RE-ESTABLISHING
NEUROMUSCLULAR CONTROL
DEFINITIONS
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DEFINITIONS:
What is neuromuscular control?
 What is kinesthesia?
 What is proprioception?
 What is muscle stiffness?
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DEFINTIONS
Neuromuscular Control
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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)
DEFINITIONS
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Kinesthesia
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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.
DEFINITIONS
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Proprioception?
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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.
DEFINITIONS
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Muscle stiffness?
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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.
PHYSIOLOGY
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Mechanoreceptors?
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They are specialized
nerve endings that
respond to
mechanical changes
(deformation) of
tissue. the change in
the tissue causes the
mechanoreceptor to
“fire”.
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.
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PHYSIOLOGY
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MECHANORECEPTORS:

2. Tenomuscular:

Include both muscle spindles, embedded
within the skeletal muscle, detect length and
rate of length changes (the stretch reflex) and
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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)
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)

Muscles

Agonist –the muscle that
contracts to produce a
movement

Antagonist – the muscle
being stretched in
response to contraction
of the agontist
PHYSIOLOGY

neural pathways of peripheral afferents

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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.
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)
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REESTABLISHING NM
CONTROL
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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.
REESTABLISHING NM
CONTROL
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1)
2)
3)
4)
Objectives of NM Rehabilitation
Four key elements
Proprioceptive amd Kineshetic
sensation
Dynamic joint stability
Reactive NM control
Functional motor patterns
REESTABLISHING NM
CONTROL
What are some techniques that can be used
to “train” or improve an athlete’s
neuromuscular control?
REESTABLISHING NM
CONTROL
 Training
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NM Control
CKC activities
Balance training
Reflex facilitation through reactive training
Stretch shortening exercises (plyos)
Biofeedback training
REESTABLISHING NM
CONTROL
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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
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REESTABLISHING NM
CONTROL
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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
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REESTABLISHING NM
CONTROL
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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
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LIGAMENTOUS INJURY
Repetitive Injury
Instability
Functional Instability
proprioceptive deficits
Decreased NM Control