The baby's first movements occur thanks to the muscle-joint sense, with the help of which the child determines its place in space long before birth. In the first year of life, muscle-joint sensation gives the child a powerful stimulus for development. It is thanks to him that the baby learns to make conscious movements (raise his head, reach for a toy, roll over, sit down, stand up, etc.). And the main characteristic of the muscular skeleton of newborns is tone.

The tone varies

First of all, you need to understand what muscle tone is and what is considered normal. Even in sleep, our muscles do not relax completely and remain tense. This minimum tension, which remains in a state of relaxation and rest, is called muscle tone. The younger the child, the higher the tone - this is due to the fact that at first the surrounding space is limited to the uterus, and the child does not need to perform purposeful actions. In the fetal position (with the limbs and chin tightly pressed to the body), the muscles of the fetus are under strong tension, otherwise the child simply would not fit in the uterus. After birth (during the first six to eight months), muscle tone gradually weakens. Ideally, the muscle tone of a two-year-old baby should be approximately the same as that of an adult. But almost all modern babies have problems with tone. Poor ecology, complications during pregnancy, stress and a number of other unfavorable factors provoke impaired tone in newborns. There are several common muscle tone disorders.

• Increased tone (hypertonicity).

  The child seems tense and tense. Even in sleep, the baby does not relax: his legs are bent at the knees and pulled up to his stomach, his arms are crossed on his chest, and his fists are clenched (often in a “fig” shape). With hypertonicity, a child holds his head well from birth due to the strong tone of the occipital muscles (but this is not good).

• Decreased tone (hypotonicity).

  With decreased tone, the child is usually lethargic, moves his legs and arms little, and cannot hold his head up for a long time. Sometimes the child’s legs and arms extend at the knee and elbow joints by more than 180 degrees. If you place the baby on his stomach, he will not bend his arms under his chest, but spread them to the sides. The child looks limp and spread-eagled.

• Asymmetry of muscle tone.

  With asymmetry, the tone on one half of the body is higher than on the other. In this case, the child’s head and pelvis are turned towards the tense muscles, and the torso bends in an arc. When a child is placed on his stomach, he always falls to one side (where the tone is increased). In addition, asymmetry can be easily detected by the uneven distribution of the gluteal and thigh folds.

• Uneven tone (dystonia).

  Dystonia combines signs of hyper- and hypotonicity. In this case, the child’s muscles are too relaxed and others are too tense.

Diagnosis of muscle tone

Usually, immediately after birth, the doctor, based on visual diagnostic tests, identifies disturbances in the tone and motor activity of the newborn. In addition, all infants have so-called “residual” (posotonic) reflexes, which can also be used to determine disturbances in muscle tone. In principle, you yourself can check how your child is doing with his tone. Here are a few basic tests that help determine abnormalities in the development of muscle tone and postural reflexes in a newborn.

• Hip spread.

  Place the child on his back and carefully try to straighten his legs and move them in different directions. But do not use force and make sure that the child does not get hurt. Normally you should feel moderate resistance. If a newborn’s legs are fully extended without resistance and easily spread in different directions, this is evidence of decreased tone. If the resistance is too strong and the child’s legs cross, this is a sign of hypertonicity.

• Sitting down by hands.

  Place the child on his back on a hard, flat surface (for example, on a changing table), take him by the wrists and gently pull him towards you, as if sitting him down. Normally, you should feel moderate resistance to extending your elbows. If the child's arms straighten without resistance, and in a sitting position the stomach is strongly protruded forward, the back is rounded, and the head is tilted back or lowered down - these are signs of decreased tone. If you cannot move your child’s arms away from the chest and straighten them, this, on the contrary, indicates hypertonicity.

• Step reflex and support reflex.

  Take the baby vertically under the arms, place him on the changing table and slightly tilt him forward, forcing him to take a step. Normally, the child should stand on his full foot with his toes straightened. And when bending forward, the child imitates walking and does not cross his legs. This reflex gradually fades and by 1.5 months it practically disappears. If this reflex persists in a child older than 1.5 months, this is evidence of hypertonicity. Also, increased tone is indicated by curled toes, crossing the legs when walking, or relying only on the forefoot. If, instead of standing, the newborn crouches, takes a step on strongly bent legs, or refuses to walk at all, these are signs of decreased tone.

• Symmetrical reflex.

  Place your baby on his back, place your hand under the back of his head and gently tilt the baby's head toward your chest. He should bend his arms and straighten his legs.

• Asymmetrical reflex.

  Place your baby on his back and slowly, without force, turn his head toward your left shoulder. The child will take the so-called fencing pose: extend his arm forward, straighten his left leg and bend his right leg. Then turn the child's face to the right side, and he should repeat this pose only in the opposite direction: stretch his right arm forward, straighten his right leg and bend his left.

• Tonic reflex.

  Place the baby on his back on a hard surface - in this position, the newborn’s extensor tone increases, he tries to straighten his limbs and seems to open up. Then turn the child over on his stomach and he will “close” and pull his bent arms and legs under him (the tone of the flexors increases on the stomach).
  Normally, symmetrical, asymmetrical and tonic reflexes are moderately expressed and gradually disappear by 2-2.5 months. If a newborn does not have these reflexes or is too weakly expressed, this indicates decreased tone, and if by three months these reflexes persist, this is a sign of hypertonicity.

• Reflexes of Moro and Babinski.

  Watch your child carefully. When overexcited, he should throw his arms to the sides (Moro reflex), and when the soles are irritated (tickling), the child reflexively begins to straighten his toes. Normally, the Moro and Babinski reflexes should disappear by the end of the 4th month.

If muscle tone and associated reflexes do not undergo changes appropriate to the baby’s age, this is a very dangerous signal. You shouldn’t rely on the proverbial “maybe” and expect that problems with muscle tone will go away on their own. Violation of tone and development of reflexes often leads to delayed motor development. And with a strong deviation from the norm, we are talking about the possible formation of diseases of the nervous system, ranging from seizures to cerebral palsy. Fortunately, if a doctor diagnoses a tone disorder at birth (or in the first three months), the threat of developing serious diseases can be prevented with the help of massage, because in the first year of life the nervous system has enormous regenerative potential.

Healing massage

It is best to start massage when the baby is two months old. But first, it is necessary to show the child to three specialists: a pediatrician, an orthopedist and a neurologist, who make a diagnosis and give recommendations. If a child requires drug treatment, it is usually “adjusted” to massage. A correctly and timely course of massage helps to correct many orthopedic disorders (incorrectly turned feet, etc.), normalize muscle tone and eliminate “residual” reflexes. In case of serious deviations from the norm, the massage should be performed by a professional. But you can slightly adjust the tone at home.

It is better to massage during the day, at least an hour after feeding. You should first ventilate the room and make sure that the temperature is not lower than 22 degrees; the child should not be hot or cold. Hands should be washed with warm water and wiped dry (so that they are warm). You should not cover your child’s entire body with massage oil or cream; just apply a small amount of cream to your hands. For massage, you can use special oil or regular baby cream. When giving a massage, talk gently to your child and watch his reaction. When the first signs of fatigue appear (crying, whining, dissatisfied grimaces), you should stop exercising.

