Arthrogenic Muscle inhibition: A Limiting Factor in Joint Rehabilitation

2000 ◽  
Vol 9 (2) ◽  
pp. 135-159 ◽  
Author(s):  
J. Ty Hopkins ◽  
Christopher D. Ingersoll
Keyword(s):  
Complete Recovery ◽  
Data Sources ◽  
Therapeutic Interventions ◽  
Limiting Factor ◽  
Reflex Inhibition ◽  
Hoffmann Reflex ◽  
Joint Injury ◽  
Muscle Inhibition ◽  
Type Data ◽  
Arthrogenic Muscle Inhibition

Objectives:To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.Data Sources:The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the termsreflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, andjoint injury. The remaining citations were collected from references of similar papers.Conclusions:AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.

Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation

2021 ◽  
pp. 1-19
Author(s):  
Grant Norte ◽  
Justin Rush ◽  
David Sherman
Keyword(s):  
Evidence Synthesis ◽  
Well Being ◽  
Limiting Factor ◽  
Joint Injury ◽  
Patient Decision Making ◽  
Patient Decision ◽  
Joint Health ◽  
Muscle Inhibition ◽  
Post Traumatic ◽  
Arthrogenic Muscle Inhibition

Context: Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. Objectives: To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. Evidence Acquisition: PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. Evidence Synthesis: 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. Conclusion: AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients’ long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician–patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.

Mechanisms of Arthrogenic Muscle Inhibition

2021 ◽  
pp. 1-10
Author(s):  
Adam S. Lepley ◽  
Lindsey K. Lepley
Keyword(s):  
Brain Activity ◽  
Limiting Factor ◽  
Joint Injury ◽  
Motor Pathways ◽  
Rehabilitation Programs ◽  
Afferent Information ◽  
Muscle Inhibition ◽  
Patients Experience ◽  
New Evidence ◽  
Arthrogenic Muscle Inhibition

Context: Arthrogenic muscle inhibition (AMI) continues to be a limiting factor in joint rehabilitation as the inability to volitionally activate muscle significantly dampens recovery. New evidence acquired at higher brain centers and in clinical populations continues to reshape our perspective of what AMI is and how to treat it. This review aims to stimulate discussion about the far-reaching effects of AMI by exploring the interconnected pathways by which it evolves. Objectives: To discuss how reflexive inhibition can lead to adaptations in brain activity, to illustrate how changes in descending motor pathways limit our ability to contract muscle following injury, and to summarize the emerging literature on the wide-reaching effects of AMI on other interconnected systems. Data Sources: The databases PubMed, SPORTDiscus, and Web of Science were searched for articles pertaining to AMI. Reference lists from appropriate articles were cross-referenced. Conclusion: AMI is a sequential and cumulative neurological process that leads to complex clinical impairments. Originating with altered afferent information arising from an injured joint, patients experience changes in afferent information, reflexive muscle inhibition, deficiencies in somatosensation, neuroplastic compensations in higher brain centers, and ultimately decreased motor output to the muscle surrounding the joint. Other aspects of clinical function, like muscle structure and psychological responses to injury, are also impaired and influenced by AMI. Removing, or reducing, AMI should continue to be a focus of rehabilitation programs to assist in the optimization of health after joint injury.

Recovery and Return to Activity Following Exertional Heat Stroke: Considerations for the Sports Medicine Staff

2007 ◽  
Vol 16 (3) ◽  
pp. 163-181 ◽  
Author(s):  
Brendon P. McDermott ◽  
Douglas J. Casa ◽  
Susan W. Yeargin ◽  
Matthew S. Ganio ◽  
Lawrence E. Armstrong ◽  
...  
Keyword(s):  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Exertional Heat Stroke ◽  
Data Synthesis ◽  
Residual Symptoms ◽  
Study Selection ◽  
Initial Care ◽  
Type Data ◽  
Return To Activity

Objective:To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).Data Sources:Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.Study Selection:Relevant peer-reviewed, military, and published text materials were reviewed.Data Extraction:Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.Data Synthesis:The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.Conclusion:Future research should focus on developing a structured return-to-activity strategy following EHS.

Effectiveness of Physical Therapy Treatments on Lateral Epicondylitis

2008 ◽  
Vol 17 (2) ◽  
pp. 119-136 ◽  
Author(s):  
Mohamed Kohia ◽  
John Brackle ◽  
Kenny Byrd ◽  
Amanda Jennings ◽  
William Murray ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Data Sources ◽  
Cochrane Library ◽  
Future Research ◽  
Data Synthesis ◽  
Study Selection ◽  
Type Data ◽  
Therapy Interventions

Objective:To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis.Data Sources:Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment.Study Selection:The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.Data Synthesis:Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions.Conclusions:There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

2005 ◽  
Vol 26 (12) ◽  
pp. 1055-1061 ◽  
Author(s):  
Eric D. McVey ◽  
Riann M. Palmieri ◽  
Carrie L. Docherty ◽  
Steven M. Zinder ◽  
Christopher D. Ingersoll
Keyword(s):  
Tibialis Anterior ◽  
Ankle Instability ◽  
H Reflex ◽  
Functional Ankle Instability ◽  
Injured Limb ◽  
Lateral Ankle ◽  
M Wave ◽  
Muscle Inhibition ◽  
Lateral Ankle Ligaments ◽  
Arthrogenic Muscle Inhibition

