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 several 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 physical therapy profession’s role is to transform society through optimizing movement. An important component of optimizing movement is neuromuscular (or neuromotor) control, 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 detecting, perceiving, and utilizing relevant sensory information to perform specific tasks (see Chapter 3). Individuals with musculoskeletal pain present deficits in motor control, affecting tissue loading and contributing 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 how a person uses their body by examining and treating peripheral and central elements that may negatively impact tissue loading. Once these suboptimal features are identified, the aim is to change 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

NMR aims to improve the nervous system’s ability to generate a fast and optimal muscle-firing pattern, increase joint stability, decrease joint forces, and relearn movement patterns and skills.⁴ Electromechanical delay (EMD) is the interval between the onset of muscle electrical activity and its mechanical response. 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. Also, several studies have shown a decrease in EMD following neuromuscular reeducation training.^9,10

Numerous studies have confirmed that strength or endurance training or general physical activity cannot alleviate many motor control alterations.¹¹ In terms of segmental joint control and spinal posture and orientation, each joint in the kinetic chain must have the ability to maintain the optimal alignment, biomechanics, and/or control required for the task ...