Asymmetry and muscle dominance
The first thing that your therapist will look for when observing you. This occurs from the minute you stand up and walk into the treatment room until you leave. But don’t be self-conscious, this observation helps us to determine what exactly is causing your symptoms. A simple subjective analysis followed by an objective assessment allows a therapist to determine the cause of your symptoms and the solution. This article will take you through this process and aim to demonstrate an effective solution if you are experiencing a similar issue in whichever sport you participate.
For example, lower back pain on the right side with some pain down into the right glutes; this has only come on in the last couple of weeks after cycling with increased mileage for three months. There has been nothing else to cause the pain and it is becoming difficult to deal with, preventing you from enjoying your cycling.
The therapist observes that you sit with your legs crossed always crossing the left leg over the right, when asked to stand on one leg you pick up your right leg and when walking up the stairs you generally lead with your left and lead with your right leg when descending the steps. So what? Well over time crossing the left leg over the right increases the flexibility in the left hip. Favouring the left leg in daily life improves the strength and stability around all of the joints in that leg. Cycling has not been an impact on the left leg, in fact it has done most of the work but the poor right leg has had to try and pull its weight, with little success.
So who’s the lucky patient?
In this instance, I am the case study, and it turns out that my right hip flexor did so much work, as my right quad didn’t feel the need to, that it overdeveloped, became overactive imposing tension on my lumbar spine from the front-side attachment. This caused nerve irritation after increased lumbar spine movement. As any good therapist, I try to practice what I preach so I made sure I stretched regularly and attempted some strengthening exercises to encourage greater engagement of my right quads and glutes. However the back pain persisted and alongside the bad weather, cycling slipped by the way side.
The problem with muscle dominance is that even if you strengthen the weaker muscles, the muscle activation pattern is ingrained and will continue unless changed. So you need to break the chain! First things first, take a break. This will stop you from reinforcing the pattern that occurs every time you push and pull the pedals. During this time do some cross training- swimming, yoga, tennis but keep active without reinforcing your current motor pattern. Now you need to start rectifying the problem.
Stretch everything that is tight and strengthen everything that is weak.
Unfortunately, as I found, stretching wasn’t enough and I had to seek the help of a therapist’s thumbs to release off my hip flexors and glutes which then allowed me to stretch with a positive effect. Strengthening then involved focusing on improved glute and quad strength. The most important part of this is ensuring you are able to activate the muscles you are trying to activate. For example, as you are now try and squeeze your bum cheeks. Any luck? Now try and squeeze one bum cheek on its own, and now the other. Easy? Lucky you! Many people struggle with this task so trying to strengthen these muscles becomes much more difficult and can reinforce this negative movement pattern. So activate first, and then strengthen!
Once you feel that you are able to contract the weak muscles then get strengthening. Glute bridges are great but not functional. So once you are able to perform all the basic strength exercises ensure that you progress them and make them functional, i.e. when cycling you spend time lunging and squatting on one leg, so practice these exercises to strengthen the muscles with the correct muscle activation. It takes time, be patient and be determined.
TOP TIP: at the bottom of a single leg squat push your heel into the ground and then commence your ascent- this will help you to engage your glutes to help the lift. Give yourself a week or two to reinforce the new activation patterns and strength before putting this into practice.
On your bike…
Now it’s time to get back on that bike, start small with short trips (1-3 miles) during which you can focus on the correct movement pattern, i.e. quads push down, hamstrings and calfs pull up while you keep your body still and core strong. Each ride you can increase the distance but ensure you concentrate you performing the correct technique and vary the speed and torque to ensure you can maintain your new technique with the increasing intensity. Cycling 10 miles while constantly checking your technique is hard work, so concentrate on it for 1 mile and then enjoy the ride for 2 miles and check in again for 1 mile, repeating this for the duration of the journey.
As they say practice makes perfect, well actually practice makes permanent so it is important that your practice is correct, frequent and backed up with the strengthening and stretching.
I would love to hear your feedback on my blog articles, any similar experiences you have relating to this topic or any topic you would like to recommend for future blog posts.
Be well, be active, have fun…