Review of Asessement and Treatment of Muscle Imbalances

Over the last several years that I have subscribed to the thoughts of Dr. Vladimir Janda, there has been a dearth of formal resources describing the principles and methods.  Since his passing in 2002, we have relied on the few of his written works, some translated, and interpretations of the students he has mentored.

Many folks have located a 15-page article on the Internet from Phil Page and Clare Frank titled The Janda Approach to Chronic Musculoskeletal Pain.  This article has 3+ pages of citations and provides enough breadth to understand the basic premises of Janda’s message.

The Janda Approach

I think this article is best at describing and illustrating the Upper and Lower Crossed Syndromes and the tonic and phasic muscles of the body.  It enumerates the basics, but it did not open the window into a full or contemporary approach to a full training program.

Also for some time, the Janda Compendiums 1 and 2, as collections of Janda’s writings. have been available.  Some of the articles in the Compendiums have less applicability than others, but again, the window was not open very far.  I will say this with much confidence though, that the value was much like “Teach a man to Fish.”  Understanding the message and then crafting your own approach based on the methods is something that I have found incredibly fruitful.

It is somewhat of a knock on our continuing education society where great books or courses that don’t force feed tons of ready-to-use exercises or techniques are looked upon as not as satisfying as those that lay out the How To for developing your own stuff.

Several months ago, the authors of The Janda Approach, Clare Frank and Phil Page, teamed with another PT, Robert Lardner who I have also spent time with, in writing Assessment and Treatment of Muscle Imbalance: The Janda Approach.

It has been a few months now since I have finished the book, and below are some of the thoughts that have moved me during reading as well as added to my practice and thoughts.

1.  Parts I-III
Assessment and Treatment is made up of 4 sections of 15 chapters.  Looking back at the book, I felt like it was 2 parts: Theory and Application.  The Theory was the first 3 sections and 11 chapters.  These chapters are the gold of this book.  The final 4 chapters are also of tremendous use, but I had much more affinity to the information that allowed me to try to fit into my own “stuff.”

I mentioned before as it related to what has been out there attributed to Janda, and quite honestly, I’ve heard the same complaints about the FMS and SFMA courses, there is a lack of satisfaction with learning resources that don’t spoonfeed ready made exercises and techniques.

I look at it like this (and you may hear this again somewhere…………..), there are a lot of courses where people think they are great because they just get the house.  The house is the end tool.  I think it’s a very weak learner that just wants as much as possible even if they promise to use it on Monday.  This whole notion that a good course is chock full of stuff that you can bring back to the clinic after a weekend of exposure is really sensational and not terribly practical.  Don’t you want to practice and understand things more than a ride home?

The house to this book is Part III, Chapters 9-11.

Not this House..............

The better courses give you the blueprints as to how they come to build their type of house.  This is more to the likes of evaluation of a situation to decide which tools to use.  This is Part II, Chapters 5-8.  Most of the techniques in these sections are things I use in my “Janda Screen,” which is what I do to prove or disprove the -Crossed Syndromes, as well as the Breakouts in the SFMA.

What I think is the most moving of this book and what I think separates some of the very best education modules is that you get the house, the blueprints, but also how to make your own blueprints.  This is the science long before the theory and way before the application.  Part I, Chapters 1-4.

I really like the idea of getting the house, the blueprints to this particular house, but also how to make your own blueprints in case you want to build your own house one day.

Try figuring out these blueprints.


2.  Need to Reconsider Unstable Surfaces
For some time, I among others, have been very vocal against the use of unstable surfaces.  I’m not sure this part is going to ultimately change in terms of why I don’t have use for unstable surfaces in terms of strength and balance training.

There is certainly no reason to believe there is an increased strengthening affect in using unstable surfaces.  I think they have some use in deload weeks where the Airex pad demands a lighter load.  But we are not getting more balance or strength in a big lift like a RFE Split Squat.

In  terms of balance, I am firmly of the belief that if you can’t balance on a stable surface, making it harder isn’t going to all of a sudden yield brilliant balance.  You need to breakout the balance dysfunction first and then decide if indeed some proprioceptive input is the fix.  It is very frustrating to watch PTs and trainers have folks try to float all over on the bright little unstable surface product du jour.

Look at me. Look at me.

The notion that doing typical exercises on an unstable surface yields more “core” is really quite unfortunate.  It just doesn’t work that way.

However, what I need a lot more exposure to is what Janda called Sensori-Motor Training.  Using flat surfaced on wobble or rocker boards progressing to sandals with a wobble-bottom appear to have excellent affect in facilitating the short foot and lower quarter stability.

When I look at SMT, I don’t see the same foolishness that prevails in big box gyms.  I see flat surfaces that allow a natural contact with the foot.  I think this qualitative position of the foot allows for the closed chain to begin with stability.

I suspect that the further I go with the Prague School and taking Clare’s Janda course will allow the proper use of unstable surfaces in certain phases of training.

3.  Phil Page Parts

I’ve never met Phil Page as I have with the other authors of this book.  But I found it to be quite humorous to probably be able to pick off the parts of the book that were his domain.

