, thoracis and cervicis, QU, Spinalis and Longissimus. You’ve done my courses so you know the isometrics for these: do them. On a more gait-related level, it may be that your client needs to learn to perform more thoracic rotation while walking to ensure these muscles are being activated from Gait, as this will be one of the main causes of inhibition even with scoliosis.
b) if there is pronounced rotation in one direction, you may need to do isolating exercises in the opposite direction to “unwind” the posture neurologically. A simple CNS test will demonstrate whether the unwinding exercise has been effective: test before – medial deltoid should be off. Do the unwind – test again. If delt is still off, that wasn’t it. Once you find a range of motion that innervates delt you’ll know you’re on the right track.
Throughout all of this, the golden rule of Vitruvian Biomechanics applies: don’t put the body under load until everything is firing, or else you’ll just get more pain and exacerbate the existing imbalances. Activate everything first and you should make headway.
If you try everything above and it still doesn’t work, you have two final options: look at leg length – sometimes a simple heel lift will fix the problem (but it can also make it worse if there is no leg length discrepancy, and don’t confuse leg length with pelvic misalignment–you’ll actually need to measure ASIS to heel); or refer him to a practitioner who knows how to muscle test and see if they’ll let you sit in on the appointment and learn.
Hope that helps, let me know how it goes.
LC
My hat is off to your asttue command over this topic-bravo!
I can’t believe you’re not pliyang with me–that was so helpful.
In principle people shouldn’t put load on muscles that are not
innervated – and yet many gym goers use heavy weight to strength train
muscles that are likely inhibited. What would some of the short term/long term consequences of this be?
Short-term: compensation patterns.
Long-term: Chronic compensation patterns.
Eventually, holding the body out of alignment elongates some ligaments while the support muscles of other joints over-contract, leading to ongoing pain-patterns which will need to be treated indefinitely until the root cause is eliminated. Quite often it goes undiscovered for life, and the person slowly sinks into degenerative pain and eventual disc deterioration.
There is a critical shortage of informative artlceis like this.
Mighty useful. Make no msiktae, I appreciate it.
How neat! Is it really this simlpe? You make it look easy.
Alakazaam-information found, problem solevd, thanks!
I have a new client that was born with ZERO arches in her feet. Literally, her ankle bones touch the floor. She was very embarrassed when I first asked to see them during my initial assessment. When I saw them I thought to myself WOW, just like the picture in your textbook! I have taped her the past 2 days and this morning her feet were so swollen, she canceled on me. She has been walking around with the “shape up” shoes on as well, which doesn’t help matters. But her feet are hurting her all of the time! I’m keeping her on the bike and will continue to tape for every session, however do you think I will be able to rehabilitate when doctors have threatened her that the only option is to break her ankles and feet and put her in braces? I only have her for 3 weeks, 4 days a week, unless she renews, but I want to try and help her as much as I can.
There’s one central issue we need to know to determine the cause of the collapsed arch. It may be a genetic deformity, in which case typical solutions wouldn’t be effective, but it may also be one of two things a traditional orthopedic surgeon may not have considered: 1) severely over-contracted toe extensors and 2) lax ligamentis stemming from deficiency in Manganese & Vitamin C.
Toe extensors (Extensor Hallucis Longus & Extensor Digitorum Longus): If they are so tight that she can’t move her foot into flexion, it may be that tibialis posterior (the standard cause of a collapsed arch) is completely inhibited because she isn’t able to move into a range of motion to activate it (in this case the toe flexors would be completely inhibited and we would expect a resultant over-contraction of hamstring, which always happens in the case of inhibited toe flexors, and tight hamstrings will further mess up her gait). In this case we wouldn’t do a standard muscle test on the extensors but rather, a visual analysis of whether the foot is able to move into flexion.
Another issue I’ve seen quite often, and this was the case in the picture you’re referring to in my VTS Level 3 manual, is severe lax ligamentis (clinically loose ligaments). When this is the case, we expect to see it in ligaments everywhere, not just in the ankles. There is a CNS test for loose ligaments (find a strong indicator muscle, then gently but firmly pull on one finger and re-test the indicator – if it goes weak, we infer that the CNS is getting shut down by the over-elongation of a ligament) but a simpler test is again visual – see if she can hyper-extend her elbow (past 90º). I’d say that if she can, its probably lax ligamentis expressing itself in the elbow and the foot, while if not, then take a closer look at toe extensors. An interesting side-note is that lax ligamentis is sometimes an expression of severe deficiency in Vitamin C and Manganese (not to be confused with Magnesium). I’ve had 2 cases where supplementation with these 2 has reversed lax Ligamentis in about 6 weeks, to the point where the client could walk around without tape.
The fact that there’s swelling in the feet is huge cause for concern. Make sure you’re CNS testing the tape to ensure its not being put on too tight.
