Moiroux-Sahraoui Ayrton, Forelli Florian, Mazeas Jean, Rambaud Alexandre Jm, Bjerregaard Andreas, Riera Jérôme
Orthosport Rehab Center, Domont, France.
Orthopaedic Surgery Department Clinic of Domont, Ramsay Healthcare, @OrthoLab, Domont, France.
Int J Sports Phys Ther. 2024 Aug 1;19(8):1044-1051. doi: 10.26603/001c.121423. eCollection 2024.
Arthrogenic Muscle Inhibition (AMI) is a phenomenon observed in individuals with joint injury or pathology, characterized by a reflexive inhibition of surrounding musculature, altered neuromuscular control, and compromised functional performance. After anterior cruciate ligament reconstruction (ACLR) one of the most obvious consequences of AMI is the lack of quadriceps activation and strength. Understanding the underlying mechanisms of AMI is crucial for developing effective therapeutic interventions. The surgical procedure needed to reconstruct the ACL has biochemical et physiological consequences such as inflammation, pain, and altered proprioception. These alterations contribute to the development of AMI. Therapeutic interventions aimed at addressing AMI encompass a multidimensional approach targeting pain reduction, inflammation management, proprioceptive training, and quadriceps activation. Early management focusing on pain modulation through modalities like ice, compression, and pharmacological agents help mitigate the inflammatory response and alleviate pain, thereby reducing the reflexive inhibition of quadriceps. Quadriceps activation techniques such as neuromuscular electrical stimulation (NMES) and biofeedback training aid in overcoming muscle inhibition and restoring muscle strength. NMES elicits muscle contractions through electrical stimulation, bypassing the inhibitory mechanisms associated with AMI, thus facilitating muscle activation and strength gains. Comprehensive rehabilitation programs tailored to individual needs and stage of recovery are essential for optimizing outcomes in AMI. The objective of this clinical viewpoint is to delineate the significance of adopting a multimodal approach for the effective management of AMI, emphasizing the integration of pain modulation, proprioceptive training, muscle activation techniques, and manual therapy interventions. Highlighting the critical role of early intervention and targeted rehabilitation programs, this article aims to underscore their importance in restoring optimal function and mitigating long-term complications associated with AMI.
关节源性肌肉抑制（AMI）是在关节损伤或病变个体中观察到的一种现象，其特征为周围肌肉组织的反射性抑制、神经肌肉控制改变以及功能表现受损。在前交叉韧带重建（ACLR）后，AMI最明显的后果之一是股四头肌激活和力量不足。了解AMI的潜在机制对于开发有效的治疗干预措施至关重要。重建前交叉韧带所需的手术操作会产生生化和生理后果，如炎症、疼痛和本体感觉改变。这些改变促成了AMI的发展。旨在解决AMI的治疗干预措施包括多维度方法，目标是减轻疼痛、控制炎症、进行本体感觉训练和激活股四头肌。早期管理通过冰敷、加压和药物等方式专注于疼痛调节，有助于减轻炎症反应和缓解疼痛，从而减少股四头肌的反射性抑制。股四头肌激活技术，如神经肌肉电刺激（NMES）和生物反馈训练，有助于克服肌肉抑制并恢复肌肉力量。NMES通过电刺激引发肌肉收缩，绕过与AMI相关的抑制机制，从而促进肌肉激活和力量增加。根据个体需求和恢复阶段量身定制的综合康复计划对于优化AMI的治疗效果至关重要。本临床观点的目的是阐述采用多模式方法有效管理AMI的重要性，强调疼痛调节、本体感觉训练、肌肉激活技术和手法治疗干预措施的整合。本文强调早期干预和针对性康复计划的关键作用，旨在突出它们在恢复最佳功能和减轻与AMI相关的长期并发症方面的重要性。
