title: A theoretical framework for understanding neuromuscular response to lower extremity joint injury.
abstract: BACKGROUND
  Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries.
  
  
  METHODS
  Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature.
  
  
  RESULTS
  Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations.
  
  
  CONCLUSIONS
  Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes.
authors.affiliation: Joint Injury and Muscle Activation Laboratory, Department of Kinesiology, University of Toledo, Toledo, Ohio.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Pietrosimone
authors.forename: Michelle M
authors.initials: MM
authors.lastname: McLeod
authors.forename: Adam S
authors.initials: AS
authors.lastname: Lepley