Last fall I was working with a teenage girl who was rehabbing a surgical repair of her ACL, which she'd torn playing basketball. In those first couple months we employed the typical protocol: gobs of quadriceps and hip strengthening in every position imaginable. Though young and petite, in no time she was doing straight leg raises and hip abduction with up to ten pound cuff weights! Very impressive, indeed.Then we got more functional: controlling her newly-repaired knee in standing. We did some step-ups and -- despite her Herculean abilities on the mat -- she looked like a marionette under a rather novice puppeteer! Translation: her knee control was awful. Even with practice, a mirror, and a persistent therapist, her control remained poor, especially in the absence of those inputs.
But why?
There's a conventional wisdom in the sports med world that, in order to improve body mechanics and control -- namely at the knee -- all you have to do is "strengthen the medial quad and proximal hip". Most research studies tell us the same thing: those with good control have strong hips/quads; those with poor control are weak.
I refer to this approach as The "Magic Wand" Approach: you strengthen certain muscles and POOF! -- knee control is normal!
I wish it were true. Then our jobs would be easier, our friend and family happier, and there'd be a lot less people with knee pain in the world.
"You've got the hen...the chicken...and the rooster...Something's MISSING!"
*****
The Sports Med world got wise. The busted out the steps, the balance boards, and the mirrors. They practiced functional movements with the patient and -- more importantly -- gave all sorts of feedback -- verbal and visual -- of their movement. The patient was able to see "right" from "wrong".
But despite this redoubled effort, we still weren't seeing ideal control. Without the mirrors and the "Don't do that!" voice to remind them, it was back to the old patterns -- the same patterns most people have used since they took their first step.
The "Don't Do That!" Approach, while better than its predecessor, still did not result in a permanent change in motor control. Perhaps this is why many that suffer ACL repairs are repeat offenders -- only with the other knee.
Something's missing, alright.
The Sports Med world got wise. The busted out the steps, the balance boards, and the mirrors. They practiced functional movements with the patient and -- more importantly -- gave all sorts of feedback -- verbal and visual -- of their movement. The patient was able to see "right" from "wrong".
But despite this redoubled effort, we still weren't seeing ideal control. Without the mirrors and the "Don't do that!" voice to remind them, it was back to the old patterns -- the same patterns most people have used since they took their first step.
The "Don't Do That!" Approach, while better than its predecessor, still did not result in a permanent change in motor control. Perhaps this is why many that suffer ACL repairs are repeat offenders -- only with the other knee.
*****
To change how a person controls their body in space is to change motor behavior -- or how a person uses their brain, muscles and nervous system to move. In order to have true success in changing motor behavior, you must affect all three systems.
The "Magic Wand" looked only at muscle. The "Don't Do That" did 'em one better: muscle AND brain (though only the conscious brain). But still missing was the nervous system.
The nervous system covers outputs (muscles and movement), but just as important, inputs: how it feels to position joints, activate muscles and move limbs.
This brings us to a new approach: Dynamic Proprioception.
According to motor control theories, we can only change motor patterns if we can FEEL the muscles actively work during the learning of new skills. Our conscious brain will then "integrate" that feeling into the new motor plan. In our step-up example in order to truly learn to "keep the knee over the foot" during a step-down activity is by FEELING the quad and the lateral hip while we're doing it correctly.
A treatment approach for knee control, for example, would begin with simple exercises aimed at gaining this sensory input -- first in static (no movement), then progressing to slow, controlled movement, then faster/more challenging movements, and finally, to functional movements.
Another way to put it is, you're making a motor control blueprint: "OK, here is what it FEELS LIKE to control your knee: feel your quad and lateral hip 'burning' with activation." Then, taking that blueprint, you apply it to increasingly demanding, complex, and functional activities, until it becomes automatic.
It's an approach with tremendous potential not only for injury rehab and prevention, but for optimization of control. "You're not hurt? Fine. Let's make you faster!"
If you're curious (or, more importantly, injured), come see us. And if that's not possible, when you are practicing that new skill, think to yourself: "What does it FEEL like? What are my muscles DOING?"
So what IS missing?
To change how a person controls their body in space is to change motor behavior -- or how a person uses their brain, muscles and nervous system to move. In order to have true success in changing motor behavior, you must affect all three systems.
The "Magic Wand" looked only at muscle. The "Don't Do That" did 'em one better: muscle AND brain (though only the conscious brain). But still missing was the nervous system.
The nervous system covers outputs (muscles and movement), but just as important, inputs: how it feels to position joints, activate muscles and move limbs.
This brings us to a new approach: Dynamic Proprioception.
*****
Dynamic Proprioception© -- developed by Jeff Giulietti, MPT, ATC, and colleagues -- is an approach that integrates both orthopedics (e.g. muscles and joints) with neurological rehabilitation -- to enact a change in motor behavior.According to motor control theories, we can only change motor patterns if we can FEEL the muscles actively work during the learning of new skills. Our conscious brain will then "integrate" that feeling into the new motor plan. In our step-up example in order to truly learn to "keep the knee over the foot" during a step-down activity is by FEELING the quad and the lateral hip while we're doing it correctly.
A treatment approach for knee control, for example, would begin with simple exercises aimed at gaining this sensory input -- first in static (no movement), then progressing to slow, controlled movement, then faster/more challenging movements, and finally, to functional movements.
Another way to put it is, you're making a motor control blueprint: "OK, here is what it FEELS LIKE to control your knee: feel your quad and lateral hip 'burning' with activation." Then, taking that blueprint, you apply it to increasingly demanding, complex, and functional activities, until it becomes automatic.
It's an approach with tremendous potential not only for injury rehab and prevention, but for optimization of control. "You're not hurt? Fine. Let's make you faster!"
If you're curious (or, more importantly, injured), come see us. And if that's not possible, when you are practicing that new skill, think to yourself: "What does it FEEL like? What are my muscles DOING?"
