NEURAL COMPONENT OF ORTHOPAEDIC INJURIES
Tid Bits of Info
- Muscles do nothing on their own, they are “run” by the nervous system.
- The nervous system can transmit signals at speeds of 100 meters (328 feet) per second.
- There are around 650 skeletal muscles in the human body.
- Muscle makes up around half of the total human body weight.
- Physical Therapists can help rehabilitate the neuromuscular activity in the human body.
Every day we stand up, sit down, walk, and move all our body parts. We rely on an entire system of muscles, joints, nerves, and the brain. Orthopaedic injuries effect the entire system. Treatment for orthopaedic injuries should also include the entire system. Recently, healthcare professionals are looking at different ways to help restore or re-educate the way the brain and entire nervous system works after an orthopaedic injury occurs to a body part.
Muscles are responsible for movement and stability of the different body parts and joints, but they cannot act alone and need a signal from the nervous system to operate. When the nervous system is not sending the proper signals to the muscles for numerous reasons, the body part does not move or function properly.
In orthopaedic healthcare, the focus is on the bones and soft tissues (muscles and connective tissue) and how they function together to perform the different tasks of everyday life. The joints of the body are the junction of bones and the areas that move via muscle action. When an injury occurs to a joint, the muscle’s ability to function is limited by a decrease or change in neurological communication to it. The inflammatory process is thought to have profound effect on neurological input to a muscle. The muscle can be over or under stimulated and the result is polar opposites.
The under stimulation of a muscle renders it nearly useless and unable to contract and generate force. This phenomenon is clearly visible following a surgery on a particular joint. In most instances, the muscles surrounding the involved joint are not able to be voluntarily recruited by the patient. The pain and swelling associated with a post op status are thought to be the stimulus for the “shut down” of that particular body part.
Over stimulation of a particular muscle following and injury can result in spasm and a “locking up” of the muscles. This condition is quite frequently encountered following a severe strain to the lumbar spine (low back) or a fractured long bone. In these cases of severe trauma which produce an intense amount of pain and inflammation, the body’s defense is to try to protect from further damage by limiting motion. The severity of the injury will determine the amplitude of the body’s response in most cases.
A Physical Therapist is trained to re-educate and stimulate the nervous system to achieve a particular result. The orthopaedic Physical Therapist specializes in restoring normal movement and function of the injured body part. The specialist will design a rehabilitation program that involves strengthening and stretching exercises and activities that are geared towards restoring normal function. They will focus on the injured body part, but will include a holistic approach to link the injured body part to the rest of the body. The nervous system controls movement and all body parts are linked together which has to be considered when going through rehabilitation. The body is similar to a chain of links which can be greatly affected if one link is out of synch.
Recently, studies and treatment are focusing more and more on the way the body works together as a unit and “kinetic chain”. Every body part can affect the way another body part “works” therefore the rehabilitation program must take this into consideration to be comprehensive and successful.
If a muscle is damaged it may have scarred down a nerve during recovery. Offering mechanical movement (soft tissue work, mobilizations, manipulations) to break up scar tissue in the suspected area along with stretches that facilitate gliding or flossing the nerve encourages an unimpeded pathway for the nerve to communicate.
Do your stretches!
Stretching is not just a muscle/tendon issue but also helps the nerves ensuring they have free access to the tissue they need to communicate with.
They always tell you in medical programs to treat the whole patient not the hole in the patient and this article does a great job of showing how you need to consider many different body systems when working with patients. Orthopedic injuries aren’t just bone in muscle but as the article says neural components can be hidden or overlooked when beginning treatment. In some orthopedic cases whether its an injury, overuse, or post surgical muscles begin to fire in irregular patterns as well as not fire at all. This is where the nervous system comes into place. Things such as neuromuscular re-education is instructing patients on various exercises to help fire their muscles in their proper form rather than having other muscles try to come into play where they can become over used and lead to injury. Post surgical patients, knee’s in particular, due to the surgical approaches can have many muscular fibers cut and the muscle contraction can be weak due to the firing from the nervous system. Modalities such as electrical stimulation help to fire muscles of the quadriceps in the case of knee replacements to have more recruitment of fibers but also to aid the nervous system and neural input for the quadriceps to contract to perform daily activities and help with maintaining knee extension range of motion. It is important to see how muscles are firing and if certain muscles are firing improperly and how we can retrain the body with neural input to achieve exercise gains in the orthopedic population and many others.
I do not think we could find an injury that does not involve the nervous system. Nervous system and its complexity in human body makes rehabilitation process more challenging for both patient and physical therapist. This article looks at the function of the nervous system and its primary and/or secondary effect on the injured organ, joint or body part. I find the study of the behavior of our body to different injuries and the nervous system response really interesting and I liked the way that this article explains all these in a simplistic way. I believe we can do much better, both as a patient or as a health care provider, if we learn more and more about our nervous system and know how to train our body to respond in a way that maximizes function and decreases the side effects of that particular injury to our body. Physical therapists have been educated both academically and clinically how to manage different types of injuries. They know and expect the behavior of the nervous system in a certain type of injury. They design the rehabilitation process in a way that helps the patient recruit muscles and nerves that could protect the joints and different body structures. Also, an important point that I believe is missing in this article is “pain” due to over stimulated nervous system secondary to a trauma or an injury to a body part. Physical therapists can also play a significant role in down regulation of the nervous system and decreasing the pain associated with a particular injury.
I like that this article gave a very simplistic way to explain neural conduction to patients. As a student, sometimes I find that I become too detailed in my patient education and I lose people. This article broke down a complicated topic and explained it in a way that was not only easy to follow but very applicable to most people receiving PT.