Botulinum toxin injection to facilitate rehabilitation of muscle imbalance syndromes in sports medicine

Abstract

Intramuscular injection of Botulinum toxin to produce reduction of focal muscle overactivity, and localized muscle spasm, has been utilized therapeutically for almost two decades. Muscle overactivity in neurologically normal muscle, where an imbalance exists between a relatively overactive muscle and its less active synergist or antagonist, can inhibit control of the antagonist producing a functional muscle imbalance. This brief review provides an overview of the role of muscle imbalance in sports-related pain and dysfunction, and outlines the potential for intramuscular injection of Botulinum toxin to be used as an adjunct to specific muscle re-education and functional rehabilitation in this patient group. A comprehensive understanding of normal movement and the requirements of the sporting activity are essential to allow accurate diagnosis of abnormal motor patterns and to re-educate more appropriate movement strategies. Therapeutic management of co-impairments may include stretching of tight soft tissues, specific re-education aimed at isolation of the non-dominant weak muscles and improvement in their activation, 'unlearning' of faulty motor patterns, and eventual progression onto functional exercises to anticipate gradual return to sporting activity. Intramuscular injection of Botulinum toxin, in carefully selected cases, provides short term reduction of focal muscle overactivity, and may facilitate activation of relatively 'inhibited' muscles and assist the restoration of more appropriate motor patterns.

Agonist muscle adaptation accompanied by antagonist muscle atrophy in the hindlimb of mice following stretch-shortening contraction training

“…The concept of muscle imbalance has been characterized as hypertrophy or high recruitment of one muscle or muscle group as linked to an atrophy response in opposing muscles [ 43 , 44 ]. Muscle imbalance has been implicated in underlying such conditions as lumbopelvic instability, lower back pain, susceptibility to knee injury, and shoulder pathology [ 43 , 45 , 46 ]. Based on observations of patients, phasic muscles (rather than tonic postural muscles) have been considered susceptible to possible atrophy and weakness from muscle imbalance [ 44 ].…”

Effects of Brief Mindfulness-Based Interventions on Health-Related Outcomes: a Systematic Review

“…The most common method of intervention delivery was by audio, with more than half of the studies using brief audio recordings (n = 49). After this, the most common mode of administration was verbal instructions (n = 14) by instructors or experimenters (Cullen et al 2007;Gamboa et et al 2010b, c). A further 13 studies used interventions used written instructions (Baquedano et al 2017;Herwig et al 2010;Hofmann et al 2009;A.…”

New Concepts in the Assessment and Treatment of Regional Musculoskeletal Pain and Sports Injury

“…Side effects of btxA injections include allergic reactions and permanent muscle and tendon injury. Although current evidence does not support the use of botulinum toxin injections for tendon injuries, studies have shown that intramuscular injection of btxA can provide short‐term reduction of local muscle overactivity [73‐76]. In one multicenter study [77], 130 subjects with epicondylitis were treated with btxA injections.…”