During massage, all movements are made from the periphery to the center, starting from the limbs: from the hand to the shoulder, from the foot to the groin. In the first lessons, each exercise is repeated only once. At first, the entire massage complex will take no more than 5 minutes. Gradually increase the number of repetitions and time to 15-20 minutes.

To eliminate hypertonicity and residual reflexes, manifested in the child’s excessive activity, the so-called gentle massage- it relaxes and calms. Start the massage by stroking your arms, legs, back with the back and palm surfaces of several closed fingers. You can alternate between flat (using the surface of your fingers) and grasping (with your whole hand) stroking. After stroking, the skin is rubbed in a circular motion. Place your baby on your stomach and place your palm along your baby's back. Without taking your hands off your baby's back, gently move his skin up, down, right and left in line movements, as if you were sifting sand through a sieve with your hand. Then place the child on his back, take his hand and shake it lightly, holding the child by the forearm. In this way, massage both arms and legs several times. Now you can move on to rocking. Grasp the baby's arm muscles (just above the wrist) and gently but quickly rock and shake his arms from side to side. Your movements should be fast and rhythmic, but not abrupt. Do the same with the legs, grabbing the child by the calf muscles. You need to finish the massage in the same way as you started - with smooth stroking.

With decreased tone, on the contrary, it is carried out stimulating massage, which activates the child. Stimulating massage includes a large number of “chopping” movements. After traditional stroking with the edge of your palm, lightly walk along the baby's legs, arms and back. Then place your baby on his stomach and roll your knuckles over his back, bottom, legs and arms. Then turn your baby onto his back and roll your knuckles over his stomach, arms and legs.

In addition to massage, it helps to normalize muscle tone physiotherapy, for example, exercises on a large inflatable ball. Place the child with his stomach on the ball, legs should be bent (like a frog) and pressed against the surface of the ball. Let dad, for example, hold the baby’s legs in this position, and you take the baby by the arms and pull him towards you. Then return the baby to the starting position. Now grab your baby's shins and pull them toward you until your baby's face is at the top of the ball or his feet touch the floor. Smoothly return the baby to its original position. Then tilt the child forward (away from you) so that his palms reach the floor (just make sure that the baby does not hit his forehead on the floor). Repeat this exercise several times forward and backward.

If you have asymmetrical tone, you should do a relaxing massage with force on the side in which the tone is lower. In addition, the following exercise on an inflatable ball has a good effect: place the child on the inflatable ball with the side in which it bends. Smoothly swing the ball along the axis of the child's body. Repeat this exercise 10-15 times daily.

Even if a child’s muscle tone is normal, this is not a reason to refuse preventative massage. Preventive massage includes both relaxing and activating movements. Massage techniques such as stroking (they begin and end the massage), rubbing, and kneading with stronger pressure are used. Use circular movements (clockwise) to massage your stomach to prevent colic and constipation. Use your thumb to stroke your baby's soles and lightly pat them. Then, with your entire palm, preferably both hands, stroke the baby’s chest from the middle to the sides, and then along the intercostal spaces. From three months onwards, it is useful to combine massage with gymnastics. The main goal of preventive massage is to prepare the child for walking. From two months to one year, a healthy child must undergo at least 4 massage courses (15-20 sessions each). When the child begins to walk, the intensity of the massage is reduced to twice a year. It is advisable to take massage courses in spring and autumn to improve the condition of the immune system, which is usually weakened at this time of year.

Natalya Aleshina
Consultant: pediatric neurologist Inna Viktorovna Knyazeva.

12/21/2008 10:50:45, Elena

I have a question, my baby is 3.5 months old and he throws his head back a lot when he lies on his back, what could this be?

12/20/2008 22:06:34, Kirill

Thank you, the article is good, I agree with Lesya’s statement. Before visiting a neurologist, bring your baby back to normal. We were fast asleep - we undressed the sleeping woman, the doctor examined her - the baby was soft, like a kitten, weak reflexes, arms outstretched, sleeping... as a result - the diagnosis "Diffusion hypotonicity" Although I will not deny, the tone is still lowered, but since the doctor was scared, It’s better not to see anyone, then I got scared, and the baby didn’t eat well. At the second appointment, everything settled down - there is hypotonicity, but not strong. We do a massage (250 per session, x 20 times, the child has no price), eat Caventon (Vimpocetine) to improve cerebral circulation. Everything is recoverable, mothers, don’t worry.

08/10/2005 14:57:26, Julia

02/09/2005 17:37:17, YuriK

This article helped us a lot. When my child, at 2 months old, went to the prof. for the first time. examination by a neurologist, by this time I was already pretty exhausted from previous examinations by a pediatrician and surgeon, and it was still time for feeding. Therefore, it is not surprising that when we entered the doctor’s office with him, he was a compressed bundle of nerves. No doctor, much less a neurologist, can properly examine such a child, who is fed up with everything and is screaming displeasedly. As a result, the child, with this condition, was diagnosed with hyperesthesia of the skin, hypertonicity of the muscles of the limbs and prescribed medication. Armed with information about these diseases and comparing them with the daily behavior of my baby, I could not agree with the neurologist’s diagnosis. Even the reflexes that are used to establish tone (they are used by neurologists, but we found them in your article and used them ourselves) did not confirm such a diagnosis. We did not carry out any prescribed treatment, especially since the medications prescribed by the doctor are used in the treatment of serious illnesses, but we waited until the child was three months old and went on a visit to an experienced neurologist. The main thing was that the child was prepared: he was well-fed and enjoyed the sound. As we expected, the doctor did not find any developmental abnormalities. Therefore, when going to a neurologist, you need to find the right time for the child so that his condition does not give rise to erroneous diagnoses.

06/18/2004 23:19:15, Lesya

Good afternoon, very useful article, thank you very much. Our Nastenka is 4 months old today. We have asymmetrical tone, which is now being corrected with massage. Local neuropathologist at 3 months. prescribed Cavinton, is it necessary to take it, what kind of drug is it, or would it be better to consult the child with another specialist?

09.19.2003 18:36:43, Julia

Stages of development posture Constant muscle activity is a powerful stimulus for their growth and proper formation. posture. In a newborn, the spine has the appearance of an arch, convexly facing backward; this relief remains in the first time after birth. When the child begins to hold his head up (on average by the end of the first month of life), the first curve appears in the neck area, convexly facing forward (cervical lordosis). Then, when sitting, from about 6 months, a curve in the thoracic region gradually forms spine, convexly facing backward (thoracic kyphosis). Children at 10 months of age are characterized by an upright posture and begin to stand and walk. But the vertical posture is imperfect: the child’s abdominal muscles are very weak, so in a vertical position, the stomach protrudes under the influence of gravity and a slight bend appears in the lumbar region with a convexity forward (lumbar lordosis). Gradually, during preschool age, the protrusion of the abdomen decreases, but does not disappear, and the lumbar curve becomes more noticeable. The chest is flattened, and the shoulders are rounded, but located somewhat back. The knees are straight in a vertical position, but remain slightly bent when walking. Forming bends spine ends at 6-7 years. At primary school age posture The child mainly retains the features of preschool age. Pronounced lumbar lordosis and moderate abdominal convexity in a child are normal. Bends spine necessary for a person to maintain balance in an upright position. They increase the elasticity of the spinal column, soften shocks and shocks during movements.

