Reestablishing proprioception and neuromuscular control in the ACL-injured athlete

C. Buz Swanik, Scott M. Lephart, Frank P. Giannantonio, Freddie H. Fu

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Anterior cruciate ligament (ACL) injury disrupts static and dynamic knee restraints, compromising functional stability. Deafferentation of ACL mechanoreceptors alters the spinal reflex pathways to motor nerves and muscle spindles in addition to the cortical pathways for conscious and unconscious appreciation of proprioception and kinesthesia. These pathways are required by the feed-forward and feedback neuromuscular control systems to dynamically stabilize joints. Feed-forward motor control is responsible for preparatory muscle activity, while feedback motor control regulates reactive muscle activity. The level of muscle activation, preparatory or reactive, influences muscular stiffness, thereby providing dynamic restraint for the ACL-deficient athlete. Rehabilitation protocols should incorporate activities that enhance muscle stiffness while encouraging adaptations to peripheral afferents, spinal reflexes, and cortical motor patterns. Four elements crucial for reestablishing neuromuscular control and functional stability are proprioceptive and kinesthetic awareness, dynamic stability, preparatory and reactive muscle characteristics, and conscious and unconscious functional motor patterns.

Original languageEnglish
Pages (from-to)182-206
Number of pages25
JournalJournal of Sport Rehabilitation
Volume6
Issue number2
DOIs
StatePublished - May 1997

ASJC Scopus subject areas

  • Biophysics
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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