Injuries And Neuromuscular Control
Neuromuscular control or coordination is defined as the organization of different elements in order for them to work together efficiently. In the body, coordination is about how smoothly and quickly we can create, accelerate and decelerate movement. Poor coordination or neuromuscular control is the second reason why a muscle might be tight and can lead to injury.
The most common cause of poor coordination is prior injury. When we sustain an injury, the brain rewires itself to allow you to keep moving while protecting the injured area. This means you have different muscle recruitment patterns and altered joint position sense. These changes will persist long after an injury has healed if intentional rehabilitation is not done to restore proper function. One of the more common examples is someone who maintains a slight limp post injury despite all tissues being healed. The primary problem with these altered motor patterns is they often overload other tissues and put other joints into vulnerable positions. Following an ankle sprain we see decreased force production in the muscles on the outside of the hip. This can lead to worse position control in the entire lower extremity and is a predisposing factor for all knee, hip, back and ankle injuries.
All of this is a very long winded way of saying we need to screen for muscular coordination and treat it even in the absence of pain, especially in the athletic or active population. The most common screen is what is known as a Y Balance Test. This is where the athlete stands on one leg and reaches forward, then 45 degrees backwards right then 45 degrees backwards left with their other leg. How far the athlete can reach is recorded and the average of each direction is taken after 3 tests. This is then repeated on the other side. If there is a difference in any direction that is greater than 4 centimeters, there is a 2.5x increased likelihood of an injury occurring to that side.
The individual or athlete should then undergo an intensive rehabilitation program focusing on coordination and control. This does not mean more squats and deadlifts. While squats and deadlifts are fantastic exercises for building strength and muscle mass, they do not create better coordination. Exercises like lunging on to an unstable surface, jumping and landing on one leg, or doing step ups are much better for developing coordination and control. Exercises that force you to balance on one leg are always ideal. These exercises should always be done with another trained individual who can correct your form and tell you when your form starts to break. Coordination training should never be taken to failure.
A well balanced training diet of strength training and exercises aimed at coordination and control is optimal for anyone looking to not only reduce injuries but also increase performance.
Hertel J, Braham R, Hale S, Olmsted-Kramer L. Simplifying the star excursion balance test: analysis of sub- jects with and without chronic ankle instability. J Orthop Sports Phys Ther. 2006;36:131-137.