Poor posture in children: causes

Development problems Usually a violation posture occurs during periods of rapid growth: at 5-8, and especially at 11-12 years. This is the time when bones and muscles increase in length, and the mechanisms for maintaining posture have not yet adapted to the changes that have occurred. Deviations are observed in the majority of children aged 7-8 years (56-82% of primary schoolchildren). There are many factors that cause curvature spine.

For example, poor nutrition and illness often disrupt the proper growth and development of muscle, bone and cartilage tissue, which negatively affects the formation posture. An important factor is congenital pathologies of the musculoskeletal system. For example, with bilateral congenital dislocation of the hip joints, an increase in lumbar curve may be noted. An important role in the formation of deviations is played by the uneven development of certain muscle groups, especially against the background of general muscle weakness. For example, hunched shoulders are the result of predominant strength of the pectoral muscles and insufficient strength of the muscles that bring the shoulder blades together, and “dropping shoulders” are the result of insufficient work of the trapezius muscle backs. An important role is played by overload of certain muscles with unilateral work, for example, incorrect position of the torso during games or activities. All these reasons lead to an increase or decrease in existing physiological curves spine. As a result, the position of the shoulders and shoulder blades changes, resulting in an asymmetrical position of the body. Incorrect posture gradually becomes habitual and can take hold.

Incorrect posture

Sitting position. You should definitely pay attention to how the child sits at the table during classes: whether he puts one leg under him. Perhaps he is slouching or “leaning” to one side, leaning on the elbow of his bent arm. Incorrect body position when sitting includes a position in which the torso is turned, tilted to the side or strongly bent forward. The reason for this situation may be that the chair is far away from the table or the table itself is too low. Or maybe the book the baby is looking at lies too far from him. An asymmetrical position of the shoulder girdle can be formed as a result of the habit of sitting with the right shoulder raised high. Take a closer look: perhaps the table at which the child is studying is too high for him, and his left arm hangs down, instead of lying on the tabletop (the same can happen if the table is round).

Standing position. The habit of standing with your leg set to the side and half-bent, like a crooked landing, develops an asymmetrical body position. This may worsen the lateral curvature spine caused by other reasons (for example, underdevelopment of the lumbosacral region spine).

Physical inactivity... in children

Another important factor in the occurrence of violations posture children should be considered a notorious way of life. As sad as it may be, modern children have begun to move less. Starting from the age of 3, many children join the ranks of early development groups (primarily mental), then the process of acquiring knowledge increases, and during classes the child is forced to sit for a long time. In addition, children are introduced early to watching TV and video products; they can sit for hours playing computer games, and on the street, meeting with friends, instead of outdoor games, they enthusiastically discuss the features and codes of this or that electronic “shooter”. What can you do, if you want to be modern, follow the modern trends of life. However, a person must develop harmoniously, physical development should not lag behind. The weakness of the muscular corset in our children is primarily due to the lack of adequate physical activity, while with rapid growth the strength of the abdominal muscles and backs simply necessary.

Poor posture in a child: how to recognize it in time?

Main signs. In order to notice the deviation in time, parents need to pay more attention to the position of the shoulders and backs baby. His shoulders and shoulder blades should be at the same level. Correct position is also important spine- whether it is curved to the right or left, whether the subgluteal folds are located at the same level. These signs of lateral curvature can be seen by examining the child from backs when he is standing. When viewed from the front, it should be noted whether the collarbones and nipples are at the same level. By looking at the side, you can identify disorders such as stooping or sluggish posture. This can be done by eye or using a special test. The child stands with his back to the wall so that the back of the head, shoulder blades, buttocks, and legs are in contact with the wall, and then takes a step forward, trying to maintain the correct body position. (The same test can be used as an exercise to develop good posture.)

If a curvature is detected, it is necessary to examine the baby’s back, placing him on a flat, hard surface face down, arms along the body. If the curvature of the spinal column in the supine position does not persist, then we are only talking about a violation posture which can be corrected. Muscle test . There are several simple tests to determine the state of the child’s muscular system. To do this, assess the baby’s ability to exert himself for long periods of time. muscles backs . The child is placed face down on the couch so that the part of the body above the hips is suspended outside the couch, hands on the belt (the child’s legs are held by an adult). Normally, children 5-6 years old can maintain a horizontal position of the body for 30-60 seconds, children 7-10 years old - 1-1.5 minutes, 12-16 years old - from 1.5 to 2.5 minutes. Development abdominal muscles, is determined by the number of continuous repetitions of the transition from a lying position to a sitting position and back (while fixing the legs) at a slow pace, no more than 16 times per minute. The norm for preschoolers is 10-15 times, for children 7-11 years old - from 15 to 20 times, for children 16-18 years old - from 20-30 times. If violations are detected posture and (or) weakness of the muscular system, the child should be consulted with an orthopedic surgeon, traumatologist or physical therapist. The doctor examines the child, and if necessary, additional research methods are performed: radiography, electromyography, etc. Recently, a new research method has appeared - topographic photometry, - allowing not only to diagnose disorders of the musculoskeletal system, but also to evaluate the effectiveness of the treatment. The method is based on photography posture patient after the doctor has applied the main landmark points on the child’s back with a marker.

Prevention of postural disorders in children

Since one of the main conditions for correct posture- proper development of the body, you need to try to create the most favorable conditions for growth. In particular, it is very important to observe a general hygienic regime: regularity in eating, sufficient exposure to air, the right combination of activities and rest, and the use of hardening agents. Strengthening the muscle corset should be done from infancy, but one should not rush the child’s physical development and force him to sit when he is not yet sitting independently, or force the baby to walk at 9 months, or even earlier. Early axial (vertical) load can cause the development of orthopedic diseases in the baby. Let your baby move more while lying down or crawling until he sits up or stands up on his own. Of no less preventive importance is a group of measures that influence the overall physical development and functional state of the muscular system, since active retention of the body, upper and lower extremities in the correct position is possible only with the active participation of muscles. Special exercises are used for this. Lack of physical activity prevents the development of the muscular corset, while with rapid growth, the strength of the abdominal muscles and backs necessary. Properly selected physical activity prevents disorders posture, and also help to overcome them. Exercises are selected depending on the type of curvature spine: for children with a tendency to stoop, extensions are recommended backs with effort to the maximum straightened position, children with shoulder joints brought forward benefit from circular movements with both arms back at the same time, moving them back, bending the arms to the shoulders, to the back of the head. With “dangling” shoulder joints, it is useful to abduct the arms upward from the sides, raise the shoulders, stretch the arms upward with counteraction (the adult places his hands on the child’s shoulders). Developing the right posture Balance exercises also help. For example, walking on a bench or log with your arms out to the sides. In addition, the age of the child must be taken into account. For babies It is recommended to select exercises of a gaming nature. For example, children will be happy to perform the straightening-extension exercise. spine, if you ask them to draw a column of mercury in a thermometer under the rays of the sun. When doing the “Lumberjack” exercise, children “chop wood” by rotating their upper body. The frog jump exercise helps correct lumbar lordosis. Preschool children (from 4-5 years old) are able to understand and cope with more complex gymnastic tasks. Inset

