Neuromuscular Training Part 1: Basics
Neuromuscular Training Part 1: Basics
When considering neuromuscular training, there are several categories and then subcategories under this umbrella term. To better understand neuromuscular training to help you also shape your programming, let’s take a deeper look.
WHAT IS NEUROMUSCULAR TRAINING?
To understand Neuromuscular training, we must first look at neuromuscular control. Neuromusclar control is defined as a muscle’s trained, unconscious response to a signal regarding dynamic joint stability. Correct messaging from the brain to the body is required for purposeful movement. (2) Neuromuscular Training is an umbrella term that represents training interventions incorporated into an athletic training program targeting categories such as muscular strength, mobility, balance, and impulsive movement. (3)
HOW DOES NMT WORK?
Neuromuscular training focuses on what are called intrinsic factors (meaning not external like a slippery surface or stable shoes). This includes factors like previous injury history, a decrease or lack in strength, as well as level endurance, flexibility, and balance. (1)
One of the goals of a NMT program is to “improve movement competency” (Williams et al). This includes developing fundamental movement skills which are typically promoted when training young athletes (movement patterns involving more than one body segment). Motor control in the context of executing movements is defined as the ability to maintain balance and posture with both expected and unexpected pertubations (Winter et al). (3)
WHEN SHOULD NMT BE IMPLEMENTED?
Due to the high level of neural plasticity of children (and high levels of new myelin formation), movement programs should be implemented in preadolescence. Young bodies typically adapt and learn motor patterns more quickly, and then reduce the time spent developing improper motor patterns. The golden age of motor learning is children under 12. (3)
WHERE ARE YOUTH GETTING INJURED?
According to Emery et al, 60% of injuries in young athletes involve lower extremities. (1)
WHAT MAKES YOUTH MORE INJURY PRONE?
An article by Kemper et all coined the term “adolescent awkwardness”. This represents a period of time in which a child has impaired neuromuscular control as a result of rapid increase in leg and arm length. (3) During these phases of rapid growth are when youth are most at risk of getting injured.
WHAT ARE THE BENEFITS OF NMT?
Meta-analysis by Emery et al found that there is “a combined preventative effect of neuromuscular training in reducing risk of lower extremity injury” in young athletes. Other benefits of neuromuscular training on young athletes included improved self-esteem, motor skill development, socialization, teamwork, and stress reduction. Injury prevention through NMT not only helps reduce the frequency of injury, but also the severity. (1)
Meta-analysis by Williams et al) found that body weight NMT programs (particularly diverse programs) improved tasks requiring dynamic balance, key for dancers considering many training facilities and studios often lack equipment, and that choreography almost always requires some sort of dynamic balance. (3)
Zech et al found that post ankle sprain NMT (with proprioceptive training) increased joint functionality and decreased incidence of recurrent sprains or “give away” sensation. There is also moderate evidence that NMT (with proprioceptive training) was effective in preventing further injuries after an ACL rupture (4).
WHAT SPECIFICS ARE REQUIRED FOR NMT TO GET RESULTS?
Neuromusclar training (NMT) needs to address several aspects of sensorimotor function and functional stabilization to improve motor control and reduce mechancial symptoms. (2) Neuromuscular programs which are multifaceted (meaning they include exercises for balance, agility, strength, etc) used as a presses on training and/or a warm up protocol can have a significant reduction in sports injury in young athletes, particularly the knee (45-85% reduction) and ankle (44-86%). Past research by Pfeiffer ext al found that a program lacking balance training failed to reduce injury risk (of the ACL in particular). This program had strength, speed, agility, and coordination but the last of balanced had negative effects on the programs outcome. There was also a greater effect found then programs included plyometric training and/or jumping training. Programs with proprioception training also had positive effects but programs focusing on stretching did not (across numerous sports). (1)
Looking at soccer players using the FIFA 11+ warm up program twice weekly for 7 to 8 weeks found a reduction of knee valgus (knocked) during double legged landing (Thompson-Kolesar et al., 2018). (3)
Another important factor to note is that these findings were achievable by implementing NMT info time-efficient warm ups. With all of this, it is worth acknowledging that some level of individualization in programming is also beneficial. It is also worth noting that NMT programs were less effective in older, taller, and heavier youth athletes. (3)
In terms of duration, it was found that longer programs (greater than 8 weeks) had better results (Williams et al). The thought is that the longer programs allow for a low magnitude of stimulil and a more diverse training program. Balance training alone required greater than 23 weeks to result in significant effects. General recommendation from Williams et all is to implement a NMT program, 2-3 times per week, at least 8 weeks. (3)
REFERENCE LIST:
Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, Van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. British journal of sports medicine. 2015 Jul 1;49(13):865-70.
Kumar P. Neuromuscular Eercise Program NEMEX [Internet]. Physiopedia. Available from: https://physio-pedia.com/Neuromuscular_Exercise_Program_NEMEX
Williams MD, Ramirez-Campillo R, Chaabene H, Moran J. Neuromuscular training and motor control in youth athletes: a meta-analysis. Perceptual and motor skills. 2021 Oct;128(5):1975-97.
Zech A, Huebscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Medicine & science in sports & exercise. 2009 Oct 1;41(10):1831-41.
