One of the often overlooked issues with musculoskeletal pain symptoms are muscle imbalances. Philip E. Greenman, DO, FAAO, who originally authored Greenman's Principles of Manual Medicine and was a world renowned Physician with Michigan State University, worked with Vladimir Janda, MD, DSc, a world renowned European Physician/Researcher on muscle function and rehabilitation (http://www.jandaapproach.com/about/), to blend and bring the "Janda Approach" to Osteopathic Medicine. Dr. Greenman's chapter on exercise prescription is the last chapter in the books he authored and goes over the evaluation and management of common muscle imbalances. For instance, with low back pain a common imblance is tight lumbar erector spinae and iliopsoas (slow twitch) muscles while having weak abdominal and gluteus (fast twitch) muscles. There is also a common muscle firing pattern that is usually found to be dysfunctional in people with low back pain. (The normal pattern is when the LE is extended there should be firing of the same side hamstring, then same side gluteus, then contralateral erector spinae and same side erector spinae muscles) By first addressing any underlying joint dysfunction in the spine, sacrum, pelvis and LE, it should allow for restoration of normal muscle function. Depending on how long the imbalances have been present, the muscle may need to be lengthened (stretched) or strengthened (shortened). Ultimately the muscle firing patterns will need to be retrained so as to function appropriately as a unit.