Neuromuscular Training Pdf
Dinah Lianes
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Purpose: Although proprioceptive and neuromuscular exercises are considered to be part and parcel of rehabilitation programs after sport injuries, there is an uncertainty regarding the effectiveness of corresponding training interventions. The objective of this review was to evaluate the effectiveness of proprioceptive and neuromuscular training (PT/NT) for the treatment of ankle, knee, and shoulder joint injuries.
Methods: Two independent reviewers performed a literature search in various databases and reference lists of articles. Data of included trials were then extracted, and methodological quality was assessed by using predetermined forms.
Results: Fifteen trials met the inclusion criteria. PT/NT was effective at increasing functionality as well as at decreasing the incidence of recurrent injuries and "giving way" episodes after ankle sprains and in conservative treatment of anterior cruciate ligament injuries. However, conflicting results or no efficacy of training were reported for static postural control, joint position sense, neuromuscular control, joint laxity, and lower extremity strength. No study that examined PT/NT after shoulder injuries was found.
Conclusions: From this review, it can be concluded that proprioceptive and neuromuscular interventions after ankle and knee joint injuries can be effective for the prevention of recurrent injuries and the improvement of joint functionality.
Neuromuscular training programs often include exercises to improve movement patterns that influence agility, or how easily you are able to change speed and direction and the ability to absorb force when you jump and land.
To try out neuromuscular training for yourself, visit RIIPREPS.com, where you can learn more about our free app-based implementation platform for schools, clubs and leagues. To take live neuromuscular training classes from the Sports Injury Prevention Program at HSS.
Although improvements are achieved by general exercise, training to improve sensorimotor control may be needed for people with osteoarthritis (OA). The aim was to apply the principles of neuromuscular training, which have been successfully used in younger and middle-aged patients with knee injuries, to older patients with severe hip or knee OA. We hypothesized that the training program was feasible, determined as: 1) at most acceptable self-reported pain following training; 2) decreased or unchanged pain during the training period; 3) few joint specific adverse events related to training, and 4) achieved progression of training level during the training period.
The NEMEX-TJR training program is feasible in patients with severe hip or knee OA, in terms of safe self-reported pain following training, decreased or unchanged pain during the training period, few joint specific adverse events, and achieved progression of training level during the training period.
Because muscle weakness of the lower extremity is common in people with OA, strength training has formed the cornerstone of specific training, with most research focusing on quadriceps strengthening in people with knee OA [7]. Improvements are achieved by strength training. However, because people with OA have functional instability [8] and defective neuromuscular function [7], it was recently suggested that neuromuscular exercises are important and may be needed to improve the effectiveness of training programs for these patients [7]. In patients with anterior cruciate ligament (ACL) injury, at high risk of knee OA [9], neuromuscular training has gained recognition over more traditionally used strength training in the past 10 to 15 years [10]. Neuromuscular training is also successfully used in the prevention of knee injuries [11].
There are some principal differences between neuromuscular and strength training programs. The aim of neuromuscular training programs is to improve sensorimotor control and achieve compensatory functional stability. Functional, weight-bearing exercises are used in various positions, resembling conditions of daily life and more strenuous activities. The quality of the performance in each exercise is emphasized and the level of training and progression is guided by the patient's neuromuscular function [12]. Strength training programs usually consist of non-weight-bearing exercises training isolated muscles selectively, and sometimes also weight-bearing exercises are used, involving multiple joints. The quantity of muscle output is emphasized and the level of training and progression is guided by the patient's one-repetition maximum [7].
The principles include the following: Active movements in synergies of all the joints in the injured extremity are included. The movements start with the uninjured extremity, initiating the normal movement and applying bilateral transfer effect of motor learning to the injured leg. To improve sensorimotor control, exercises are mainly performed in closed kinetic chains in different positions (e.g., lying, sitting, standing) in order to obtain low, evenly distributed articular surface pressure by muscular coactivation. The model emphasizes the enhancement of antigravity postural functions of weightbearing muscles and the provocation of postural reactions in the injured leg by using voluntary movements in the other lower extremity, trunk and arms. The goal is to obtain equilibrium of loaded segments in static and dynamic situations without undesirable compensatory movements, with the aim of acquiring postural control in situations resembling conditions of daily life and more strenuous activities. Thus, the quality of the performance in each exercise with an appropriate position of the joints in relation to each other (postural orientation), i.e., with the hip, knee and foot well aligned, is emphasized.
The level of training and progression is guided by the patient's neuromuscular function and with regard to the affected joint structures. Strength, coordination, balance, and proprioception are all included in the exercises. Although these aspects are all included, the main focus can be, e.g., balance in one exercise and strength in another. To achieve the desired requirement of postural activity, the patients perform the exercises in various positions, i.e., lying, sitting, and standing. Progression is provided by; varying the number of, direction, and velocity of the movements; increasing the load; and/or changing the support surface.
We have named the neuromuscular training method NEuroMuscular Exercise (NEMEX). Since the training method is based on principles, an ending is added after NEMEX to indicate the patient group to which the specific program applies. In this particular study, including patients assigned for TJR, the training program is called NEMEX-TJR.
We have applied the principles of neuromuscular training in the NEMEX-TJR training program as follows: The training sessions consists of three parts: warming up, a circuit program, and cooling down. The warm-up period consists of ergometer cycling for 10 minutes. The circuit program comprises four exercise circles, including neuromuscular exercises with the key elements: core stability/postural function; postural orientation; lower extremity muscle strength; and functional exercises. The exercises are mainly performed in closed kinetic chains. Because muscle weakness of the lower extremity, particularly the quadriceps, is common in patients with OA, exercises in open kinetic chains are also used to improve muscle strength of the knee and hip muscles. One or two exercises are performed in each exercise circle. Each exercise is performed 2-3 sets * 10-15 repetitions, with rest corresponding to one set, between each set and exercise. The exercises are performed with both the non-affected and the affected leg, although focus is on the affected leg. To allow for progression, three levels of difficulty are given for each exercise. Progression is made when an exercise is performed with good sensorimotor control and good quality of the performance (based on visual inspection by the physical therapist) and with minimal exertion and control of the movement (perceived by the patient). The last part of the training program includes cooling down, and stretching exercises for the lower extremity muscles (10 minutes). The exercises in the three parts of the training program are given in the additional file 1.
Training took place in groups, under the supervision of an experienced physical therapist specializing in training of musculoskeletal disorders. On average, about 10 patients attended a training session. Patients continuously entered the group training, i.e., the group held both novice patients and those who had participated in several training sessions and, thus, were more familiar with the training. During each group training session, each participant was monitored individually so that the exercises were performed at a training level according to their neuromuscular function. The patients were offered 2 training sessions a week of 60 minutes each. The training sessions took place late morning/before noon, since patients with hip or knee OA often report more pain early morning and in the afternoon. The patients participated in the training until they underwent TJR. The number of weeks of training was dependent on the waiting list for surgery, and was not pre-defined in the study.
Pain is a major symptom for patients with hip or knee OA. Therefore, we included a scale for monitoring pain during training (additional file). The patients were told that pain was allowed up to 5 on a 0 to 10 scale during and after the training session [20]. They were also told that the day after training, pain should subside to "pain as usual". If pain did not subside, the level of training was reduced [20].
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