Muscle Imbalance 

Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

What is a Muscle Imbalance?

If you have any kind of muscle imbalance, it can be the cause of severe chronic pain. There are over 650 named skeletal muscles in the human body and all of them serve a unique function. What’s even more significant, is that each muscle was designed to balance each other as they work in synergy to contract and control their counterparts. This process requires a balance between muscle tone, strength, and length. Muscles must be able to ‘work’ in order to keep you independent in mobility and meaningful activities (ADLs and IADLs), but they must also be able to ‘rest’ if they are not being called upon for a task. 


    Your muscles must have the right amount of strength, tone, and length (flexibility) to carry your body and keep it in an upright position while sitting or standing. Because of the intricate relationship your muscles have to one another, if you have even the slightest muscle imbalance, this could cause you pain.

    More specifically, a muscle imbalance is when muscles that should be strong for a specific reason are too weak to carry out their task or the muscle that should be ‘controlling’ your movement during an action (contracting), is not strong enough. When there is an imbalance of muscle power (not enough ‘control’ during a movement, your body calls on the action of close-by muscles to help control your movements which creates compensatory movements or compensation strategies. This means your body is recruiting muscles to perform an action they were never meant to perform, and eventually, your body will tell you by creating painful signals. If you allow your body to move and function using compensation strategies for too long, your body becomes misaligned and you will see the signs and symptoms of muscle imbalance.

    Example: When you lie on one side to sleep every single night, you put excess pressure and weight distribution through that hip that was not supposed to be there long-term (why back sleeping is recommended). Over time,  this creates a muscle imbalance in your hip, which leads to hip pain and causes you greater difficulty in meaningful activities (occupations) like walking, climbing stairs, rolling from side to side, and getting into and out of your car.

    What Causes a Muscle Imbalance

    • Poor posture 
    • Lack of physical activity
    • Using the wrong muscles to perform specific activities
    • Sitting for too long
    • Not having the right support if standing for long periods of time
    • Focusing on the same muscle groups in your exercise program over time
    • Natural causes 
    • Medical event resulting in a change in muscle tone, length, or strength. 


    Most Common Pain Points Caused by Muscle Imbalance

    Total hip replacement

    • Lower back pain
    • Hip Pain
    • Neck Pain
    • Knee Pain
    • Full leg pain 
    • Shoulder pain
    • Ankle Pain


      Signs and Symptoms of Muscle Imbalance

      • You are walking with a limp to keep wait off of one of your joints for no apparent reason
      • You are sleepless at night because of pain
      • You can’t sit or stand for long periods of time without experiencing pain
      • You have muscle pain in your shoulders/chest affecting your ability to raise your arms or drive
      • You have pain that starts in your groin and radiates down your leg
      • You feel a “clicking” sensation when walking or moving your arms 

      Occupations (meaningful activities) that may be Affected by Muscle Imbalance

      • Sleeping through the night peacefully
      • Putting on your shirt or jacket
      • Driving
      • Fulfilling caregiving roles
      • Showering
      • Shoveling (in winter)
      • Getting up and down from a chair or bed
      • Walking around your home or the community
      • Carrying a child or groceries while maintaining precautions or getting stronger
      • Standing for extended periods of time at the sink or stove
      • Putting on your pants, socks, and shoes while maintaining precautionsWriting (with non-dominant hand)
      • Getting up and down from a chair or bed
      • Walking around your home or the community
      • Carrying a child or groceries while maintaining precautions or getting stronger
      • Standing for extended periods of time at the sink or stove
      • Putting on edema sleeves or compression garments

      How can outpatient occupational therapy help address your muscle imbalance?

      Occupational Therapy is imperative if any of your meaningful activities (occupations) are affected by muscle imbalance. Occupational therapy can provide many approaches and modalities in outpatient therapy. Some of these techniques include: 


      What are some problems occupational therapy can address?

      Check out other problems we help resolve!

      Helpful Page Definititions

      Instrumental Activities of Daily Living (IADLs)

      Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

      Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

      Cleaning -   The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc. 

      Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

      Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time. 

      Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time. 

      Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

      Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house. 

      Activities of Daily Living

      Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.  

      ADLs include:

      • Bathing and showering
      • Getting dressed
      • Going to the bathroom
      • Walking and getting up and down from a chair or car
      • Eating and swallowing
      • Feeding 
      • Sexual activity 
      • Personal hygiene and grooming
      • Being able to use personal care devices like adaptive equipment and durable medical equipment 
      Functional Activities

      Occupation-based interventions are the most functional-based approach to rehabilitation. When you are invested in the activity and understand why you are doing something, your brain's ability to heal and re-learn motor patterns improves exponentially! Occupational therapists are functional rehabilitation specialists which means we are experts in translating physical strategies into functional activities! We understand that performing a sit-to-stand in the studio is much different than getting up from your favorite recliner chair! Likewise, re-learning how to move your arm or walk in the studio is much different than feeling confident entering your home or moving about the community! Buffalo Occupational Therapy always bridges this gap and includes these real-life elements as part of our outpatient rehabilitation process!

      Neuromuscular Massage

      Neuromuscular massage helps many diagnoses. Most specifically used for chronic pain and the release of trigger points (knots), NMM can help resolve debilitating pain resulting from soft tissue implications. Another way we use NMM is to enhance reaction time in individuals after a traumatic neurological event. Studies suggest that NMM can break up adhesions allowing for stronger and faster communication between nerves. 

      Comprehensive Evaluation

      Occupational therapists treat the entire person. Much like your primary care physician, we were required to learn elements of the entire body so that we could treat holistically (a one stop shop). Because of this, your outpatient rehabilitation specialist will perform an evaluation that assesses the following things: 

      • Personal history
        • Who are you? What do you do? What makes you tick? Why are you seeking outpatient therapy?
      • Physical function (upper body and lower body)
        • Strength, range of motion, and flexibility 
      • Neuromuscular function (brain to muscle communication)
        • Coordination, speed, agility, and reaction time 
      • Cognitive and Mind health
        • Short term memory, recall, information processing, and perception of illness 
      • Occupational Inventory (Activity and role inventory)
        • Roles you play like a caregiver, spouse, parent, employee, etc. 
        • Mobility inventory like the places you need to go 
        • IADL inventory and what activities are required for you to be independent 
        • Other activities that are important to you