Intuitively, I think the program for the remainder of her sessions should be toe extensor stretches and foot muscle exercises – I’d completely forego upper body work or load bearing leg exercises until you fix the base of support, and none of that should even happen until the swelling goes away – I hope she’s icing it. I know a couple doctors who specialize in these sorts of things and they also know how to use muscle testing so unlike traditional doctors, they won’t have to “guess” what the correct answer is – if you’re able to convince her to see one of them, I’d strongly suggest it and I can send you their contact info. If the poor thing is seriously considering letting a surgeon break her ankles, I would think she’d be open to as many alternative opinions as she can get.
I’m going to be at your club this Saturday (I know I said Sunday but its Saturday). If she’s able to come by, I’m happy to do a quick assessment on her and we’ll see what the muscle tests reveal. But try what I’ve recommended first so you have a better sense of control over the two variables in question (toe extensors vs. lax ligamentis).
What a joy to find sonmoee else who thinks this way.
Wonderful explanation of facts avialbale here.
64 yr old female tested negative on all tests within my knowledge (VTS 1). She’s extrememly tight throught the legs, hips and back, so we’re working on a lot of stretching. After 4 sessions and homework on her own, her tib posts are staying on most of the time and everything loooks promising, but when I tried to activate QL’s there was no improvement. I didn’t attempt any other spinal intrinsics. I surmised that it might be too early to try to activate these muscles since she is still so tight all over and not permitted adequate range of motion to allow them to work effectively? Would this make sense?
Thanks,
Steve
Hi Steve, by Negative, you mean everything is working? There are two questions here. #1 why is she tight, #2 why won’t her QL fire. For #1, try agonist/antagonist for the toe flexors & extensors (toes down, foot down, toes up, foot up, with resistance). I suspect you’ll be pleasantly surprised by the result. From that exercise alone I’ve noticed a 20-30% increase in upper body muscle activation. On another level though, keep in mind she’s 64, so the fascia has had 64 years to grow unchecked. Think of fascia like vines on a wall – it can take over and reduce flexibility no matter what you do. For #2, some people can’t engage their QL because they don’t know how to engage it. There’s a way of “pushing out” via the abdominal wall when you flex QL that brings it on every time – try that.
Okay – let me know if those worked.
I love reading these articles because they’re short but inofmtraive.
I had no idea how to approach this before-now I’m locked and loadad.
Why does this have to be the ONLY reliable source? Oh well, gj!
To make a long story short, I’m getting pain from my hamstring being tight, going up to my Glutes (trigger Points flare up) causing low back pain. This is my Biggest problem that has nagged me for over 8 years. I might have pulled it slightly but for sure have scar tissue, my Hamstring is giving me problems. I believe its my Semitendinosus that is causing my Glutes to go on fire which gives me low back pain. I do feel some pain in my Trigger points meduis as well adductor magnus. So I get Medial Trigger pain in the points located adjacent to the sacrum and gluteal cleft as well. I get pain after sitting for awhile or when walking up hill. I have been doing this new treatment Shockwave Therapy which is helping me but want to know the root and how to heal it faster. I have been told it could be bursitis?
Hi Richard. There are two levels to your problem. The first you’re already aware of, although we’re using different language to describe it:
1. Fascial adhesions (which you call scare tissue). I prefer my term because it emphasizes that these are temporary, and can be worked out with therapy. You can try different methods: trigger point, shockwave, whatever you like; but none of them will work until you answer one important question. What is causing the adhesions in the first place? Sure there was an initial injury but why has it lingered so long, or why does it keep coming back after being massaged out?
2. The root cause. Initially, your injury was the root cause of the pain but now there will be a different root cause: continued compensation through gait and movement. The process is simple: when you hurt yourself, you started moving differently to favour the sore spot. The soreness never fully went away because by learning to move in compensation, the area has stayed seized up, creating the impression that no therapy works.
By only focusing on the tissue release, and not the compensation through gait, you’re only doing half of what is needed, kind of like shoveling out a sand pit by throwing the sand up-hill so it slides back into the pit. Futile and frustrating.
A muscle testing evaluation will ascertain which muscles are in adhesion but may not tell you anything you don’t already know. What you probably need is really, really deep fascial release combined with gait cycle coaching. If your hamstring and glute are tight, that’s a sign of a shortened stride on one side, which is consistent with compensation from an injury. So do both, and that should fix it. My VTS Level 2 students understand how to modify gait to produce muscle activation in the glute & hamstring. If you can figure it out of yourself, go for it. If you’d like a referral to one of my students, let me know and I’ll put you in touch.
One final note: I suspect every muscle in your upper leg is over-contracted with fascia, so by really deep tissue release, I mean about 6 hours of deep tissue massage, hitting every muscle you have: all 4 quads, all 4 hamstrings, all 3 glutes, the piriformis, gemellus superior, inferior, oburator internis & externis, and all 3 adductors. And probably both calf muscles, all 3 peroneals and the politeus. A simple muscle testing exam will reveal which ones aren’t firing and need help, but don’t miss any or your attempts to walk properly will be thwarted by fascial resistance.
Okay, good luck. Hope that gets you out of pain once and for all.
Sounds like an idea, just concerned about the gait ( walking correctly) nobody really walks with the heals up at 45 degree angle? I would like to see one of your students. I really appreciate you taking the time to explain and help.