Although Neuromuscular Re-Education has no universally accepted definition, it generally refers to a treatment technique or exercise performed by an individual with the purpose of improving, via the nervous system, the level of communication between the body and the brain.
Because of the fact that vibration training and vibration therapy exercises rely on the involuntary stretch reflex, there is a significant amount of communication occurring between the brain and the contracting muscles with each individual exercise.
This serves to jump start the muscle through the severely high frequency of muscle contractions thereby enhancing the patients ability to efficiently recruit the muscle fibers, coordinate movement being performed by the joint, and muscle tissue, and reduce the typical post-injury mechanical dysfunction in a much more rapid fashion than traditional exercise; exercise that relies on voluntary movement.
This is often best demonstrated by having the patient perform a multi-planar exercise (an exercise that combines movements along several planes of motion. For example, raising a weight from the floor, in front of your left leg, to overhead using the right arm. This movement requires that the weight be raised up (sagittal plane), moved left to right (frontal / coronal plane) and rotated from in front to behind during the motion (transverse plane).
Also built in to the neuromuscular re-education process of this phase is something referred to as proprioceptive training. Proprioception is defined as the sense of the relative position of neighboring parts of the body. The proprioceptive system provides feedback solely on the status of the body internally. It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other (thank you Wikipedia!).
In my practice it is joint position that is of primary concern to my patients. Much like in Phase 1 mentioned above, proprioceptive information is sent to the brain by certain receptors in the joints so while performing an exercise on the platform, this positional information battles the vibratory information already being overwhelmingly supplied to the brain. With careful consideration to the position being held during an exercise on the platform, certain case-specific movements can be performed in adjacent regions with the intention of actively enhancing the proprioceptive information being sent to the brain by those regions.
Successful enhancement of this proprioceptive communication is best measured by having the patient perform a simple region-specific proprioceptive exercise before and after exercising on the platform (i.e. pelvic clocks – #1 below or single leg balance exercises – #2 below)
What is even more exciting about this phenomenon is that, in some cases, the proprioceptive benefits are seen in regions located far from those being stimulated. In the articles to follow, I will discuss the 3rd and 4th phases of treatment as well as other areas that have peaked my interest and that of my patients as well.
Written by By Gabriel Ettenson, MS, PT