How To Assess A Client For Body Asymmetries (repost)

Asymmetric Musculature

I originally wrote this piece for AFE and am reposting it here.

Fitness pre-testing is a valuable tool for evaluating movement patterns and assessing a client’s strengths and weaknesses. The information gathered from such testing can then be utilized to develop a customized program which addresses and corrects functional abnormalities. The more thorough the pre-testing, the better equipped a trainer is to help the client reach optimal potential within the training program, while also guarding against injuries which the client might be predisposed to as a result of compensatory patterns.

Many people have developed compensatory patterns over time. Sometimes structural abnormalities exist from birth, or develop in childhood, and often throw surrounding soft tissues and joints out of alignment. In other cases, injuries from sports or other activities can cause a person to begin favoring one side of the body in an effort to reduce the stress load on the injured side. The problem with these compensatory patterns is that they allow the weak or restricted side to become even worse over time. Because of this, functional weight training should always address these patterns in an effort to correct them.

How To Determine Asymmetry

One of the most valuable early tests for determining structural asymmetry is the single leg stance, in which the client’s ability to stabilize the trunk over the supporting leg is determined. Misalignments of the hips, knees, or ankles/feet can be detected easily with this screening tool. For example, if one hip joint is restricted or otherwise unstable, the client will shift weight in an effort to maintain balance. A trainer can then utilize the information gathered from the single leg stance test to focus on compromised function in a joint or extremity.

Clients will frequently exhibit asymmetries in strength, range of motion, or muscle recruitment which can easily be overlooked if a trainer doesn’t have a practiced eye. Because of this, a thorough assessment of the client’s posture, range of motion, and form should be implemented before training begins so that the trainer can identify and properly address compensatory movement patterns.

Let’s say a client exhibits poor movement while performing a basic bodyweight squat, the source of the dysfunction must be determined so that the trainer can correct it. Is the limitation is coming from the foot, the knee, the hip joint, the pelvis, or the sacrum? Is the issue one of limited mobility, muscle weakness, joint instability, or of poor muscle activation? The origin and the nature of the dysfunction will determine which corrective exercises should be added to the client’s program.

Sports and Compensatory Patterns

Asymmetries are especially common in people who engage in sports such as baseball, golf, soccer, football, and tennis, which rely heavily on one side of the body. Because of this, it is important to ask clients if they currently play sports or have played them in the past. It is also important to ask clients about any past injuries which may be contributing to current compensatory patterns. Compensation results from a number of factors, including muscle weakness, impaired joint mobility, musculoskeletal asymmetry, leg length discrepancy, previous injury, and even joint stress from obesity. Joints can become lax and unstable, forcing contralateral muscles to take the brunt of the movement in order to stabilize the dysfunction. What often results is overuse in the compensating region, which in turn adversely affects the client’s training, and also reinforces the asymmetry.

Offset Load Training

weight plates


Offset load training is a training approach in which different loads are used on the right and left sides of the body during an exercise, challenging the body to adjust. If you have ever dealt with clients who have demonstrated asymmetry in strength or power between one side of the body and the other, or who have visible differences in muscle mass when comparing each side, and have addressed their asymmetry solely with isolated unilateral movements, you can implement offset load training as a very effective way to break through training plateaus and to address accumulated asymmetry between the right and left sides of the body. Offset load training is not only more challenging than isolated unilateral exercises, it also results in more neural connections and greater kinetic efficiency.

Asymmetries in strength or muscle development most commonly result from natural dominance on one side, but they can also emerge as a result of injury. During bilateral training, the stronger side will always compensate for the weaker one by taking on more of the load, so the weaker side remains at a disadvantage. In contrast, unilateral and offset movements force each side of the body to bear the load fully and independently, effectively forcing the weaker side to work. Over time, differences in strength between each side are diminished as a result of this type of training.

Benefits Of Offset Load Training

One of the greatest benefits of offset load training is greater trunk stability and strength. Any time you perform a unilateral or offset movement (think of using a shovel), you activate your abdominal muscles in order to resist rotational forces and maintain a neutral spine. Another benefit of offset load training is that offset exercises challenge the nervous system to adapt to the unequal weight distribution by recruiting muscles in a coordinated fashion to maintain balance. You might be surprised by how much your client’s overall strength will increase as a result of improved conditioning in the smaller stabilizing muscles of the trunk. This is because enhanced balance and trunk strength stabilize the extremities and transfer power to them. In other words, if the muscles in the trunk are more efficient at stabilizing the spine, the limbs will benefit from greater power.

