Losing your inhibitions is usually understood as a negative thing…like when someone had a little too much to drink.
But what if your inhibitions hold you back from making continual improvements?
Are you inhibited in a way that you don’t even realize?
You might be surprised to find out that your movements and abilities are not always what you think they are…especially if you have ever experienced an injury.
Recent research has shown that there can be long-lasting changes to your patterns of movement after an injury.
It’s a problem called Arthrogenic Muscle Inhibition. That’s a fancy way of saying that an injury to a joint causes your body to hold back in using the muscles across that joint. But it really isn’t as simple as just that…and it doesn’t stop with just the joint and local muscles.
What is Arthrogenic Muscle Inhibition (AMI)?
Arthrogenic Muscle Inhibition is a reflexive change in how you use a joint and the muscles surrounding that joint, especially when pain or swelling are present. This reaction actually highlights the underlying complexity in the nervous system that controls our ability to move.
For example, if you have ever sprained your ankle, you know that the ankle swells up and that swelling limits your movement. But you will also experience pain because of the disrupted tissue on the ankle (ligament tear).
That pain and swelling combination makes using the ankle very difficult, so many folks end up needing to use crutches for some time after the injury. If you can walk, though, you are probably not walking in your normal fashion.
That’s because the arthrogenic muscle inhibition (AMI) is active in your body. You will limp over the ankle, without having to think about it. It’s automatic.
No Pain/Swelling, No Arthrogenic Muscle Inhibition, correct?
So, getting the swelling down, reducing the pain with some OTC medication, and moving again should eliminate AMI.
If only it were that simple.
Again, if you suffered the sprained ankle, you know that the ankle swelling and pain being diminished might allow you to start walking better, but still probably not normally. Why not?
For starters, the muscles can still be turned off because of the ankle feedback not being correct. Remember, there is usually some tissue (ligament, in this case) that is truly damaged. That tissue is a part of the overall function of the joint. It helps guide motion, and it gives feedback to help your brain and body know where it is in space.
Without that feedback, your muscular responses are delayed.
You cannot balance on your sprained ankle side, even if you can walk “normally”. The muscles cannot react quickly enough to help with the balance, so it takes larger motions for you to “catch” your balance.
And, what’s even more interesting, you might not be able to balance well on your UNINJURED side either!
So, what gives with that?
Arthrogenic Muscle Inhibition isn’t just a local issue
Thus far, everything I have written about has focused on the local tissue, which are the tissues directly affected by the injury. In the current example, that would be the ankle joint, the muscles surrounding the ankle, and the ligaments that guide/limit the movements.
Interestingly, AMI is not just a local phenomenon.
It actually takes more effort to engage a muscle after an injury. Researchers have found that there are higher motor thresholds after an injury. This means that getting your muscles to do what you ask them to takes more effort and more energy…which also delays and often weakens the muscle activity.
But why is this?
It’s because the brain actually changes based on the injury to the ankle. Remember, your brain is the thing that needs to integrate what just happened to your ankle tissues and then reconfigure how to control the ankle.
Functional MRI has shown inhibition of the motor cortex (the part of your brain that plans movements). So much change occurs that it actually causes visible nerve changes in ALL of the connections related to sending/transmitting those messages back down to the ankle!
…and if a muscle doesn’t have the nerve sending it a message, it does not work. Which means it will continue to get weaker, or in the case of the ankle sprain, stay weak and not help with your balance when you most need it to.
Summary of the Stages of Arthrogenic Muscle Inhibition
So here is the basic process in 5-steps:
1-You suffer an injury
2-Injured area has pain/swelling
3-Inhibitory spinal signals are sent turning off the local muscles
4-Your brain (somatosensory cortex) changes the way it “sees” the injured area and then “reorganizes” how it will use the muscles and joint. AKA-Your brain learns to compensate.
5-You now have to “cheat.” That means your brain now has to rely on other feedback to overcome the lack of information from the injured tissue. Often, there is an over-reliance on vision to make up for the lack of information coming from the injured tissue.
Ultimately, the increase in brain work that follows causes you to have to expend a lot more energy to do what used to come naturally and automatically.
What do you do now with your Arthrogenic Muscle Inhibition?
So what does this mean for you?
Arthrogenic Muscle Inhibition might be the reason that you never quite regained your ankle balance after you sprained your ankle all those years ago.
Or, maybe you “just trained through it” when you had shoulder pain with swimming, It seemed like it went away, but more than likely, your brain changed the way it saw the shoulder, and learned a compensation.
So now you know “why” getting your movement pattern back, or getting the “feel” of doing an activity can be difficult after an injury or pain episode.
But what can you do about it?
Actually, a lot!
1- Keep exercising the area. Using the muscles is the best way to start sending those messages up to the brain to start the rewiring process to make the entire system work efficiently, again.
2-Use electrical stimulation on the muscles. Again, this just reinforces the neurologic feedback for your brain to process and make corrections that look more like the pre-injury brain patterns.
3-Make conscious efforts as you perform your exercise. Focus on really engaging the area that was injured. This is working from the top down, by creating better nerve patterns to send out to the injured area. But it doesn’t happen automatically at first, so put some effort into thinking about what you are doing.
4-Consult with a PT to get help deciding which exercises and activities can get you moving in better patterns, sooner.
Conclusion
Despite recent advances in the understanding of arthrogenic muscle inhibition, AMI continues to be a limiting factor in recovery from an injury. The multifaceted changes at both the local tissue level, muscular health, and the neural function can have effects on many aspects of how your body works. These can include poor coordination, muscular weakness, poor spatial awareness, and even psychological stresses.
Exercise is most likely your best weapon against the long term effects of arthrogenic muscle inhibition, but not all exercise is equal as some movements might reinforce the compensatory patterns.
The physical therapists at Lifestrength can help you decide which exercises and activities can get you moving in better patterns, and back to doing what you love quickly. Give us a call, and start moving efficiently, again.
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