Background: Functional ankle instability or a subjective report of “giving way” at the ankle may be present in up to 40% of patients after a lateral ankle sprain. Damage to mechanoreceptors within the lateral ankle ligaments after injury is hypothesized to interrupt neurologic feedback mechanisms resulting in functional ankle instability. The altered input can lead to weakness of muscles surrounding a joint, or arthrogenic muscle inhibition. Arthrogenic muscle inhibition may be the underlying cause of functional ankle instability. Establishing the involvement of arthrogenic muscle inhibition in functional ankle instability is critical to understanding the underlying mechanisms or chronic ankle instability. The purpose of this investigation was to determine if arthrogenic muscle inhibition is present in the ankle joint musculature of patients exhibiting unilateral functional ankle instability. Methods: Twenty-nine subjects, 15 with unilateral functional ankle instability and 14 healthy control subjects, consented to participate. Bilateral soleus, peroneal, and tibialis anterior H-reflex and M-wave recruitment curves were obtained. Maximal H-reflex and maximal M-wave values were identified and the H:M ratios were calculated for data analysis. Separate 1 × 2 ANOVA were done for both the functional ankle instability and control groups to evaluate differences between limbs on the H:M ratios. Bonferroni multiple comparison procedures were used for post hoc comparisons ( p ≤ 0.05). Results: The soleus and peroneal H:M ratios for subjects with functional ankle instability were smaller in the injured limb when compared with the uninjured limb (p < 0.05). No limb difference was detected for the tibialis anterior H:M ratio in the functional ankle instability group ( p = 0.904). No side-to-side differences were detected for the H:M ratios in patients reporting no history of ankle injury ( p > 0.05). Conclusions: Depressed H:M ratios in the injured limb suggest that arthrogenic muscle inhibition is present in the ankle musculature of patients exhibiting functional ankle instability. Establishing and using therapeutic techniques to reverse arthrogenic muscle inhibition may reduce the incidence of functional ankle instability.

Acute and Chronic Tendon Injuries: Factors Affecting the Healing Response and Treatment

2003 ◽  
Vol 12 (1) ◽  
pp. 70-91 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Biomechanical Properties ◽  
Rehabilitation Program ◽  
Tendon Injuries ◽  
Data Sources ◽  
Therapeutic Exercise ◽  
Data Synthesis ◽  
Factors Affecting ◽  
Therapeutic Modalities ◽  
Healing Response ◽  
Type Data

Objective:Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.Data Sources:MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched weretendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization,andhealing.Data Synthesis:The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.Conclusions and Recommendations:All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.

scholarly journals Management of the Knee Extension Deficit after Acute Trauma

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Thiago Alvim do Amaral ◽  
David Sadigursky
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Knee Extension ◽  
Extension Deficit ◽  
Acute Trauma ◽  
Muscle Inhibition ◽  
Articular Pathology ◽  
Functional Gain ◽  
Arthrogenic Muscle Inhibition

A 25-year-old man initially presented with right knee extension deficit after an acute trauma, caused by a condition known as arthrogenic muscle inhibition. This should not be confused with a mechanical block caused by intra-articular pathology. The loss of knee extension, even if minimal, is disabling and leads to worse results after knee surgical treatment. Therefore, it is necessary to recognize and diagnose arthrogenic muscle inhibition to ensure the best treatment for patients with this condition. In this case report, the patient was managed with a rehabilitation technique resulting in an effective functional gain of the quadriceps and full restoration of knee extension.

Defining and Measuring Functional Limitations and Disability in the Athletic Shoulder

2001 ◽  
Vol 10 (3) ◽  
pp. 221-231 ◽  
Author(s):  
Douglas R. Keskula ◽  
Jason Lott
Keyword(s):  
Outcome Measures ◽  
English Language ◽  
Functional Limitations ◽  
Self Report ◽  
Data Sources ◽  
Measurement Properties ◽  
Data Synthesis ◽  
Shoulder Dysfunction ◽  
Study Selection ◽  
Type Data

Objective:To define, identify, and briefly describe functional outcome measures for assessing functional limitations and disability in athletes with shoulder conditions.Data Sources:The MEDLINE and CINAHL databases were searched for English-language articles published from 1982 to 2000, using the termsfunctional outcomes, shoulder, questionnaires, disability,andfunctional limitations,among others.Study Selection:The authors identified disease-specific self-report questionnaires that assess functional limitations and disability in patients with shoulder dysfunction.Data Synthesis:When describing outcome measures, the authors considered the items to be assessed, the measurement properties, and the practicality of the test. They categorized the available measures designed to assess patients with shoulder instability or general shoulder conditions.Conclusions:The ability to define and measure function is a fundamental consideration in managing athletes with shoulder dysfunction. The measures described might be useful in assessing functional limitations and disability in such athletes.

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