The Balance of Power

By June 29, 2015 December 7th, 2016 Exercise

Triathlete and doctor Amanda Stevens gets her groove back when muscle abnormalities are identified and corrected.

Dr. Phil Maffetone is well-known for coaching methods such as training slow to race fast. Many also know him as the longstanding nutrition guru who says avoid all junk food and eat healthy fats and protein.

Only a few know about the other part of his career, which also involved athletes — hands-on therapy. It’s why successful professional athletes like Mark Allen and Stu Mittleman, as well as teams from various sports, have brought Phil to their important events to fine-tune their bodies.

While Phil is no longer in private practice, he does work with an exclusive handful of athletes. He recommends others seek out a healthcare professional to help assess and treat problems. (MAF will be creating a list of recommended healthcare professionals and coaches for referral in the future.)

“The goal,” says Phil, “is to evaluate muscle balance, uncover abnormalities, and correct them.” By doing so, he says mechanical improvements are quickly realized and better movement economy leads to faster paces.

“For me, this is as much a part of coaching, as training, nutrition and other aspects of human performance,” he says. “In fact, they all work together.”

Evaluation includes a good performance history — answers to questions such as how do you feel on the bike after an hour or two? Which areas don’t feel normal, which feel weak? Do you have pain or energy patterns where there are lows and highs? These and other questions apply to both training and racing. Every answer is an important piece of information, which is combined with other findings.

Dr. Amanda Stevens is a professional triathlete and medical doctor. She started working with Phil last year. Before that time, she acquired the latest technology in power meters — Pioneer’s Power Meter System, which can measure watts in the left and right side separately.

“I was excited to see this new technology because it can serve as an important assessment tool to measure body balance,” says Phil. “It’s important to measure human performance, the reason I use heart rate. But observation of gait in runners, posture on the bike, swim mechanics, and other movements are just as important to assess.”

He says the advent of power meters provides another way to measure performance. Instead of using miles or kilometers per hour at a given MAF (submax) heart rate, the new equipment measures wattage output and gives the ability to observe power balance.

Phil has evaluated cyclists in a wind tunnel, on stationary devices in his clinic, and spent many hours watching athletes out on their road bikes.

“Observation before and after therapy also has great value,” he says, “helping to assess whether the treatment has actually accomplished anything as indicated by better performance and improved posture and gait.”

Phil says devices that measure left and right power output now make biomechanical evaluation even easier. Along with other factors, looking at the power numbers before and after treatment is of great value.

On their first meeting, Phil evaluated Amanda from the feet up and head down, starting with standing and sitting posture.

Even when lying down, postural deviation is meaningful.

_4-18 Phil and Amanda_-20 (1)

In many ways, these postures reflect biomechanical performance on the bike. A head that’s tilted or rotated abnormally, even a small amount, will probably be that way on the bike, and have a negative impact on movement economy. Changing a cyclist’s posture changes many things, including one’s relationship with the bike itself. In many cases, making a mechanical change in the body will require an appropriate and precise change in the bike setup.

The hard part is uncovering these muscle imbalances and determining which are primary and don’t hurt — but are the ones to treat — and which are secondary and often symptomatic, but don’t need treatment. Once that is determined, fixing imbalances is easy for a skilled practitioner.

At her first meeting with Phil, Amanda already was aware of her muscle imbalances. “For the past year or so, my left leg felt ‘dead’ and seemed to lag behind. I would have to mentally coach it to get a small response from it. I felt very unbalanced and had little control over the whole left side.”

This was easily demonstrated on the new technology as a significant imbalance — 60 percent of power was going through the right foot, and only 40 percent on the left. This is a good example of poor economy.

Based on early assessments, Phil evaluated a variety of muscles and found a weakness in the left quadriceps (specifically, the vastus group). This was associated with a tight hamstring group.

“Muscle imbalance usually involves an inhibited, or “weak” muscle or group of muscles that is primary, and a secondary one that is too tight,” he says.

4-18 Phil (1)

This would contribute to Amanda’s significant imbalance in power output between left and right side. The assessment process continued.

It may seem counter-intuitive, but Phil says the most misunderstood muscles in endurance athletes (and non-athletes as well) are those in the head and neck. While many people think the quads, hamstrings and foot muscles are key, muscles higher up control whole body balance and are typically a more primary and often a hidden problem. These include the neck flexor muscles (front of neck), those that open and close the jaw joint, and the upper trapezius on either side of the head, neck and shoulder.

