You may have heard the term Neuromuscular training and rehab in the media recently, it’s bit of a buzz-term at the moment – much like ultrasound was in the 80s. Everybody from elite athletes to people living with persistent pain conditions are talking about it. So what is it and more importantly, how might it help you?

Neuromuscular training is a rehab/prehab method to:
Improve the ability of your body to generate a fast and efficient muscle firing pattern
Increase dynamic joint stability
Relearn movement patterns and skills necessary during activities of daily living and sport after injury and/or surgery

Your body is an amazingly resilient and resourceful bit of hardware and more often than not, it’s going to get the job of movement done but it doesn’t always do it as effectively or efficiently as it could. This can then lead to muscle and joint injuries and complaints over time.

Example: Your knee might hurt when you go up and down stairs, it never used to but it does now. Are you damaging something and that’s why it hurts??

Probably not damaging the tissue, but the way in which the muscles and joints of the hip/knee/ankle are going about their business of moving to help get you up the stairs might be the culprit.

The knee structures may not be appreciating how they are being loaded or used in this situation and send danger messages to the brain which then wants to protect you. The brain gets annoyed and decides it’s time to let you know about it in the form of a pain sensation in the hope that you’ll stop what you are doing so that the knee structures stop firing off the danger messages.

What you might feel as your knee hurting and therefore the problem, we (the physios) might see as the knee moving too far inwards or outwards, or the glutes over or under firing, the ankle being either too mobile or stiff, the knee cap not be moving up and down the knee joint as efficiently, or the brain might be a bit lazy in recruiting the right muscles for the job at hand etc. etc. etc…  these could be just some of the types of contributing factors to what might be happening at the knee.

Take the above contributing factors and apply that to a sports scenario where you suddenly have to jump, land and change direction at high speed – you realise that you really need your nerves, muscles and joints firing efficiently and effectively to not only perform the movement but also to protect against injury.

Addressing these contributing factors is where neuromuscular training can help.

What does neuromuscular training involve?
Neuromuscular training utilises a combination of balance, weight based, plyometric, agility, and sport-specific exercises

Balance exercises in a training program have been shown to be beneficial in optimising sports performance, injury prevention and rehabilitation. Functional improvements resulting from balance exercises as part of a multi-faceted training program aid in proprioception (how body parts talk to each other and the brain) and spinal reflex activity (Zech et al 2010).

Weight/strength training will help not only the muscles themselves get stronger through increasing the size and number of muscle fibres but also through getting the brain to use the muscles more efficiently and quickly. The brain controls how the muscles and joints are used, so the more you use it, the better the brain gets at using them for everyday and sporting tasks. You don’t have time to sit there and think about how your hip/knee/ankle should be moving before you climb the stairs and even less time when you are suddenly changing direction in a game of footy.

‘Plyometric’ is a term used to describe explosive storage and release of energy from muscles, typically but not always, in the form of jumping and landing based exercises to aid in speed and strength.

Agility training has been shown to quicken the cortical (brain) response time to recruiting muscles of the lower limb during sports specific exercises (Wojts et al 1996) – recruiting muscles faster plays an important part not only in performance but also in joint protection.

Sports specific training ties in with everything we have already discussed above – take netball or football for instance – players need to be able jump, land and change direction quickly and in 360 degrees of motion, therefore there is no point training in just one direction. If you want to improve the brain’s ability to talk to the joints and muscles, be able to plan the action and pull it off quickly, efficiently and effectively, then you need to train these movements. Again, the more you practice this, the better your body will perform it when it comes to game time.

Now back to where we started, how does this help you when your knee hurts going up and down stairs?

Suddenly you’ve done a training program where the muscles of your hips, knees and ankles are now stronger, being recruited more effectively and efficiently and the knee joint is being loaded optimally and no longer needs to send danger messages to the brain to stop you from going up and down stairs.

There are number of programs which specifically incorporate neuromuscular training into sports injury prevention and performance including Netball Knee Australia, FIFA11+ for soccer and Footy First for AFL. Physiotherapists also utilise neuromuscular training as part of rehab programs for people living with osteoarthritis and other joint and muscle conditions which impact on daily routines. These specific programs will be discussed in part 2 of this blog series on neuromuscular training for rehab and performance.

Zech, A, Hubscher, M, Vogt, L, Banzer, W, Hansel, F & Pfeifer, K 2010 ‘Balance training for neuromuscular control and performance enhancement: A systematic review’, Journal of Athletic Training, vol. 45, iss. 45, pp 392-403

Wojtys, E, Huston, L, Taylor, P & Bastian S 1996 ‘Neuromuscular adaptations in isokinetic, isotonic and agility training programs’, American Journal of Sports Medicine, Vol 24, Issue 2, pp. 187 – 192.