Muscle Injury vs Muscle Imbalance

Are you injured or imbalanced?

EV Sports | Injury Prevention for Runners

Are you injured or are your muscles imbalanced?

Let’s first look at what each of them mean.

Also known as physical trauma, is damage to the body caused by external force. When it comes to sports, this external force is contact with something external to the body, which under the right conditions, is needed to optimally perform. However a change in or excessive range of movement that the body cannot withstand
, such as rolling an ankle in running, may result in injury of the soft tissues around the foot and ankle.

The body will usually heal a soft tissue injury with the right rest, load and reintroduction to running.

Is a lack of proportion or relation between corresponding things. When it comes to the body, for example, you may have heard about anterior pelvic tilts. This, broadly speaking, is when the muscles in the back 
(erector spinae) and those that flex the hip (mainly rectus femoris (one of the quads) and iliopsoas) are tighter than the opposing muscles (mainly rectus abdominis (abdominals) and the hamstrings). An efficient runner is one where these muscles balance each other out to create a stable and controlled pelvis, or neutral pelvis.

The body cannot fix an imbalance and any healing that appears to be done is either short lived and the same ‘injury’ reoccurs, or another ‘injury’ is experienced elsewhere relatively shortly afterwards.

So, are you injured or imbalanced?

In my experience, an imbalance occurs over a period of time (usually months or years) with some warning signs along the way (that most runners ignore) until a pain forces them to stop.

Ever wondered what happened to that niggle that ‘magically’ went away? Sometimes resting, cross training or cutting back is enough to allow the body to catch up and adapt. 

For the most part, however, this niggle is the start, or next part, of the imbalance occurring and is the warning sign that this is happening. If this is not addressed, then another part of the body takes over the role of the niggly (dysfunctional or overused) muscle and compensates for whatever is not working effectively until the niggle ‘disappears’.

This pattern continues until there no muscles left in this chain of movement that can compensate for this series of dysfunctions, which is when the pain gets worse and eventually forces you stop.

This is usually the point at which people book in to see me.

An efficient runner is one where muscles balance each other out to create a stable and controlled pelvis, or neutral pelvis.

What I will then do

Assuming there are no warning signs of more serious symptoms, such as stress fractures or ruptures, I will first look at your alignment:

  • Head position
    Are your ears in line with your shoulders and, if not, is that because your neck or shoulder/chest muscles are imbalanced (usually a bit of both)
  • Shoulders
    If they look slouched and this isn’t addressed by the previous step, I’ll skip this and move onto the next step
  • Pelvic alignment 
    In 99.9% of people I see, their pelvis appears misaligned, sometimes rotated and/or mostly anteriorly tilted, and sometimes off centre. The pelvis itself is usually fine, but the muscles that control the movement of the pelvis are imbalanced
    If the shoulders looked slouched on the previous step, I’ll show them how to engage their abdominals correctly (this is not just drawing the belly button to the spine), and see how their shoulders lift
  • Feet position
    I look to see in which direction they are pointing, which gives a really good indication of any further imbalances between the hips and the feet

Viewing the body as a whole gives me a snapshot of what is going on and usually indicates the best place to start your treatment.

In the vast majority of times, this is not where you are feeling the pain. In fact, I can often address, reduce or relieve the pain by not even touching the area that hurts.

And this is why it is so important to get these little niggles checked out, because by the time you get the pain that stops you, your first instinct is to stretch, foam roll, poke and prod the area where you are getting the pain. This, at best, does very little and, at worst, can make the problem worse.

Your first instinct is to stretch, foam roll, poke and prod the area where you are getting the pain. This, at best, does very little and, at worst, can make the problem worse

So, what should you do?

Whether you have a niggle or an injury, or think you might have an imbalance, the response is the same – stop and seek advice, even if that is to simply read and take action from this article.

Tip – everyone has an imbalance of some degree and, unless you are an elite or professional athlete, usually only the ones that are visible are relevant to amateur/club runners.

  • Check your shoulders
    1) Looking face on in a mirror, or asking someone to look at you from this angle, does one shoulder look lower than the other? This usually indicates that one side of your torso, around the lower rib area, is tighter than the other
    2) To double check this, ask someone to take a photo of you from the back (ideally without a top on) and see if you notice a crease more on one side than the other around the bottom of the ribs – this is further clarification that there is an imbalance going on around your torso somewhere.
  • Check your pelvis
    1) Looking side on in a mirror, or asking someone else to look at 
    you from this angle, does your lower back look arched? This usually indicates that your pelvis is anteriorly rotated. To the naked eye, your lower back should look relatively flat with only a very small curve as it goes towards the top of your glutes/buttocks
    2) To view this better, ask someone to take a photo of you from the side,ideally with a tight or no top on
    3) Now tuck your pelvis under by drawing your belly button up towards your chest and contracting/engaging your rectus abdominus muscle. Use this video to help guide you.
    4) Take note of what you are feeling. In the majority of cases, there is a tightness felt in the mid-lower back, the front of your pelvis (hip flexors) and sometimes in the front of your thigh (quads) if particularly tight.
    5) Take a second photo of your pelvis in this position and compare the difference.

From your findings, I would recommend the following:

  • Start to address the imbalances yourself by using a soft foam roller and/or tennis ball plus stretches on your back muscles (making sure to not apply direct pressure to the spine itself), hip flexors and quads. Use this video to help you choose the right exercises to do
  • And/or book a sports massage appointment with me or someone else who knows how to address muscular imbalance
  • Book a strength and conditioning session with me or someone else who knows how to address muscular imbalance (make sure they start with your pelvic alignment)
  • Tailor your training to allow your body to adapt to these new alignments
  • Let me know how you get on


Nothing is supposed to hurt or ache when you run, and you shouldn’t feel sore the day after a run. If any of this is happening then you should address this yourself and/or with the help of a professional physical therapist, and/or strength & conditioning coach/trainer who knows what they’re doing when it comes to postural alignment.

Only once your pelvis is neutrally stable, or you are working to address this, should you be increasing your running, whilst including adaptation, strength and conditioning sessions.

Specific or tailored advice will differ depending on your overall health and fitness, your experience with running and whether you are currently experiencing any niggles.

One or two sessions to understand what you need to work on, can help make you a better runner for life.

Next steps

If you get stuck or are confused by what you should be doing, book a Planning & Mentoring Session with me to discuss your running. 

We can discuss your goals, what is realistic, what you are feeling when you are running, as well as reviewing your runs to date and analysing the data to ensure you are choosing the right sessions for you.

If you are experiencing any pain when running, the advice is to get it checked out by a sports therapy professional who has a good understanding of running injuries, postural alignment and muscle activation.

If you are local to Fareham, Hampshire then you can book a Sports Massage with me where I can assess what is going on and provide an appropriate treatment and rehabilitation plan to get you back running again.