Muscle testing revealed a problem with Amanda’s left upper trapezius. Correcting this muscle imbalance using manual biofeedback was the first step and secondary muscle imbalances also improved quickly.


Amanda was amazed with the results.

“The next morning I went out to ride with no expectations. The minute I got on my bike, I felt different and good!” she says. “My left leg was functioning better and without thought. The left and right sides felt more balanced than ever.”

And the power meter provided definitive proof — the left was about 49 percent and the right 51.

After another evaluation and treatment, with additional improvement in riding, something still was not quite right. The remedy was simple: getting a better bike fit for Amanda’s newly balanced body.

“This was a huge step forward. I was finally able to start riding a bike the way it was meant to be ridden,” Amanda says. “I was able to relax my shoulders, which helped open up and loosen my hips, and riding became much more efficient and consistent. I felt like I started to absorb the training better and also recover a little quicker.”

Phil had seen this too many times before to be surprised.

“Just the awareness of the muscles and how they work helps balance the whole body,” he says. “This is important for the brain to better control muscle contractions and relaxations.”

“I can use all my muscles in concert and correctly,” Amanda says. “My left knee would collapse inward and I couldn’t get it working even when trying to rotate it outward with other muscles. Now things feel balanced, even my core, deep abdominal and latissimus and lower traps work well.”

Phil says athletes often try to consciously compensate for mechanical problems, which is almost impossible to do well and could lead to other injuries, and Amanda was no different.

“Getting balanced from the top down means the feet work better too — an obvious need as that’s the body’s power that goes into the pedal,” he says.


Amanda says her entire body now feels stable from the foot up. “I’m now able to ride with more power at the same heart rate,” she says.

At age 38, she wants to keep pace with the younger stars of the sport, and wants any healthy advantage she can attain to improve fitness.

Phil notes that as we age, it takes a bit longer to recover, and we don’t compensate as fast. “When we’re 20 years old, imbalances often don’t hurt as much, and are compensated for really well by a healthy body.

With Amanda’s muscle imbalances corrected, both she and Phil expect the wattage output to increase at that same heart rate through the summer leading up to the Ironman World Championships in Kona, Hawaii, in October.

Amanda’s first three races this year were in June. She placed third in the St. Croix triathlon on the way to Brazil Ironman, where she also placed third, and had an Ironman PR by 4 minutes and run/marathon PR by 7 minutes. More recently, she placed 2nd at the Ironman Coeur d’Alene in Idaho on June 28.


By Hal Walter
Senior Editor


  • James says:

    Hi Ivan, thanks for the reply as usual. Do you mean stability training as in weight training, body weight (strength) training? Perhaps you could mention to Dr Maffetone about maybe writing an article on practical ways to prevent muscle imbalances? A point in this article about imbalances not bothering us as much when we are younger – I totally agree with this. When I was younger (I’m nearly 27 now so not exactly ‘old’ haha) I could eat rubbish food, get minor injuries, sleep not great, muscle issues etc and performance didn’t seem to be affected much, if at all and issues seemed to correct themselves within a day or two. I’ve noticed though that in the last maybe 3 years that little things that wouldn’t have affected me then significantly bother me now.

    • James:

      The majority of weight exercises double as stability exercises when they fulfill two requirements:

      1. They are done at 20% or less of 1RM (1 repetition maximum)
      2. They challenge present motor control such as by being done on an unstable surface

      The differences between weight exercises and stability exercises is that with weight exercises you are challenging the prime movers (big muscles) while stability exercises challenge the auxiliary muscles that help control arcs of motion. Here’s a link to a video where Gray Cook, movement expert, breaks down the difference in an awesomely eloquent way.

      Here’s a follow-up video. Check both out. They’re each just over 2min long. Each will blow your mind.

  • James says:

    Hi Ivan

    Do you recommend foam rollers for myofascial release and maintaining muscle balance, posture, etc?

    • James:

      I do, but only when used before, and in conjunction with, stability training that addresses the relevant area. Without stability training, myofascial release via foam roller can be harmful: a tight muscle doesn’t just exist in a vacuum. Its opposing muscle (which pulls the joint in the other direction) is weak.

      By doing myofascial release you are allowing the joint to move again, but in doing so you’re creating instability: the weak muscle and the newly released muscle don’t know how to coordinate each other in the range of motion you just created. Not to mention the fact that a joint is usually actuated by an array of other muscles. (Take as an example the knee joint and the scapula, which are each actuated by 15-odd muscles). If you apply myofascial release on the hamstring or the gluteus minimus, all those muscles must learn how to stabilize the joint in the newly acquired range of motion.

