18 sports medicine High-tech Healing Comparing biofeedback to electrical muscle stimulation in athletic rehabilitation have been involved in evaluation and treatment of sports medicine injuries for over 33 years. I’ve been very fortunate to have a “true” sports medicine practice that predominantly includes professional, college, high school, amateur and aging athletes. Treating this clientele has forced me to explore and pursue restoring full function in the timeliest manner, being very careful to not cause further harm by using an aggressive approach. Attacking Neurological Deficit One secret to successful return to sports with minimal adverse effects is fully restoring muscle function. Although many aspects of our field have seen excellent advancements and growth, we continue to combat one of the most difficult challenges following injury and surgery — muscle atrophy and weakness. Restoring muscle function should not only be measured by muscle force output and scores obtained on functional tests, but neurological function. In my practice, establishing normal neurological function following knee surgery is the primary goal on the path toward successful return to function. Biofeedback is my preferential method of attacking the neurological deficit following surgery or injury. New advances in clinical products have allowed the ability to provide a general assessment of the patient’s EMG neurological status. Subjects’ ability to fire the inhibited muscle may now be conveniently measured by recording EMG activity of the involved extremity and comparing it to the opposite, normally functioning muscle group. The primary rationale for biofeedback is the belief that the patient should begin to use their own “electrical system” as soon as possible through volitional contraction. The concept known as “order of recruitment” lends support to biofeedback to enhance volitional contraction. This order is based on Henneman’s size principle, which states that under load, motor units are recruited from smallest to largest.1 In practice, this means that slow-twitch, low-force, fatigue-resistant muscle fibers are activated before fast-twitch, high-force, less fatigue-resistant muscle fibers. When using a biofeedback device, the clinician sets the goal for the inhibited muscle so that a strong voluntary effort is required by the patient for each contraction. This is visible to the JANUARY 2017 | REHAB INSIDER I Russ Paine, PT is director of the Memorial Hermann IRONMAN Sports Medicine Institute, Texas Medical Center, Houston, Texas. Thinkstock/istock Restoring muscle function should not only be measured by muscle force output and scores obtained on functional tests, but neurological function.
REHAB INSIDER • January 2017 Vol.1 No.1
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