What is the contribution of addressing motor inhibitions in the context of post-traumatic knee rehabilitation?
The concept of AMI
Following a knee trauma Whether or not you have had surgery, you frequently experience quadriceps muscle weakness, particularly in the vastus medialis oblique (VMO), with or without associated symptoms. flexum.
These difficulties most often have a central corticospinal origin, now well documented scientifically under the term Arthrogenic Muscle Inhibition (AMI) (1)(2)(3). This disruption of the motor pattern is attributable to the clinical picture of knee trauma: inflammation associated with swelling, pain, and instability.
The diagnostic assessment of AMI in knee rehabilitation
The differential diagnostic assessment of these AMIs is relatively easy to highlight.
Quadriceps shock is evaluated:
- Visually, by comparing the quality of quadriceps contraction with that of the contralateral limb,
- Due to the patient's inability to assume active recurvatum
- Through a difference in muscle activity objectively measured by surface EMG.
The flexum due to a reflex contraction of the hamstring is visually objectified by placing the patient in prone position, which allows the contraction of the hamstring to be visually observed.
AMIs constitute a major obstacle to rehabilitation because they accentuate muscle atrophy, joint instability, pain and delay or block the return to motor function, despite well-conducted rehabilitation.
In the longer term, they induce an increased risk of osteoarthritis and cyclops syndrome (4)(5)(6).
The management of AMI for post-traumatic knee rehabilitation
For these motor inhibitions resistant to classical rehabilitation, the Allyane neuromotor reprogramming method provides encouraging clinical results.
A clinical study (*) presented at ECOSEP Congress Sports Medicine and Science (7) highlights the following results:
- Increase in average muscle activity measured by surface EMG (average of 3 isometric contractions measured before and after a session) of 41% (p<0,001)
- Average reduction in flexion of 9,01 degrees (p<0,001) over one session.
(*) Retrospective clinical study, case series, level of evidence 4.
Conclusion
Early identification of motor impairments and their management immediately following a sprain can significantly improve motor rehabilitation. Based on neuroscience, neuromotor reprogramming using the Allyane method shows encouraging clinical results, which will be further explored in future studies. References:
(1) Hopkins, J.T.; Ingersoll, CD Arthrogenic Muscle Inhibition: A Limiting Factor in Joint Rehabilitation. Journal of Sport Rehabilitation 2000, 9 (2), 135–159. https://doi.org/10.1123/jsr.9.2.135.
(2) Rice, D.A.; McNair, PJ Quadriceps Arthrogenic Muscle Inhibition: Neural Mechanisms and Treatment Perspectives. Semin Arthritis Rheum 2010, 40 (3), 250–266. https://doi.org/10.1016/j.semarthrit.2009.10.001.
(3) Sonnery-Cottet, B.; Saithna, A.; Quelard, B.; Daggett, M.; Borade, A.; Ouanezar, H.; Thaunat, M.; Blakeney, WG Arthrogenic Muscle Inhibition after ACL Reconstruction: A Scoping Review of the Efficacy of Interventions. Br J Sports Med 2019, 53 (5), 289–298. https://doi.org/10.1136/bjsports-2017-098401.
(4) Pinto FG et al. Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome Orthop J Sports Med. 2017 Jan 27;5(1)
(5) Delaloye JR et al. Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database Sports Med. 2020 Mar;48(3)
(6) Shelbourne KD. Results of Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts: Objective Factors Associated With the Development of Osteoarthritis at 20 to 33 Years After Surgery m J Sports Med. 2017 Oct;45(12)
(7) Ladoucette S., Arthrogenic Muscle Inhibition: a new approach in joint rehabilitation. ECOSEP Congress Sports Medicine and Science: Facts for the future, November 19-20, 2021, Athens