Chapter 14: Improving Neuromuscular Control

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. Define the components of neuromuscular control.

2. Describe ways in which neuromuscular control can be improved.

3. Describe a number of exercises that can be used to improve proprioceptive control.

4. Provide examples to enhance balance retraining.

5. Explain the concepts related to stabilization retraining.

OVERVIEW

The entire rehabilitation process is focused on restoring function as quickly and as safely as possible. Indeed, the APTA has stated that the role of the physical therapy profession is to transform society through optimizing movement. An important component of optimizing movement is neuromuscular (or neuromotor) control, which is a product of the interplay among the skeletal, muscular, nervous, cardiovascular, pulmonary, integumentary, and endocrine systems.¹ Other terms used to describe neuromuscular control include segmental stabilization, movement impairment control, motor control, and motor function (see Table 14-1).

Neuromuscular control involves the detection, perception, and utilization of relevant sensory information in order to perform specific tasks (see Chapter 3). Individuals with musculoskeletal pain present with deficits in motor control, which not only affect tissue loading, but also contribute to deficits in general features of motor output such as poor endurance and strength.² These deficits in motor control can change normal movement patterns and increase the risk of musculoskeletal injury. Neuromuscular rehabilitation (NMR) aims to modify the way in which a person uses his or her body by examining and treating both peripheral and central elements that may be negatively impacting tissue loading. Once these suboptimal features are identified, the aim is to achieve a change in the target feature of sensorimotor control, so that this change in muscle activation, posture/alignment, and/or movement modifies loading in a manner that affects the patient’s symptoms beneficially.³

The aims of NMR are to improve the ability of the nervous system to generate a fast and optimal muscle-firing pattern, to increase joint stability, to decrease joint forces, and to relearn movement patterns and skills.⁴ Electromechanical delay (EMD) can be viewed as the time interval between the onset of electrical activity of the muscle and the mechanical response of the muscle. It corresponds to the time needed for the contractile component in the muscle–tendon complex to initiate stretching of the elastic component series,⁵ and its duration is related to the mechanical properties of the elastic component series (see Chapter 1).⁶ The shorter the EMD duration, the faster the muscle force transmission and the better the performance and protective reflex. Significantly longer EMDs in the vastus lateralis, vastus medialis obliquus, and fibularis (peroneus) longus have been reported in patients with anterior cruciate ligament reconstruction,⁷ patellofemoral pain syndrome,⁶ and unstable ankles,⁸ respectively, compared to healthy individuals. In addition, a number of studies have shown a decrease in EMD following neuromuscular reeducation training.^9–12

Numerous studies have confirmed that many of the alterations in ...