Vladamir Janda was a respected Czech neurologist, physical therapist and teacher who sadly died in 2002, at the age of 74. However, his life’s work left a legacy that is only now receiving the acclaim it deserves in the United States, in the fields of chiropractic, physical therapy, orthopedics and exercise science.
Janda’s philosophy is not an intervention, or a technique, but an approach to understanding muscle imbalances and how they interact with the nervous system. The Janda approach is based on observation rather than evidence. Through the observation of postural alignment and movement patterns, the Janda approach facilitates clinicians in identifying neurologically mediated syndromes.
Traditionally, orthopedists and physical therapists have taken a structural approach to treatment for pain. For example, if I go to a traditional orthopedist complaining of shoulder pain, they will evaluate my shoulder, conduct a battery of strength and range of motion tests, and possibly do an MRI. They will then prescribe treatment based on any observed structural anomalies. If they cannot identify the source of pain, they will likely treat the pain itself with pain medication, steroid injections and muscle relaxants.
Janda argued that chronic pain cannot be treated from a structural approach, and that you cannot just look at an isolated structure without taking into account the nervous system. In other words, you cannot just treat the shoulder, or the neck, or the hip. You must treat the sensory motor system, because that is where the problem resides.
Janda’s approach is functional rather than structural. From this perspective, chronic pain can be thought of as a software issue, rather than a hardware issue. If you take a structural approach, you are treating the symptoms but not getting at the underlying problem. Functionally, the body moves in a coordinated sequence of movement, mediated by the sensory motor system. When muscles are out of balance, postural and movement anomalies occur that are out of sync with optimal mechanics, manifesting as pain in one or more of the affected structures.
Janda identified two functional groups of muscles, tonic and phasic. The tonic muscles are flexors and are developed in the fetal position, when the body is flexed in on itself. The phasic muscles are extensors that develop after birth. Flexors are dominant in repetitive rhythmic activity, and extensors work eccentrically against the force of gravity. The tonic muscles are prone to tightness and the phasic muscles are prone to weakness. In his work with patients, Janda observed that after structural lesions in the central nervous system, the tonic muscles tended to be spastic, while the phasic muscles were flaccid. Hence, he attributed muscle imbalances to influences of the CNS, rather than structural changes in the muscles themselves.
Janda always looked at posture first, rarely asking about pain levels, which are subjective. When muscle tension is balanced, optimal posture is achieved, lending to efficiency of balance, conservation of energy and fluid movement. Posture, balance and gait speak volumes about muscle imbalances and the underlying neurological cause of pain. Janda looked for patterns that he associated with three dominant syndromes: Upper Crossed, Lower Crossed and Layer Syndrome.
In Upper Crossed Syndrome, tight muscles in the trapezius and levator scapula in the upper back cross with tight pectoral muscles of the chest, and weak deep neck flexor muscles in the neck cross with weak scapular stabilizers, retractors and depressors in the mid-back. In this syndrome, the head is shifted forward, the upper trunk shifts rearward, shoulders round forward and the pelvis assumes a posterior tilt.
Lower Crossed Syndrome affects the muscles that govern pelvic alignment, which in turn translates along the entire spinal column. Tightness of the trunk extensor muscles on the dorsal side crosses with tight hip flexors on the ventral side; weakness of the hip extensors on the dorsal side crosses with weak abdominal muscles on the ventral side.
The result is an anterior pelvic tilt coupled with knee flexion, hip flexion, lumbar lordosis and thoracic kyphosis. Alternately, lordosis is minimized and the knees hyperextend. Joint dysfunction occurs at the L4-L5 and L5-S1 segments of the spine, and at the sacroiliac joint and the hip.
Often seen in older adults, layer syndrome is a combination of upper crossed and lower crossed syndromes. Layer Syndrome is characterized by tight hamstrings, tight trunk extensors, tight pectorals, and tight upper back and neck muscles, coupled with weak mid-back, abdominal and hip extensor muscles.
After an initial postural assessment, Janda validated his findings by following through with six simple movement tests to identify muscle weaknesses, to confirm or rule out suspected sources of pain.
Cervical Flexion: Lying supine, the patient is asked to lift their head and look at their feet. If the chin comes up first, it indicates the SCM muscles is hyperactive, and the deep neck flexor muscles are weak.
Hip Extension: The patient lies prone with a neutral neck and attempts to lift one leg. If gluteus maximus activation is delayed, the spinal muscles are tight and the abdominals are weak.
Hip Abduction: From a side-lying position, the patient is directed to abduct the top leg, and then resist as the clinician presses downward. Low resistance indicates weak or disengaged core muscles.
Trunk Curl Up: From a supine position, the patient bends the knees to 90 degrees and places their heels in the palms of the clinician, on the floor. The patient then curls up until the scapulae leave the floor, keeping pressure on the heels. If heel pressure lessens early on, the hip flexors are over-activated.
Push-up: The pushup test assesses dynamic scapular stabilization. If the scapulae wing or there is excessive shoulder elevation, the scapular stabilizers are weak.
Shoulder Abduction: To test for cervical nerve compression or herniated disc, the patient assumes a seated position, abducts the shoulder, bends the elbow and places the hand on the head. If pain symptoms are alleviated, the test is positive for cervical nerve compression.
Treating pain and mechanical deficiencies from a functional approach rather than a structural approach equips clinicians to address the root cause of pain and dysfunction, and to prescribe rehab protocols that address all the factors associated with a patient’s symptoms.
The sports medicine professionals at NYDNRehab understand that human movement requires integrated coordination of multiple structures, and relies on the sensory nervous system to govern the sequence of movement. We use state of the art technology, including CAREN, virtual imaging and gait analysis technology to identify the source of your pain and correct your mechanical deficiencies. If you are suffering from chronic pain, contact NYDNRehab, and see why our team of sports medicine experts is the very best in NYC.
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