An approximate set of special exercises to strengthen muscles backs and press (can be performed from 4-5 years old until adolescence): 1. Initial position- standing, hands on your belt. Spread your elbows, squeezing your shoulder blades together - inhale; return to IP - exhale. 2. I.p.- standing, legs apart, hands to shoulders. Lean your body forward with your back straight - exhale; return to IP - inhale. 3. I.p.- standing with a gymnastic stick in his hands. Raise the stick forward up - exhale; return to IP - inhale.. 4. I.p.- standing, stick in lowered hands. Sit down with your arms stretched forward; return to IP The back is straight. 5. I.p.- standing, stick on shoulder blades. Lean forward with your arms stretched up (take out the stick); return to IP 6. I.p.- lying on your back, on an inclined plane, holding the bar of the gymnastic wall with your hands. Bend your legs, pull them to your stomach - exhale; straighten - inhale. 7. I.p.- lying on your back, arms along your body. Bicycle leg movements. 8. I.p.. - lying on your back, arms to the sides. Stretch your arms forward, lift your left leg and touch your arm, then your right leg. Accept i.p. 9. I.p. - lying on your stomach, arms to your sides. Raise the body, bending the thoracic region spine(reach for the ceiling); return to IP 10. I.p. - lying on your stomach, hands on your belt. Raise your body up and raise your right leg - inhale; return to IP - exhale. Repeat the exercise, raising your left leg straight. eleven. I.p.- lying on your stomach, arms bent at the elbow joints, holding a gymnastic stick on your shoulder blades. Raise your body by bending it through a gymnastic stick; return to IP Breathing is voluntary. A set of exercises is performed daily in the morning or evening, depending on the child’s peak activity, but not earlier than an hour after a meal or 30-60 minutes before it. The pace is slow, you should start with 5 repetitions, increase to 10, the whole complex takes 30-40 minutes. In order for the exercises to have a sufficiently accurate effect, they must be performed intensively, that is, above the usual level of children’s ability. First, easier exercises are given with a gradual transition to more difficult ones. Throughout the lesson there are repeated breaks to rest. It is recommended to rest in a lying position: lying on your back, legs slightly pulled up to your stomach, hands behind your head; lying on your stomach, your chin resting on your hands.

If the child is significantly weakened, it is advisable to combine daily exercise with physical therapy classes to strengthen muscles backs and abdominal pain in the clinic with a physical therapy doctor. At the beginning and end of each lesson, children should practice correct posture. A test exercise that is performed against a wall is suitable for this. You should get them interested in the problem. posture, make you think about it during the day, check it not only during gymnastics, but also during classes at the table, on a walk. A child attending kindergarten can be asked to monitor not only himself, but also the posture of his friends. Usually this turns into a kind of competition between children: who will catch whom in the wrong position more often? posture. Such competition forces children to be alert and always maintain a normal position. backs- eventually it will become a habit. The set of exercises we have presented can be considered rather preventative. It is primarily useful for practically healthy children, and not just for those who have been diagnosed with a disorder. posture(for such young patients, depending on the defect, the doctor will select an individual set of special exercises). Treatment of pathology of the musculoskeletal system is always lengthy, complex, requiring significant effort not only from specialists, but also from the patient himself. Sometimes problems with posture and therapeutic measures make certain aspects of the child’s “social” life inaccessible to the child. Therefore, it is important to prevent the occurrence of violations posture, i.e. systematically engage in adequate physical activity and regularly (annually) visit an orthopedic doctor with your child for preventive examinations. In addition, the overall development of the child can be improved with the help of sports sections, which can be attended from 4-5 years old. Better development posture promotes swimming (preferably breaststroke, backstroke). In addition, volleyball, basketball, and cross-country skiing are useful. Try to maintain your child's interest in sports activities, and this will allow him to avoid many problems associated with posture.

Muscle weakness can be present in a few muscles or many muscles and develop suddenly or gradually. Depending on its cause, the patient may experience other symptoms. Weakness of certain muscle groups can lead to oculomotor disturbances, dysarthria, dysphagia, or difficulty breathing.

Pathophysiology of muscle weakness

Voluntary movements are initiated by the motor cortex of the brain in the posterior parts of the frontal lobe. Neurons in this area of ​​the cortex (central, or upper motor neurons, or corticospinal tract neurons) transmit impulses to motor neurons in the spinal cord (peripheral, or lower motor neurons). The latter come into contact with the muscles, forming a neuromuscular junction, and cause their contraction. The most common mechanisms for the development of muscle weakness include damage to the following structures:

• central motor neuron (damage to the corticospinal and corticobulbar tracts);
• peripheral motor neuron (for example, with peripheral polyneuropathies or anterior horn lesions);
• neuromuscular junction;
• muscles (for example, with myopathies).

Localization of the lesion at certain levels of the motor system leads to the development of the following symptoms:

• When the central motor neuron is damaged, inhibition is removed from the peripheral motor neuron, which leads to an increase in muscle tone (spasticity) and tendon reflexes (hyperreflexia). Damage to the corticospinal tract is characterized by the appearance of the extensor plantar reflex (Babinski reflex). However, when severe paresis suddenly develops due to central motor neuron damage, muscle tone and reflexes may be suppressed. A similar picture can be observed when the lesion is localized in the motor cortex of the precentral gyrus, far from the associative motor areas.
• Peripheral motor neuron dysfunction leads to rupture of the reflex arc, which is manifested by hyporeflexia and decreased muscle tone (hypotonia). Fasciculations may occur. Over time, muscle atrophy develops.
• Damage in peripheral polyneuropathies is most noticeable if the longest nerves are involved in the process.
• In the most common disease affecting the neuromuscular junction, myasthenia gravis, muscle weakness usually develops.
• Diffuse muscle damage (for example, in myopathies) is best seen in large muscles (muscle groups of the proximal limbs).

Causes of muscle weakness

The numerous causes of muscle weakness can be divided into categories depending on the location of the lesion. As a rule, when the lesion is localized in one or another part of the nervous system, similar symptoms occur. However, in some diseases the symptoms correspond to lesions at several levels. When the lesion is localized in the spinal cord, the pathways from the central motor neurons, peripheral motor neurons (anterior horn neurons), or both of these structures may be affected.

The most common causes of localized weakness include the following:

• stroke;
• neuropathies, including conditions associated with trauma or compression (eg, carpal tunnel syndrome), and immune-mediated diseases; “damage to the spinal nerve root;
• compression of the spinal cord (with cervical spondylosis, metastases of a malignant tumor in the epidural space, trauma);
• multiple sclerosis.

The most common causes of widespread muscle weakness include the following:

• dysfunction of muscles due to their low activity (atrophy from inactivity), which occurs as a result of illness or poor general condition, especially in older people;
• generalized muscle atrophy associated with prolonged stay in the intensive care unit;
• critical illness polyneuropathy;
• acquired myopathies (eg, alcoholic myopathy, hypokalemic myopathy, corticosteroid myopathy);
• use of muscle relaxants in a critically ill patient.

