RE-ESTABLISHING NEUROMUSCLULAR CONTROL

1. RE-ESTABLISHING NEUROMUSCLULAR CONTROL

2. DEFINITIONS • DEFINITIONS: • What is neuromuscular control? • What is kinesthesia? • What is proprioception? • What is muscle stiffness?

3. DEFINTIONS Neuromuscular Control • Is the integration of a number of sensations from the periphery. These “inputs” from the periphery are combined with a coordinated muscular response as the outcome (the efferent response)

4. DEFINITIONS • Kinesthesia • It is the sensation or feeling of joint motion or acceleration. It is also the awareness one has of their body in space (knowing how quickly your hip, knee and ankle joints are moving when you walk) • essentially, what you feel when a joint is moving • These sensations are transmitted to the CNS via afferent pathways.

5. DEFINITIONS • Proprioception? • Is both the conscious and unconscious appreciation of joint position…or the ability to determine the position of a joint in space (i.e. where your foot is when you walk, in relation to your hip, knee and ankle) • These sensations are transmitted to the CNS via afferent pathways.

6. DEFINITIONS • Muscle stiffness? • It is the muscle’s ability to resist stretch/deformation. It is through this resistance that there is an increase in joint stability/restraint to joint displacement.

7. PHYSIOLOGY • Mechanoreceptors? • They are specialized nerve endings that respond to mechanical changes (deformation) of tissue. the change in the tissue causes the mechanoreceptor to “fire”.

8. PHYSIOLOGY • MECHANORECEPTORS: • There are 2 types: • 1. Articular • Found within joints (ligament, capsule, menisci, and labrum) • Function: stabilize and guide skeletal segments while providing mechanical restraints to abnormal joint movements.

9. PHYSIOLOGY • MECHANORECEPTORS: • 2. Tenomuscular: • Include both muscle spindles, embedded within the skeletal muscle, detect length and rate of length changes (the stretch reflex) and

10. GTO’s responsible for monitoring muscle tension or load, located within the tendon and tenomuscular junction, force detectors (inhibit muscle activation when excessive loading might cause damage under load)

11. MECHANORECEPTORS • Both respond to changes in muscle length. GTO’s also respond to changes in muscle tension. • Muscle spindles elicit a reflex contraction in the agonist muscle • GTO’s cause relaxation (protection)

12. Muscles • Agonist –the muscle that contracts to produce a movement • Antagonist – the muscle being stretched in response to contraction of the agontist

13. PHYSIOLOGY • neural pathways of peripheral afferents • Either one (or both) of the mechanoreceptors respond to a signal (i.e., deformation in joint; change in muscle length/tension). • Send signal along afferent nerve to the CNS (cerebral cortex, or directly synapses at spinal level…ie knee jerk of muscle spindles) • CNS evaluates the signal, then responds via efferent nerve to the appropriate muscle/tendon for the required response.

14. REESTABLISHING NM CONTROL Why is NM control important in the rehab process? • When injured, there is an increase in the response time of the mechanoreceptors. • This leads to mechanical instability and functional instability (i.e. balance on foot)

15. REESTABLISHING NM CONTROL • Therefore we must retrain the Mechanoreceptors in order to increase the reaction time and decrease the chance of potential re injury due to mechanical instability.

16. REESTABLISHING NM CONTROL • Objectives of NM Rehabilitation • Four key elements • Proprioceptive amd Kineshetic sensation • Dynamic joint stability • Reactive NM control • Functional motor patterns

17. REESTABLISHING NM CONTROL What are some techniques that can be used to “train” or improve an athlete’s neuromuscular control?

18. REESTABLISHING NM CONTROL • Training NM Control • CKC activities • Balance training • Reflex facilitation through reactive training • Stretch shortening exercises (plyos) • Biofeedback training

19. REESTABLISHING NM CONTROL • LOWER EXTREMITY TECHNIQUES • CKC • Balance training (PWB stable – PWB unstable) ( wobble boards etc) • Combine strength and balance • Stretch shortening exercises (plyos) • Reactive NM activities (trampoline hopping) • Functional activities

20. REESTABLISHING NM CONTROL • UPPER EXTREMITY TECHNIQUES • CKC (PU’s, slide board, circles, etc) • Stable to unstable platforms • Plyo ball training (for stretch shortening/reactive training) • Reactive NM activities (maintain hand position against resistance) light training • Functional training , ball tosses

21. REESTABLISHING NM CONTROL • Important point: • During rehab, it is important to progress the athlete into “unstable” positions. By doing so, the athlete will “learn” what the position feels like, and how to prevent the position from happening/over-extending. • i.e. in shoulder dislocation, train in increasing abduction/external rotation

22. LIGAMENTOUS INJURY Repetitive Injury Instability proprioceptivedeficits Functional Instability Decreased NM Control