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Neuromuscular Control in ACL Rehab


What is Neuromuscular Control? Neuromuscular (NM ) control is a component of our ACL rehab program here at Made 2 Move and is exactly what it sounds like: neuro=brain; muscular= muscle. NM control refers to how the brain and muscles are connecting and contributes to the unconscious “muscle memory” most people are familiar with. But what exactly does neuromuscular control and training mean?



A 2019 study on neuromuscular control in patients undergoing ACL reconstruction states, “Neuromuscular control is defined as the afferent sensory recognition of joint position and motion and the following efferent response to that awareness” (Lee et. al 2019). Afferent refers to the signals your brain is receiving from the outside world and efferent refers to the way your brain, muscles, and ligaments and body as a whole respond to this sensory signal. This is often an unconscious response that can become distorted following injury or surgery, such as an ACL reconstruction.


Let’s take a familiar scenario as an example in understanding NM control. Almost everyone has experienced slipping or tripping with a subsequent catching of yourself before you hit the ground. A sigh of relief and then you move on with your life. But what just happened in your brain and body to prevent you from smacking your face on the pavement? The afferent (sensory) signal in this instance is the quick signal sent to your brain of “oh no this is not the stable surface I was just walking on” and the efferent (motor) signal is your body’s response- the quads contracting to keep you from falling and your hands extending out in front of you in case you fall.


Neuromuscular control is involved in any movement we do from brushing our teeth to landing after a layup in a basketball game. This concept is utilized in any movement or rehab program we do at Made 2 Move, but is especially important in ACL risk reduction and rehab, seeing as an “injured ACL could disrupt complex interactions within the neuromuscular system, resulting in impaired kinesthesia and proprioception, abnormal muscle activation, and dynamic knee joint stability” (Lee et. al 2019).


What does the research say about neuromuscular control and training?

A 2019 study followed 96 patients pre and post ACL reconstruction and found that NM control of the affected knee didn’t match the uninvolved knee until 1 year after surgery.


Another study examined a traditional strength training protocol vs. a neuromuscular training (NT) protocol in a 6 month ACL rehab program. The NT program “consisted of balance exercises, dynamic joint stability exercises, plyometric exercises, agility drills, and sport-specific exercises” (Risberg et. al 2007). What did the researchers find? While both the strength training and NT programs improved “strength, balance, proprioception, and hop tests” there was a greater increase in patient reported improvement in the NT group: “Subject reported knee function after ACL reconstruction (as measured with the Cincinnati Knee Score and VASs) was significantly better after 6 months of the NT program compared with 6 months of the ST program” (Risberg et. al 2007). Confidence in one’s knee following an ACL tear is one of the biggest obstacles for athletes and one of the primary components we address in return to sport programs at Made 2 Move, contributing to a mental improvement in addition to the physical.


A 2014 study looked at 12 different studies examining the effect of NM training on ACL risk reduction. “There was a 73.4% and 43.8% relative risk reduction for non-contact and overall ACL injuries” (Sugimoto et. al 2014). This amount of injury reduction following a protocol is unheard of in scientific research! There was likely a higher reduction for non-contact (73.4%) because this type of ACL tear consists of only the individual, the surface, landing mechanics etc.- it is more controllable by the individual. Overall ACL injuries (43.8%) can include those in which an opponent collides into athlete and this aligns, seeing as no matter how prepared you are physically, you cannot control how fast an opponent collides with you.


How can Neuromuscular (NM) Training help me?

At the Made 2 Move ACL Performance Lab, we will address your dynamic core stability (ie- how well can you control your trunk in space when shoved by a defender), proprioception (your awareness of where your body and knee are in space), as well as all the other recognized components critical for sport: acceleration, declaration, and change of direction as part of your ACL rehab program.


The positive effects of neuromuscular training doesn’t just stop at its role in your ACL rehab. The benefits go way beyond that. Strengthening this mind muscle connection can improve motor control, stability, confidence and enhance your muscle memory.


Performance enhancement is another improvement coaches have seen in their athletes following a NM training protocol. Sugimoto’s study noted, “performance enhancement is an added benefit to neuromuscular training as demonstrated in one investigation which used pediatric aged girls and boys (mean age=10±1-years-old) revealed improvements in balance and vertical jump height after 9 weeks of injury-prevention programme implementation”(Sugimoto et. al 2014).


Lastly, NM training functions in overall injury prevention- if we strengthen one thing, and simultaneously improve your body awareness and mind muscle connection- it spreads up and down the chain, making it less likely you incur other injuries such as an ankle sprains!


How do we apply Neuromuscular (NM) Training at Made 2 Move?

Here at Made 2 Move, we don’t just strengthen your quads and hamstrings and send you back on the field. ACL rehab is much more than just getting your affected knee strong again. Are we going to build strength through the quads, glutes, and hamstrings? Heck yeah we are! But we will also address landing mechanics, plyometrics, strength, and all the other components that embody neuromuscular control.


We will work on minimizing your pain and swelling in the early stages and progress towards regaining range of motion, building strength and neuromuscular control, in order to get you back to life and sport.


Addressing the above components helps to ensure you are ready both mentally and physically to return to sport. ACL rehab can seem daunting, but it doesn’t have to be. We are here for you- as your PT and biggest fan. You may not love us as your quads scream at you during BFR training, but you will be grateful when you go back onto the field as a stronger and more confident athlete!


Looking to begin your ACL rehab with the only ACL performance clinic in the Charleston area? Reach out to frontdesk@made2movept.com today to get set up with one of our clinicians at Made 2 Move’s ACL Performance Lab.





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