Fatigue. Many patients complain of muscle weakness, meaning general fatigue. Fatigue may interfere with the development of maximal muscle force when testing muscle strength. Common causes of fatigue include acute severe illnesses of almost any nature, malignant tumors, chronic infections (for example, HIV, hepatitis, endocarditis, mononucleosis), endocrine disorders, renal failure, liver failure and anemia. Patients with fibromyalgia, depression, or chronic fatigue syndrome may complain of weakness or fatigue, but have no objective problems.

Clinical examination for muscle weakness

During a clinical examination, it is necessary to distinguish true muscle weakness from fatigue, then identify signs that will allow us to establish the mechanism of the lesion and, if possible, the cause of the disorder.

Anamnesis. The medical history should be assessed using questions such that the patient independently and in detail describes the symptoms he has that he regards as muscle weakness. Following this, follow-up questions should be asked that specifically assess the patient's ability to perform certain activities, such as brushing teeth, combing one's hair, talking, swallowing, rising from a chair, climbing stairs, and walking. It is necessary to clarify how the weakness appeared (suddenly or gradually) and how it changes over time (remains at the same level, increases, varies). Appropriate detailed questions should be asked in order to distinguish between situations where weakness has developed suddenly and where the patient has suddenly realized that he has weakness (the patient may suddenly realize that he has muscle weakness only after the gradually increasing paresis reaches this degree , making it difficult to perform normal activities such as walking or tying shoelaces). Important associated symptoms include sensory disturbances, diplopia, memory loss, speech impairment, seizures and headache. Factors that aggravate weakness, such as overheating (which suggests multiple sclerosis) or repetitive muscle strain (common with myasthenia gravis), should be assessed.

Organ and system records should include information that suggests possible causes of the disorder, including rash (dermatomyositis, Lyme disease, syphilis), fever (chronic infections), muscle pain (myositis), neck pain, vomiting, or diarrhea ( botulism), shortness of breath (heart failure, lung disease, anemia), anorexia and weight loss (malignant tumor, other chronic diseases), change in urine color (porphyria, liver or kidney disease), heat or cold intolerance and depression, difficulty concentrating , agitation and lack of interest in daily activities (mood disorders).

Past medical conditions should be assessed to identify diseases that may cause weakness or fatigue, including thyroid, liver, kidney or adrenal disease, malignancies or risk factors for their development, such as heavy smoking (paraneoplastic syndromes), osteoarthritis and infections. Risk factors for possible causes of muscle weakness should be assessed, including infections (eg, unprotected sex, blood transfusions, contact with tuberculosis patients) and stroke (eg, hypertension, atrial fibrillation, atherosclerosis). It is necessary to find out in detail what medications the patient used.

Family history should be assessed for hereditary diseases (eg, hereditary muscle pathologies, channelopathies, metabolic myopathies, hereditary neuropathies) and the presence of similar symptoms in family members (if a previously undetected hereditary pathology is suspected). Hereditary motor neuropathies often remain unidentified due to variable and incomplete phenotypic presentation. Undiagnosed hereditary motor neuropathy may be indicated by the presence of hammertoes, high arches, and poor performance in sports.

Physical examination. To clarify the location of the lesion or identify symptoms of the disease, it is necessary to conduct a complete neurological examination and muscle examination. It is essential to assess the following aspects:

• cranial nerves;
• motor function;
• reflexes.

Assessing cranial nerve function includes examining the face for gross asymmetry and ptosis; Normally, slight asymmetry is allowed. Eye movements and facial muscles are studied, including determination of the strength of the masticatory muscles. Nasolalia indicates soft palate paresis, whereas testing the swallowing reflex and direct inspection of the soft palate may be less informative. Weakness of the tongue muscles can be suspected by the inability to clearly pronounce certain consonant sounds (for example, “ta-ta-ta”) and slurred speech (ie, dysarthria). Slight asymmetry in tongue protrusion may be normal. The strength of the sternocleidomastoid and trapezius muscles is assessed by turning the patient's head and by how the patient overcomes resistance when shrugging the shoulders. The patient is also asked to blink to detect muscle fatigue when opening and closing the eyes repeatedly.

Study of the motor sphere. The presence of kyphoscoliosis (which in some cases may indicate long-term weakness of the back muscles) and the presence of scars from surgery or injury are assessed. Movement may be impaired by dystonic postures (eg, torticollis), which may mimic muscle weakness. Assess for the presence of fasciculations or atrophy, which may occur in ALS (localized or asymmetrical). Fasciculations in advanced ALS patients may be most noticeable in the tongue muscles. Diffuse muscle atrophy may be best seen on the arms, face, and shoulder muscles.

Muscle tone is assessed during passive movements. Tapping muscles (eg, hypothenar muscles) may reveal fasciculations (in neuropathies) or myotonic contractions (in myotonia).

Assessment of muscle strength should include examination of the proximal and distal muscles, extensors and flexors. To test the strength of large, proximal muscles, you can ask the patient to stand up from a sitting position, squat and straighten, bend and straighten, and turn his head against resistance. Muscle strength is often assessed on a scale of five.

• 0 - no visible muscle contractions;
• 1 - there are visible muscle contractions, but there is no movement in the limb;
• 2 - movements in the limb are possible, but without overcoming gravity;
• 3 - movements in the limb are possible that can overcome the force of gravity, but not the resistance provided by the doctor;
• 4 - movements are possible that can overcome the resistance provided by the doctor;
• 5 - normal muscle strength.

Despite the fact that such a scale seems objective, it can be difficult to adequately assess muscle strength in the range from 3 to 5 points. With unilateral symptoms, comparison with the opposite, unaffected side can help. Often, a detailed description of what the patient can and cannot do is more informative than a simple scale rating, especially if it is necessary to re-examine the patient over the course of the disease. In the presence of a cognitive deficit, the patient may experience variable performance on muscle strength assessments (inability to concentrate on a task), repeating the same action, exerting incomplete effort, or having difficulty following instructions due to apraxia. With malingering and other functional disorders, usually a patient with normal muscle strength “yields” to the doctor when checking it, simulating paresis.

Coordination of movements is checked using finger-nose and heel-knee tests and tandem gait (putting heel to toe) to exclude disorders of the cerebellum, which can develop with impaired blood circulation in the cerebellum, atrophy of the cerebellar vermis (with alcoholism), some hereditary spinocerebellar ataxias, disseminated sclerosis and Miller Fisher variant in Guillain-Barré syndrome.

Gait is assessed for difficulty at the beginning of walking (temporary freezing in place at the beginning of movement, followed by hasty walking with small steps, which occurs in Parkinson's disease), apraxia, when the patient's feet seem to stick to the floor (with normal pressure hydrocephalus and other lesions of the frontal lobe), shuffling gait (with Parkinson's disease), limb asymmetry, when the patient pulls up his leg and/or swings his arms to a lesser extent than normal when walking (with hemispheric stroke), ataxia (with cerebellar damage) and instability when turning (with Parkinsonism) . Walking on heels and on toes is assessed; if the distal muscles are weak, the patient has difficulty performing these tests. Heel walking is especially difficult when the corticospinal tract is affected. Spastic gait is characterized by scissoring, or squinting, leg movements and walking on the toes. With paresis of the peroneal nerve, stepping and foot drop may occur.