Whenever there were suggestions of using anything Theraband or some other choices that didn’t seem to be very contemporary, I suspect these were his parts.  These sections I think really drew away from the overall quality of the book and sent a mixed message of isolated and impairment-based movements in a world of movement-based training and rehab.


4. PRRT
PRRT stands for Primal Reflex Release Technique.  Assessment and Treatment does not go over PRRT, but it was very excited to be reminded of this technique.

ThePRRT.com

I don’t remember what brought me to be exposed to this several months ago, but its inclusion along with Voijta’s Reflex Stimulation and Developmental Kinesiology ideas was an excellent reminder.

From the little I know about this approach, it is every bit as magic as Reflex Stimulation and DNS, and it is without a doubt on my To Do List in 2011.  They have a Home Study course that I may try sooner than later.

5.  WBV
Whole-Body Vibration was briefly mentioned, and I think it’s mechanism has an immediate role in tapping into the Sensori-Motor System and reflexive core.

What was troublesome was the unfortunate poor dissemination of information regarding WBV itself.  It wasn’t even the whole vertical vs. rotational thing, but more just what was an incomplete description.  Maybe it was just supposed to be a mention or teaser like PRRT was, but certainly this is a topic I feel confident in and wanted to see more, especially since I think it has a useful role in this whole approach.

I think the book below is the best independent resource for learning WBV.

7.  Movement-Based Approach
Assessment and Treatment of Muscle Imbalance: The Janda Approach is a must read in my opinion.  For fitness folks, there is not much of a need to go beyond certain chapters.  This is the identical case for Shirley Sahrmann’s book where the 1st 6 chapters are the theory and foundation for the system: The Blueprints.

For the medical professional, along with Liebenson’s, Lewit’s and Sahrmann’s texts and Gray Cook’s Movement, this book is the framework we need to keep everything we hold on to from an impairment- and kinesiology-based approach while putting it into a Movement-based approach.

The bottom line is that whoever the “guru” you prefer, the Movement-Based approach is a link between biomechanics, neurology, and pediatrics, and blending these approaches, as I see it, is the premiere and most contemporary methodology that we have available at this time.

And Janda started this stuff back in 1964.  How’s that for contemporary?

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10 Responses to “Review of Asessement and Treatment of Muscle Imbalances”

  1. Bob Tayor says:

    Great stuff, as usual, Charlie.

  2. Charlie,

    I agree, it was a good book that brought some good things to the table. Of particular interest to me was PRRT. It seems like it may be an excellent addition to the PT arsenal, particularly if it is capable of reducing pain as well as they suggest.

    Regards,
    Carson Boddicker

  3. Joe Bonyai says:

    Great review, Charlie – I was glad to read a more thoughtful perspective on unstable surface training. I have a question as it relates to the Core Pendulum theory: Can the ground be used to create synthetic stability? In this case, would using something like a wobble board or half foam (round down) be beneficial to allow the ankle greater freedom, training it to find “home base”? (the application being prep exercises or something like med ball split stance chops/throws). Looking forward to your UST thoughts.
    JB

  4. Charlie says:

    Joe – I need to review the SMT-specific goals more, but this type of unstable surface training I believe is geared towards exactly what you are saying, but not necessarily from a pedal goal, but a whole-body goal. It may be an access point to pure regional interdependence.

  5. Carl Valle says:

    I think single leg hops and bounds really shed the most insight of what levels of torque the ankle and foot can handle. Polish boxes are great ways to challenge the foot without getting into artificial loads and angles.

  6. Charlie says:

    Carl – What are Polish boxes?

    I would agree hopping and bounding are very ideal performance tests and can expose a lot.

  7. Phil Page says:

    Hi Charlie, Phil Page here. Thanks for the review of our textbook. I’m glad you found it helpful and recommended it as a “must read”. Clare, Robert & I have tried to ‘modernize’ Janda’s work into a more contemporary, evidence-based approach that would appeal to today’s practicing ‘movement professional.’ Therefore, you may see some mix of impairment, and movement based approaches since we dont subscribe to one particular approach. Our mission was not to promote elastic bands and “non-contemporary” devices, but to help clinicians re-think their current treatment approaches using inexpensive devices. All 3 of us simply shared what we use on a daily basis with patients in the clinic. Dr. Janda was a great proponent of low-cost rehabilitation devices such as elastic bands and balance pads. Unfortunately, he didn’t speak much about the actual treatment approaches in his compendia and lectures; we worked with him to develop the exercise approaches before he died so that today’s clinicians would be better able to apply his excellent diagnostic scheme into a very practical way of approaching rehabilitative exercises. Thanks again for your review, and I’m glad you enjoyed the book.

  8. Charlie says:

    Hi, Phil. Thank you for reading and posting. In the production of such an excellent book that was in need of publishing, it is just so frustrating to see highlighting of methods that allow poor clinicians to be reaffirmed in their lazy and mediocre techniques. A poor clinician would rather listen to 1 “guru” that says they are right than the other 11 that say they are wrong. This is human nature, and I wish, in all avenues and media, we did not have these speedbumps in growth and development.

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  10. Adrian Datu says:

    Hey Charlie,

    Great review of this book. Just recently finished this a few months ago and am very interested in taking DNS courses. I was curious if you ever ended up taking the PRRT courses and what you thought of them?

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