Injury can be both physically and mentally debilitating.  If you have ever endured an injury, you understand the hard work and often frustration that stands behind this one state we all hope to avoid, injury. 

After breaking my back and pelvis in a car accident and undertaking decades of surgeries, procedures and rehabilitation, injury resolution finally happened after incorporating one important technique commonly overlooked even by the best doctors and physical therapists.  Neuromuscular rehabilitation, not just muscular rehabilitation, was the magic that finally brought my much-needed healing and has now provided the healing of hundreds of chronically injured athletes I have coached over the years. 

NEUROMUSCULAR VERSUS MUSCULAR

The injury path is pretty familiar.  Your doctor diagnoses your injury and recommends physical therapy for hands-on manipulation.  You are sent home with home exercises to address musculoskeletal issues such as weak or unbalanced muscles or resulting compensations.

Why then does injury often return? Or why does injury never resolve?

Why are you told that your gluts are strong but not firing with each running foot strike?

Why are your hip flexors overtaking when pedaling your bike?

You are told you are a heel striker.  Why is it impossible to change your running biomechanics?

All too often we train only the muscular instead of the neuromuscular. 

According to Physiopedia, neuromuscular rehabilitation is the unconscious trained response of a muscle to a signal from the nervous system. Movements of the lower extremity are controlled through this system, which needs to provide the correct messaging for purposeful movement.

Addressing musculoskeletal issues is not enough for the functional recovery of an injury because the coordinated neuromuscular controlling mechanism required during sport-specific activities would be neglected.

Unlike conventional strength training, neuromuscular exercise addresses the quality of movement and emphasizes performance in all three biomechanical/movement planes.  [1]

Simply put, you can’t resolve an injury by just addressing the physical or musculoskeletal aspects.  The brain and nervous system (neuromuscular) initiate and control every response a muscle makes.  Without neuromuscular retraining, an in injury will seldom resolve. 

Photo credit: Neural Rehabilitation Group – Spanish Research Council
http://www.neuralrehabilitation.org/en/?page_id=62

NEUROMUSCULAR REHABILITATION WITH STRENGTH TRAINING

Unfortunately, the application of neuromuscular training is not simple.  Perhaps this is why few physical therapists treat or personal trainers train in this manner.  Or perhaps they are educated to focus on the ‘muscular.’  Let’s explore a way that neuromuscular retraining can be applied to your strength training or home exercise program for each and every single exercise. 

It’s HOW you do the exercise that matters.  Making it a conscious process (i.e. thinking about it to engage the brain) is key.  First engage your core, second engage your gluts, third do your exercise.  If you lose either engagement throughout the range of motion of the exercise, stop, re-engage and start again. 

Let’s use a squat as an example.  Engage core, engage gluts, slowly squat down with perfect form.  If you have lost either engagement, reengage and slowly come back up.  Repeat.

Ideally you want both engagements held through the full range of motion.  The slower you do the exercise, the more muscles you recruit and, with a host of practice, retrain the ‘automatic’ or unconscious engagement. 

If your IT band, knee or Achilles, etc., is your source of pain and discomfort, a neuromuscular focus on core and glut engagement trains them to engage taking the pressure off your injured area.  Optimally, these engagements are also the key to endurance performance.

According to Alun Woodward of Ironguides, true core engagement is the ability of the core muscles to hold your body in a strong stance protecting your spine, properly positioning your pelvic and allowing your major muscles to work more effectively in performing their task. If we have strong core engagement, we will move more efficiently and so save energy for any given activity—this is the key to performance in endurance events. [2]

NEUROMUSCULAR REHABILITATION WITH RUNNING

Since the vast majority of injuries stem from running, neuromuscular rehabilitation is your lifeline.  Undoing decades of suboptimal running habits and retraining correct running biomechanics cannot happen without neuromuscular reeducation.  This is why so few runners are successful at ingraining proper running biomechanics. Engaging your neuromuscular system with running requires a different approach.  

This neuromuscular retraining process starts with static running drills often prompted by cueing, like a metronome.  A key drill, running in place to a cadence of 90 steps per minute (one foot) or 180 steps per minute (two feet) is an important skill that must be ingrained before applying it to a dynamic activity, like running. 

Holding a light weight, static arm swings drilled at a similar cadence is crucial drill to master since your feet follow your arms.  If you cannot comfortably hold both drills independently, and eventually integrated, in a static environment, it will be nearly impossible to do so in a dynamic one.  However, remember your core and glut engagements are the foundational elements of your running drills too!

Through a progressive series of static and dynamic running drills, an athlete will eventually transition these mechanics to running.  This must be done at a very slow, controlled, conscious pace or old habits will override your hard work.  The key here is to run quietly.  If you can hear yourself running, you are running too fast and/or with improper mechanics. 

A return to running program is a helpful way to transition your new biomechanics into practice.  While practice and patience are the key ingredients for success, the neuromuscular oversight of a properly trained coach or physical therapist is recommended.  Here are video resources to support your efforts in refining proper running biomechanics: https://www.youtube.com/user/ajm3298/videos.

Now you know why science recommends dynamic exercises, including plyometric, as a warm up for any activity like running, swimming or cycling. They engage the neuromuscular system. You have to ‘think’ about which leg to put in front of the other when doing carioca! 

During my injury rehabilitation process, my most memorable moment happened when my sport medicine physicians asked me how I was mentally dealing with my injuries.  Without an ounce of control, the tears just started flowing.  We seldom recognize and address the emotional ill-effects that result with chronic injury.  Consciously engaging the mind to activate the appropriate corresponding muscles may just be the key to finally resolving your injury once and for all. 

Coach Alyssa (AJ) Morrison; Multisport in Motion (multisportinmotion.com)

[1] Neuromuscular Exercise Program. (2020, October 17). Physiopedia. Retrieved 17:41, February 27, 2021 from https://www.physio-pedia.com/index.php?title=Neuromuscular_Exercise_Program&oldid=254848.

[2] Woodward, A. (2021, January 15). The Benefits of Strength Training for Triathletes AsiaTRI.com: Asian Triathlon Online Magazine. Https://Www.Ironguides.Net/?Ap_id=asiatri. https://www.asiatri.com/2021/01/strength-training-benefits-endurance-athletes/