Sensitivity is examined for abnormalities that may indicate the location of the lesion causing muscle weakness (for example, the presence of a level of sensory impairment suggests damage to a segment of the spinal cord), or the specific cause of muscle weakness.

Paresthesias distributed in a stripe pattern may indicate spinal cord lesions, which can be caused by both intramedullary and extramedullary lesions.

Study of reflexes. If tendon reflexes are absent, they can be tested using the Jendrassik maneuver. Decreased reflexes can occur normally, especially in older people, but in this case they must be reduced symmetrically and must be induced using the Jendrassik maneuver. Plantar reflexes (flexion and extension) are assessed. The classic Babinski reflex is highly specific for damage to the corticospinal tract. With a normal reflex from the lower jaw and increased reflexes from the arms and legs, the lesion of the corticospinal tract can be localized at the cervical level and, as a rule, is associated with stenosis of the spinal canal. With damage to the spinal cord, the tone of the anal sphincter and the wink reflex may be reduced or absent, but with ascending paralysis in Guillain-Barre syndrome they will be preserved. Abdominal reflexes below the level of the spinal cord lesion are lost. The integrity of the upper segments of the lumbar spinal cord and associated roots in men can be assessed by testing the cremasteric reflex.

The examination also includes an assessment of pain on percussion of the spinous processes (which indicates inflammatory lesions of the spine, in some cases - tumors and epidural abscesses), a test with raising outstretched legs (pain is noted with sciatica), and checking for the presence of pterygoid protrusion of the scapula.

Physical examination. If the patient does not have objective muscle weakness, then physical examination becomes especially important, and in such patients, a disease other than nerve or muscle involvement should be excluded.

Note symptoms of respiratory failure (eg, tachypnea, weakness on inspiration). The skin is assessed for jaundice, pallor, rashes, and stretch marks. Other important changes that may be identified on examination include a moon-shaped face in Cushing's syndrome and enlarged parotid glands, smooth hairless skin, ascites, and stellate hemangiomas in alcoholism. The neck, axillary and groin areas should be palpated to exclude adenopathy; It is also necessary to exclude enlargement of the thyroid gland.

The heart and lungs are assessed for dry and moist rales, prolonged expiration, murmurs, and extrasystoles. The abdomen must be palpated to identify tumors, as well as if there is a suspicion of damage to the spinal cord or a full bladder. A rectal examination is performed to detect blood in the stool. The range of motion in the joints is assessed.

If tick paralysis is suspected, the skin, especially the scalp, should be examined for ticks.

Warning signs. Please pay special attention to the changes listed below.

• Muscle weakness that becomes more severe over a few days or even less time.
• Dyspnea.
• Inability to raise head due to weakness.
• Banal symptoms (eg, difficulty chewing, speaking, and swallowing).
• Loss of the ability to move independently.

Interpretation of survey results. History data allows you to differentiate muscle weakness from fatigue, determine the nature of the disease and provide preliminary data on the anatomical location of weakness. Muscle weakness and fatigue are characterized by various complaints.

• Muscle weakness: Patients usually complain that they are unable to perform a specific activity. They may also notice heaviness or stiffness in the limb. Muscle weakness is usually characterized by a specific temporal and/or anatomical pattern.
• Fatigue: Weakness, which refers to tiredness, usually does not have a temporary (patients complain of fatigue throughout the day) or anatomical pattern (eg, weakness throughout the body). Complaints mostly indicate fatigue rather than the inability to perform a specific activity. Important information can be obtained by assessing the temporal pattern of symptoms.
• Muscle weakness that develops over a period of minutes or even less is usually associated with a severe injury or stroke. Sudden onset weakness, numbness, and severe pain localized to a limb are most likely caused by arterial occlusion and limb ischemia, which can be confirmed by vascular examination (eg, pulse, color, temperature, capillary refill, differences in blood pressure measured with Doppler scanning).
• Muscle weakness that progresses steadily over hours and days may be caused by an acute or subacute condition (eg, spinal cord pressure, transverse myelitis, spinal cord infarction or hemorrhage, Guillain-Barré syndrome, in some cases muscle atrophy may be associated with the patient being in critical condition, rhabdomyolysis, botulism, poisoning with organophosphorus compounds).
• Muscle weakness, progressing over weeks or months, may be caused by subacute or chronic diseases (eg, cervical myelopathy, most hereditary and acquired polyneuropathies, myasthenia gravis, motor neuron disease, acquired myopathies, most tumors).
• Muscle weakness, the severity of which varies from day to day, may be associated with multiple sclerosis and sometimes metabolic myopathies.
• Muscle weakness that varies throughout the day may be due to myasthenia gravis, Lambert-Eaton syndrome, or periodic paralysis.

The anatomical pattern of muscle weakness is characterized by specific activities that patients find difficult to perform. When assessing the anatomical pattern of muscle weakness, certain diagnoses can be suggested.

• Weakness of the proximal muscles makes it difficult to raise the arms (eg, when combing one's hair, lifting objects above the head), climbing stairs, or rising from a sitting position. This pattern is characteristic of myopathies.
• Weakness of the distal muscles impairs activities such as stepping across a sidewalk, holding a cup, writing, buttoning a button, or using a key. This pattern of disorders is characteristic of polyneuropathies and myotonia. In many diseases, proximal and distal muscle weakness may develop, but one pattern of involvement is more pronounced initially.
• Paresis of the boulevard muscles may be accompanied by weakness of the facial muscles, dysarthria and dysphagia, both with and without impaired movements of the eyeballs. These symptoms are common in certain neuromuscular diseases, such as myasthenia gravis, Lambert-Eaton syndrome, or botulism, but may occur in certain motor neuron diseases, such as ALS or progressive supranuclear palsy.

First, the pattern of motor dysfunction as a whole is determined.

• Weakness primarily affecting the proximal muscles suggests myopathy.
• Muscle weakness, accompanied by increased reflexes and muscle tone, suggests damage to the central motor neuron (corticospinal or other motor pathway), especially in the presence of an extensor reflex from the foot (Babinski reflex).
• A disproportionate loss of finger dexterity (eg, fine movements, playing the piano) with relatively intact hand strength indicates selective damage to the corticospinal (pyramidal) tract.
• Complete paralysis is accompanied by the absence of reflexes and a pronounced decrease in muscle tone, which develop suddenly with severe damage to the spinal cord (spinal shock).
• Muscle weakness with hyperreflexia, decreased muscle tone (both with and without fasciculations) and the presence of chronic muscle atrophy suggests peripheral motor neuron damage.
• Muscle weakness, most noticeable in muscles supplied by longer nerves, especially in the presence of sensory loss in the distal parts, suggests impaired peripheral motor neuron function due to peripheral polyneuropathy.
• Absence of nervous system symptoms (i.e., normal reflexes, no muscle atrophy or fasciculations, normal muscle strength or insufficient effort on a muscle strength test) or insufficient effort in patients with fatigue or weakness that is not characterized by any temporal or anatomical pattern , allows us to suspect that the patient has fatigue, and not true muscle weakness. However, if there is intermittent weakness that is not present at the time of examination, abnormalities may go unnoticed.

