Summit’s ASCEND Program: Rehabilitating Neuromuscular Imbalances

Knee, hip, and ankle surgery can take a toll on leg strength and balance. Summit’s ASCEND program is designed to help athletes reclaim the neuromuscular balance they need to compete safely.

Higher level reconditioning

Recovery after a lower extremity injury takes time. During the first three months following a surgical repair, patients focus on resuming the activities of daily life—but athletes need a higher level of conditioning before they can safely return to competitive sports. Summit’s ASCEND program is designed to provide the more intensive conditioning athletes need. One focus of the ASCEND program is identifying and correcting neuromuscular imbalances.

Neuromuscular imbalances

“An imbalance occurs when people just don’t have enough proximal strength,” explains ASCEND physical therapist Jenny Blade. “These imbalances put extra stress on lower joints. In some cases, we’ll see knees collapse inward. Or, when quads are dominant, athletes land with their knees farther forward instead of sitting their hips back. This puts additional stress on joints and can lead to another injury.”

Types of neuromuscular imablance

Neuromuscular imbalances can present in a number of different ways. Physical therapist Kyle Hall reviews some of the imbalances that the ASCEND program is designed to address.

  • Ligament Dominance. “We see this when patients move in a way that does not allow their muscles to absorb force,” she explains. “Instead, they are putting increased stress on the joint ligaments.
  • Quadriceps Dominance. When an athlete’s quadriceps muscles are strong, they may rely too much on those quadriceps muscles in the front of the thigh without using their hip, hamstring, and gluteus muscles.
  • Leg Dominance. “Many people have a preferred plant, kick, or drive leg,” says Kyle. “That preference can lead to asymmetries in muscle recruitment, strength, and flexibility from one leg to the other. Interestingly, female athletes tend to be more one-leg dominant than males.”
  • Trunk Dominance. “Trunk dominance is also referred to as core dysfunction,” Kyle explains. “We see it when patients don’t properly sense the position of their trunk in space and in relation to their legs and body. This creates increased stress to the joints. Core dysfunction is more common in ages where we experience increased growth periods; during these growth periods, we are relearning how to position our body in relations to our trunk. When an injury interrupts this stage of growth, a patient may need some support to learn proper positioning.”

“Correcting imbalances is one advantage of the ASCEND program,” Kyle says. “When all of your muscles engage properly to share the impact of high-intensity performance, you’ll play with more strength and with less risk of a reinjury.”


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