Motor Control / Muscle Activation / Motor Re-education, whatever you might want to call it — is one of the crucial keys to a successful rehabilitation program especially in sports medicine rehabilitation but is often times overlooked by many clinicians.
What Happens After Injury and How it relates to Motor Control?
Injury causes chemical pain and swelling, both of which have inhibitory effect on muscle’s ability to contract.
“Persistent pain alone will cause muscle weakness due to decrease in neural output” — P. Brukner & K. Khan
Therefore, muscle conditioning or motor control must commence after initial injury along with pain and inflammation management. This process or treatment aims to teach the patient how to activate those muscles that are inhibited following an injury. For example, following a shoulder impingement injury, local stabilizers of the shoulder like the supraspinatus are inflamed and inhibited. Athletes or clients should be taught how to activate and control that damaged muscle before proceeding to other forms of muscle conditioning and/or strengthening.
I have been blessed to grew up in a university and clinics which taughts and applies the practice of activating first the local stabilizers of the body is the first priority rather than taking theshortcut of activating global muscles thinking that if global muscles are activated so do the local stabilizers. But sadly, it is not always the case. I am devastated to see so many clinics trying to fire up global muscles without knowing if local stabilizers are right on point before firing their guns.
“It’s like pulling the trigger of a gun without positioning the gun first to hit it’s target.”
It is important to differentiate what a global muscles and local muscles are. Global muscles are the large, torque-producing muscles, whereas local muscles are responsible for local stability. For example, in the shoulder region, global muscles are your deltoids & upper trapezius, while local muscles are your rotator cuff like supraspinatus and infraspinatus. In the recent years of study, there has been an increasing understanding of the important role of activating first the local stabilizers of the joint before the torque producing global muscles.
When There is No Motor Control..
When there is no motor control, there is a incorrect motor patterning syndrome, especially after injury.
According to the book, Brukner & Khan’s Clinical Sports Medicine (Mcgraw Medical)..“Rehabilitation of these incorrect motor patterning syndrome relies on careful assessment of the pattern of movement, theindividual strength, function of the involved muscles and the flexibility of the muscles and joints. As this abnormal movement pattern has been developed over a lengthy period, it is necessary for the patient to learn a new movement pattern. This takes time and patience.The movement should be broken down into components and the patient must initially learn to execute each component individually.Eventually, the complete correct movement pattern will be learned.”
How To Do Motor Control? Tips and Tricks.
As I practice in clinics, I always use cuing and tactile / verbal feedback to facilitate control of desired movements. For me to feel if the right muscle is being activated I always palpate 2 groups of muscles. One is the muscle in which I want to control or facilitateand another are the groups of muscles which I do not want to be substituting during motor learning. I find this effective in facilitating motor control. Other techniques I use are visualization of the correct muscle action. Also, I often times demonstrate and describe the muscle action to the patient. One technique which I haven’t used yet because it is so time consuming, but I think will be more effective is to have anatomical illustrations of the muscles involved around what you want to monopolize. Use of instructions that cue the correct action also helps. For example, phrases like “pull your navel towards towards your spine” to facilitate control of transversus abdominis. One of the best advise that I would give is to focus on precision. The patient has to concentrate and focus on the precise muscle action to be achieved. It should be stressed that activation of the muscles should be a gentle action. Other muscles should remain relaxed during this localize exercise.
“Do not pull the trigger of gun without positioning the gun first to hit it’s target.”
- Clinical Sports Medicine Revised 3rd Edition by Peter Brukner and Karim Khan
I like to hear it from you. What are your thoughts on these? Do you agree or disagree?