With the help of additional information, you can more accurately localize the lesion. For example, muscle weakness that is accompanied by signs of central motor neuron disease in combination with other symptoms, such as aphasia, mental status changes, or other symptoms of dysfunction of the cerebral cortex, suggests a lesion in the brain. Weakness associated with peripheral motor neuron disease may result from a disease affecting one or more peripheral nerves; In such diseases, the distribution of muscle weakness has a very characteristic pattern. When the brachial or lumbosacral plexus is damaged, motor, sensory disturbances and changes in reflexes are diffuse in nature and do not correspond to the zone of any of the peripheral nerves.

Diagnosis of the disease causing muscle weakness. In some cases, a set of identified symptoms allows one to suspect the disease that caused them.

In the absence of symptoms of true muscle weakness (for example, a characteristic anatomical and temporal pattern of weakness, objective symptoms) and the patient complains only of general weakness, fatigue, lack of strength, the presence of a non-neurological disease should be assumed. However, in older patients who have difficulty walking due to weakness, determining the distribution of muscle weakness may be difficult because Gait disturbances are usually associated with many factors (see chapter “Features in elderly patients”). Patients with multiple diseases may be functionally limited, but this is not due to true muscle weakness. For example, in patients with heart or lung failure or anemia, fatigue may be associated with shortness of breath or exercise intolerance. Joint abnormalities (such as those associated with arthritis) or muscle pain (such as those associated with polymyalgia rheumatica or fibromyalgia) may make it difficult to exercise. These and other disorders that manifest as complaints of weakness (eg, influenza, infectious mononucleosis, renal failure) are usually already identified or indicated by history and/or physical examination.

In general, if the history and physical examination do not reveal symptoms suggestive of an organic disease, then its presence is unlikely; the presence of diseases that cause general fatigue, but are functional, should be assumed.

Additional research methods. If the patient has fatigue rather than muscle weakness, further testing may not be necessary. Although many additional testing methods can be used in patients with true muscle weakness, they often play only a supporting role.

In the absence of true muscle weakness, clinical examination data (eg, shortness of breath, pallor, jaundice, heart murmur) are used to select additional testing methods.

In the absence of deviations from the norm during the examination, the research results will also most likely not indicate any pathology.

If it develops suddenly or in the presence of severe generalized muscle weakness or any symptoms of respiratory distress, forced vital capacity and maximum inspiratory force should be assessed to assess the risk of developing acute respiratory failure.

If true muscle weakness is present (usually after assessing the risk of developing acute respiratory failure), the study is aimed at finding out its cause. If it is not obvious, routine laboratory tests are usually performed.

If there are signs of central motor neuron damage, the key research method is MRI. CT is used if MRI is not possible.

If myelopathy is suspected, MRI can detect the presence of lesions in the spinal cord. MRI can also identify other causes of paralysis that mimic myelopathy, including damage to the cauda equina and roots. If MRI is not possible, CT myelography can be used. Other studies are also being conducted. Lumbar puncture and cerebrospinal fluid examination may not be necessary if a lesion is identified on MRI (eg, if an epidural tumor is detected) and is contraindicated if a cerebrospinal fluid block is suspected.

If polyneuropathy, myopathy or pathology of the neuromuscular junction is suspected, neurophysiological research methods are key.

After a nerve injury, changes in nerve conduction and denervation of the muscle can develop several weeks later, so in the acute period, neurophysiological methods may not be informative. However, they are effective in diagnosing some acute diseases, such as demyelinating neuropathy, acute botulism.

If myopathy is suspected (the presence of muscle weakness, muscle spasms and pain), it is necessary to determine the level of muscle enzymes. Elevated levels of these enzymes are consistent with a diagnosis of myopathy, but can also occur in neuropathies (indicating muscle atrophy), and very high levels occur in rhabdomyolysis. In addition, their concentration does not increase in all myopathies. Regular use of crack cocaine is also accompanied by a long-term increase in creatine phosphokinase levels (on average up to 400 IU/l).

MRI can detect muscle inflammation, which occurs in inflammatory myopathies. A muscle biopsy may be required to definitively confirm the diagnosis of myopathy or myositis. The appropriate site for biopsy can be determined using MRI or electromyography. However, needle insertion artifacts can mimic muscle pathology and it is recommended to avoid this and not take biopsy material from the same location as the electromyography. Some hereditary myopathies may require genetic testing to confirm.

When motor neuron disease is suspected, studies include electromyography and conduction velocity testing to confirm the diagnosis and exclude treatable diseases that mimic motor neuron disease (eg, chronic inflammatory polyneuropathy, multifocal motor neuropathy, and conduction blocks). In advanced stages of ALS, MRI of the brain may reveal degeneration of the corticospinal tracts.

Specific tests may include the following.

• If myasthenia gravis is suspected, an edrophonium test and serological studies are performed.
• If vasculitis is suspected, determine the presence of antibodies.
• If there is a family history of a hereditary disease - genetic testing.
• If there are symptoms of polyneuropathy, perform other tests.
• In the presence of myopathy not related to drugs, metabolic or endocrine diseases, a muscle biopsy may be performed.

Treatment of muscle weakness

Treatment depends on the disease causing the muscle weakness. In patients with life-threatening symptoms, mechanical ventilation may be required. Physiotherapy and occupational therapy can help you adapt to persistent muscle weakness and reduce the severity of functional impairment.

Features in elderly patients

In older people, there may be a slight decrease in tendon reflexes, but their asymmetry or absence is a sign of a pathological condition.

Because older people tend to lose muscle mass (sarcopenia), bed rest can quickly, sometimes within a few days, lead to the development of disabling muscle atrophy.

Older patients take a large number of medications and are more susceptible to drug-induced myopathies, neuropathies, and fatigue. Therefore, drug therapy is a common cause of muscle weakness in older people.

Weakness that prevents walking often has many causes. These may include muscle weakness (eg, stroke, use of certain drugs, myelopathy due to cervical spondylosis or muscle atrophy), as well as hydrocephalus, parkinsonism, arthritis pain, and age-related loss of neural connections that regulate postural stability (vestibular system, proprioceptive pathways), motor coordination (cerebellum, basal ganglia), vision and praxis (frontal lobe). During the examination, special attention should be paid to correctable factors.

Physical therapy and rehabilitation can often improve a patient's condition regardless of the cause of muscle weakness.

Almost all skeletal muscles in our body are paired and located symmetrically - on the right and left. Muscle imbalance is a violation of symmetry, a discrepancy in the size and strength of paired muscles or muscle groups.

In some cases, an imbalance can be noticed, for example, when one arm or pectoral muscle is noticeably larger than the other, in others the difference is not so obvious, but is felt during training.

For example, if one arm is stronger than the other, the bar may tilt to one side during a bench press because the stronger arm will push it up faster.

