Moving Towards Better Rehab

In any rehab program, there can (and usually should) be multiple modalities/ techniques/ principles/ etc. that help to achieve your goal. One often overlooked aspect is proprioception and the application of Hilton’s Law.

What Is Proprioception?

It is a term used to describe the body’s awareness of itself (limbs and such) in space. In a way, proprioception can be compared to “co-ordination”. However, the neurology behind proprioception can be used to accelerate just about any rehab program.

What Is Hilton’s Law?

It is the idea that every nerve innervating a muscle that moves a given joint, has an articular branch innervating the joint itself as well as the skin over the joint. This may sound confusing but it’s quite simple. Look at the shoulder for example. The muscles that move the shoulder (directly) are:

· Deltoid (axillary nerve)

· Pectoralis major (lateral & medial pectoral nerves)

· Supraspinatus (suprascapular nerve)

· Infraspinatus (suprascapular nerve)

· Teres minor (axillary nerve)

· Teres major (lower subscapular nerve)

· Subscapularis (upper & lower subscapular nerves)

· Latissimus dorsi (thoracodorsal nerve)

· Biceps brachii (musculocutaneous nerve)

· Triceps (radial nerve)

These nerves innervate muscles, but also the fibrous capsule, ligaments, and synovial membrane of the shoulder. They provide both pain and proprioceptive nerve fibers. Some of them only innervate a certain tissue type with a certain fiber type, while others innervate multiple tissues with multiple different fibers.

How Can This Be Applied?

If there is for example, an injury to the supraspinatus muscle (a fairly common rotator cuff injury), shoulder function may be severely impaired. Treating the supraspinatus and the suprascapular nerve will likely be beneficial and is fairly straightforward. However, treating the other muscles (and therefore nerves) stated above will likely also improve the overall function of the impaired shoulder thus accelerating the rehab process. So, if there is a supraspinatus injury, treat the lat. If the long head of the bicep is strained or torn, treat the pec and deltoid. Get the patient using the shoulder, focusing on the shoulder musculature that is still functioning well, in order to stimulate the joint and aid healing in the injured muscle.

Final Words

Physical therapy is more than rubbing a tender spot. It involves a deep understanding of anatomy and neurology. Moreover, you shouldn’t be scared to move an injured joint (barring severe injury, fractured bones, ruptured tendons, etc.).