      Furthermore, muscles aren’t “just tight”—they’re tight for a reason. Tightness in a muscle is caused by an instability in an associated joint: for example, the most frequent mechanism for hamstring tightness is an inability of the abdominal muscles to provide stability for the hips. So, if you do myofascial release on the hamstrings or a brettzel 2.0 to mobilize the posterior chain, it’s important to do exercises to add stability to that newly gained mobility: good mornings on an unstable surface to add stability to the hip hinge pattern, and single leg deadlift patterning to add stability to the single-leg hip hinge (for example).

      And regarding my earlier comment that myofascial release may be “harmful”—it’s harmful in the sense that leaving a complex process when it’s halfway done can cause problems: myofascial release or mobility exercises are the first step to a multi-step process. The problem, of course, is that people think they’ve solved the problem once the muscle is loose.

      In summary: all gains in mobility must be tempered with increased stability.

      I hope this helps.

  • John Goelz says:

    Dr Maffetone put out a great DVD on manual biofeedback.

    I want to second the “can’t wait for the referral list of practitioners”.

    The DVD on manual biofeedback is a great way to learn about the things in this article . Understand that it take two people ( 1 to assess, & 1 to be assessed, a patient & a therapist). Until that referral list of practitioners comes out, motivated people like those found on this site, could study that DVD & get together & accomplish a lot without a “professional therapist”. I’m all for a professional therapist, but there is an enormous amount of help on the DVD, you just need a second person to help you, and you can help that other person, learn together. You won’t do any harm following the DVD.
    I would love to get together with someone in my area interested in studying that DVD together & provide therapy to each other. I did just that when my brother was visiting me- wow! I made notes on that DVD like when I was in college. We just went right down my notes & watched the DVD & we did the assessments etc on each other all at the same time. And we made further notes based on the findings and just went right through it.

    Dr Maffetone has a huge following, anybody in or near big towns could probably find a nearby “manual biofeedback partner”, but how that is done, or if it is even a good idea, I will leave up to the editors & Dr Maffetone (plenty forums allow private messaging between participants of the forum). People trying to get balanced & trying help others get balanced, I’m all for that.

    Balance isn’t usually something you get & keep without effort. Most of us get imbalanced from all we do. So the manual biofeedback is something that should probably be done routinely, so you need to find a partner or a therapist to help you.

    Thanks for the tip re Bowen Therapy, I’ll check it out.

  • David Wharton says:

    Try Bowen Therapy. It was invented in Australia & gone to many countries including USA.
    Treatment starts with rebalancing/realigning the body.
    Keep in mind if you have a problem,treat above & below that area as well as they may be contributing.

  • Allie says:

    Is there more information on the manual biofeedback? Or is it something that has to be first done by a professional?

  • Pamela Chapman-Markle says:

    Dr. Phil,
    How do you detect muscle imbalances in runners? I am an ultra marathon runner and I have had a weak left hamstring that radiates toward my left hip. After each race I am constantly trying to rehabilitate this. I have done several hip and thigh exercises and have gone down to a zero drop shoe.
    Thank you!

  • Lonel says:

    Hi Dr Phil,

    Great article. Can you recommend any particular type of therapist over others for this i.e. Chiropractors better than Kinesiologists or?

    thank you

    • There are so many possible reasons for why there might be a power imbalance. A particularly strong example of this is a story told to me by Dr. Ivo Waerlop of The Gait Guys. A hockey player with extensive musculoskeletal imbalances came to see Dr. Ivo. Turns out the problem had been that a hockey puck had hit him in the temple a few months ago, temporarily disabling the muscle that rotates the eye within the socket (like a doorknob). The imbalances occurred because the brain was literally twisting the body around this eye in an effort to keep visual inputs balanced correctly.

      The point is that given the variety of domains that any problem could come from, any or all specialists may have something relevant to say on the topic.

  • Zubair Sheikh says:

    I can’t wait for the referral list of practitioners ready. I am no no junk food high fat, protein diet. Run 90% on MAF for marathon training. Yet I got injured. I am sure the reason is muscle imbalance. It would really help to have a specialist to work with in NYC area to correct these.

  • Dafydd says:

    I seem to have this problem too, right upper trapezius is tight & left leg is slow. Would you recommend physio/massage to iron this out?

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