How To Add Offset Load Training To A Client’s Regimen

Offset load training works with most barbell and dumbbell movements and can be easily incorporated into a client’s training regimen. You can use this form of training as an adjunct to bilateral movements in a client’s plan. When selecting weights, make sure the difference in weights between sides is moderate, and keep the rep range around eight to twelve reps. Instead of handing dumbbells to your client, have the client lift them so that the muscles of the trunk will become activated even before the exercise is performed. If you are using a barbell, load each side with a different number of plates. If using the double cable assembly, set the pins at different weights. Be sure to monitor your client closely during this type of training, especially those relatively new to lifting weights who have poor balance and coordination.

Putting Down Roots

There are a number of people I know who are keenly interested in living in different locations, and who dream of hopping from one place to another every few months in order to have a change of scenery and a fresh start. I am the exact opposite. Though I love traveling to different places both within and outside of the United States, I have never had any interest in living anywhere other than California. I also HATE moving, and would rather put down roots and have a stable home environment than to move frequently.

Once I was on my own, I lived in one apartment for nine years before moving. The only reason why I had to move was because I was about to start medical school in a different county. I lived in a few places during medical school and residency, but that was mainly because I had roommates, then got married. Once my marriage was destined to meet its end after a few years, I moved back to Los Angeles and planted new roots again.

I like being able to come home and know where everything is. I like the fact that I have worked out at the same gym for over ten years now, that I go to the same grocery stores, the same fuel stations, and take the same routes to work. It’s not that I don’t like change, because the cadence of my day to day life has enough randomness and unpredictability. But at least the one constant in my life is the fact that I can go to the same home base I have gone to for years.

Before you assume that I have a ton of stuff in cold storage, I can assure you that I keep my belongings well sorted and organized, and I don’t like to hold onto a lot of clutter. Though I have a backup supply of toiletry items and food items, I truly do use them on a regular basis, so the supply is always moving. I also impose limits on the amount of clothing I can keep, because I don’t want my dresser drawers, cabinets or closet overflowing with unnecessary items.

Even though I have done a fair amount of traveling in recent years, I always relish the comforts of home. There is nothing more satisfying for me after traveling (especially if I travel abroad) than returning to the home I know well. You won’t find me fantasizing about living in a different place, because I am perfectly comfortable where I am. Barring any sudden financial windfalls which would enable me to buy the house of my dreams, I am staying put for as long as I can.

Weightlifting Safely While Pregnant

Originally published on RxGirl on Monday, 27 January 2014
Pregnant with weights
Female competitors don’t have to give up lifting weights while pregnant, but it is very important to make modifications so that the growing fetus and the mother are both protected from injury. Make sure to inform your doctor of your desire to continue weight training while pregnant, and be prepared to put your exercise regimen on hold if conditions such as pre-eclampsia or cervical insufficiency exist.

Though you may be accustomed to training like a warrior, you need to drop your intensity while pregnant and remember that the focus is on maintaining current muscle tone rather than on gaining muscle. It is even more important to listen to your body’s cues, and stop exercising if any pain emerges during the routine. Whatever you do, do NOT be stubborn and engage in heavy lifting or contact sports which could harm you and your baby!

Usually even the most athletic and conditioned women will tire very quickly while exercising during pregnancy, requiring an additional hour nap for every 30 to 45 minutes spent working out. Balance will also become an issue, especially in the later stages of pregnancy, so free squats, lunges, bosu work, and plyometrics should be replaced with exercises which are more stable.

When performing cardio, it is probably best to switch to an elliptical machine which will confer more stability than a treadmill and will be more comfortable to use. Slow your pace down so that you avoid ballistic movements, and increase rest intervals to about 2 minutes per set. You will also need to drop the amount of weight lifted. Lastly, keep your heart rate below 140 beats per minute.
It is important to remember that during the later stages of pregnancy, a hormone called Relaxin will relax ligaments in an effort to prepare your body for delivery, which means that joint stability will be compromised. At this point it is best to switch to machines for all your resistance training so that you have maximum support during your lift. Another important thing to remember is to avoid lying on your back for any exercises, as this position can make you feel dizzy as well as compromise blood flow to the fetus. If you are concerned about retaining some tone in your abdominal muscles, you can perform a cat stretch which is done on all fours, in which you pull in your abdominal muscles and curve your back towards the ceiling.

The good news is that women who are fit before pregnancy typically enjoy easier pregnancies and shorter labor. They are also able to bounce back into pre-baby shape more quickly (gotta love muscle memory!). There are countless competitors and fitness celebrities (Gina Aliotti is one awesome mommy who comes to mind) who have remained fit during their pregnancies and bounced back to their pre-pregnancy bodies. So, as long as you practice consistency while turning down the intensity enough to ensure a safe environment for you and your baby, you should be able to enjoy the same benefits.