Chapter 14. Improving Neuromuscular Control

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 through physical therapy.

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

4. Provide examples to enhance balance retraining.

5. Explain the concepts related to stabilization retraining.

The entire rehabilitation process is focused on restoring function as quickly and as safely as possible. An important component of function is neuromuscular control. Neuromuscular control involves the detection, perception, and utilization of relevant sensory information in order to perform specific tasks. Successful performance of a task requires the intricate coordination of various body parts using information provided by peripheral receptors located in and around the articular structures (see Chap. 3). This feedback provides information that assists with proprioception, balance, and neuromuscular control. It is now well accepted that neuromuscular control impairment can change movement patterns and increase the risk of musculoskeletal injury.

Neuromuscular rehabilitation (NMR) is a method of training the enhancement of these unconscious motor responses, by stimulating both the afferent signals and the central mechanisms responsible for dynamic joint control.1 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.1 Before developing a neuromuscular training program, the faulty movement pattern or absent motor skill must be identified.2 In addition, before initiating a neuromuscular training program, individuals must have adequate muscle strength to perform training exercises correctly. If weaknesses are present, training activities must begin at a more baseline level that includes weight training, technique instruction, and performing single plane versus multiplanar movements.2 The three major components of NMR are proprioceptive retraining, balance retraining, and stabilization retraining.

Because afferent input is altered after joint injury, proprioceptive training must focus on the restoration of proprioceptive sensibility to retrain these altered afferent pathways and enhance the sensation of joint movement.3 In designing exercises to improve three-dimensional dynamic lower extremity postural stability, the clinician should consider the following: 4

• Postural differences between patients
• Lower extremity loading pathomechanics
• Hip, knee, and ankle joint positions for optimal muscle moment arm lengths
• The interplay between global and local proprioceptive mechanisms
• The concept of rehabilitating movements that facilitate the development of synergistic lower extremity muscle function

Although ROM and progressive resistance exercises (PREs) help reestablish joint proprioception, they are not as effective in restoring function as exercises that involve technique or task training. Technique or task training involves the performance of specific movements with an emphasis on proper technique, with the primary chosen movement being one that results in a large percentage of injuries, such as changing direction, transferring from sit to stand, or more advanced techniques such as performing a cut maneuver.2 According to ...