Imbalances can also occur between major muscle groups, such as the back and chest, triceps and biceps, upper legs and calf muscles.

Not only does it look bad and reduce athletic performance, but it can also lead to injury. For example, if an athlete has a pumped chest and poorly developed back muscles, this increases the risk of injuring the shoulders.

In addition, muscle imbalance leads to poor posture. For example, weak back extensors and tight, clenched abdominal muscles are characteristic of a slouched posture, while tight hip flexors can cause.

What Causes Muscle Imbalance

There is no such thing as a perfectly symmetrical body. Genetics influence muscle strength and susceptibility to hypertrophy, but other factors play a major role in causing imbalances.

Poorly designed program or lack thereof

Men often prefer to pump up their chest, shoulders and arms, while forgetting about their back and legs. Women pay all their attention to their legs and buttocks, being afraid to do exercises on their arms and shoulders so as not to “become a jock.”

As a result, both of them end up with muscle imbalance and an asymmetrical body that is far from ideal.

Lack of attention to technology

If you do not follow the correct technique during the exercise, the load may shift to one side.

Let's say your back muscles are more developed on the right side. When you do bent-over dumbbell rows with your right hand, your back muscles can withstand the load and you are using proper technique. On the left side, weak back muscles quickly give way, and the load shifts to the shoulders.

If you do not pay attention to this, the muscles on the right side will become increasingly stronger, a noticeable muscle imbalance will appear and the risk of injuring the shoulder will appear.

Insufficient joint mobility

Many people spend all day at their desks maintaining poor body posture. This causes the muscles to tighten, become stiff and limit the mobility of the joints.

The body compensates for lack of mobility with poor technique. As a result, some muscles receive too much load, while others are practically not involved in the movement.

How to Tell If You Have a Muscle Imbalance

The easiest way is to determine the presence of asymmetry of paired muscles. Take a tailor's tape, measure the muscles on both sides and compare the numbers.

Measure the volume of the limbs in a bent state. This way you won't be able to squeeze the muscle with the tape and reduce the size.

It is much more difficult to identify imbalances between different muscle groups because your judgment is subjective.

Try to soberly assess the correspondence of different muscle groups. If you have an obvious imbalance, you will probably notice it.

How to Prevent Muscle Imbalance

Do multi-joint exercises

There are isolated exercises that work only one muscle group, and complex multi-joint exercises that work almost all the muscles of the body.

For example, if you perform leg extensions on a machine, only the quadriceps are loaded. When performing a multi-joint squat, the main load is on the hips, but the buttocks and buttocks are also involved in the work.

By incorporating multi-joint exercises into your workout, you protect your body from muscle imbalances. Even if you completely exclude working out some muscles from the program, they will still be loaded and strengthened during the training process.

Add unilateral exercises

Unilateral exercises are movements in which both paired muscles work, but separately from each other. Such exercises will help you avoid transferring the load from a weak muscle to a stronger one.

For example, when performing a bench press with a barbell, you can shift some of the load from your weaker arm to your stronger one. The bar will tilt, but you will be able to work with the selected weight, exacerbating the imbalance with each repetition.

To prevent this, replace barbell exercises with variations. If your weak arm cannot handle the weight of the dumbbell, you will have to choose lighter implements so that the difference in limb strength does not increase.

Develop mobility

If your body lacks the joint mobility to perform exercises correctly, it will compensate with poor form.

For example, if you have tight hip flexors on one side, you will end up leaning to one side when squatting with heavy weights. Constantly increasing the load will cause imbalance or injury.

Pay attention to your limitations and try to correct them before they cause asymmetry or injury.

How to Correct Muscle Imbalance

How to correct paired muscle asymmetry

To correct paired muscle imbalances, increase the number of repetitions on your weaker side by 25–35%.

Let's say your left shoulder is smaller than your right. Typically you do 3 sets of 10 dumbbell lateral raises. To strengthen a weak shoulder, add another set of 10 reps for your left arm only.

With your right hand you will do 30 repetitions and with your left hand you will do 40 repetitions with the same weight.

If you do not want to increase the load on a weak muscle, perform the same number of repetitions on the strong and weak sides. To do this, always start the exercise on the weak side to find out how many repetitions and with what weight you can perform.

How to correct muscle group imbalances

If some muscles look weak and undeveloped compared to others, simply add more load: increase the number of exercises or work weights. However, the total load should remain the same.

For example, if you decide to pump up weak legs, it is not at all necessary to arrange a separate workout in addition to what you are already doing. This can result in overtraining and stalled progress.

Instead, you need to rearrange yours in a way that makes room for additional stress on your legs. You shift the focus to one muscle group, eliminate imbalances and have time to fully recover between sessions.

conclusions

Let's summarize:

• Muscle imbalance occurs during training when one muscle or muscle group is used more often and more than another.
• To prevent imbalance, you need to:
  • add multi-joint exercises to the program that load the muscles of the whole body;
  • perform unilateral exercises that load paired muscles separately;
  • develop joint mobility and monitor technique.
• To correct the imbalance, you need to make sure that strong muscles do not receive more load, and also increase the intensity of working weak muscles.

Don’t ignore your weaknesses, correct muscle imbalances in time, then you will increase your performance and reduce the risk of injury.

To find out if your child has sufficient muscle strength and can acquire the motor skills that are so necessary at his age. Try checking your back muscles. The trapezius muscle, it starts from the back of the head, occupies the entire upper back and is responsible for the movement of the shoulder blades and neck of the head. The latissimus muscle, it occupies the entire lower back and lateral chest, which, contracting, lowers the arm raised up.

A muscle along the spinal column that is responsible for straightening the spine. The test can be performed from the age of 6 months. He, lying on his stomach, is lifted above the surface of the table, holding his waist with his hands. At the same time, the baby must hold his body, straightening his back. Any deviations during these procedures can indicate that a child has weak back muscles.

To solve this problem, it is necessary to conduct regular training to strengthen the back muscles of the child, during which you can periodically return to the test to evaluate the results of the exercises carried out with the child. Exercises to strengthen your back muscles: To strengthen your back muscles, start by carrying your baby with his back facing you, holding him in the pelvic area.

Lean forward slightly with it. Make sure he tries to keep his upper body upright on his own. Insure your baby every time. Exercises on a gymnastic ball are considered beneficial for the back muscles. To do this, place the baby with her stomach on the ball with her legs facing you. Holding it under your armpits, make rolling movements towards and away from you.

To solve the question of how to strengthen a child’s back, you should ensure that it bends correctly in the shape of a boat. If the child does the previous exercise well, then it’s time to complicate the lesson. To do this, hold the baby not in the armpit area, but by the hips.

At the same time, make sure that during the rolls the child himself holds himself hanging for several seconds. Back massage is also a method of strengthening muscles. At any age, it is necessary for the child to hold his back straight so that the load on the spine is correct. But no matter what type of muscle strengthening you choose for your baby, it is important to consult with an orthopedist.

It is also necessary that the classes be carried out with passion and cause slight fatigue in the child. To begin with, exercise three times a week, and over time – every day. The older child can already be assigned to the sports section, while doctors recommend swimming, yoga, team sports and skiing.