Sensory-motor control of ligaments and associated neuromuscular disorders.

The ligaments were considered, over several centuries, as the major restraints of the joints, keeping the associated bones in position and preventing instability, e.g. their separation from each other and/or mal-alignment. This project, conducted over 25 years, presents the following hypothesis: 1. Ligaments are also major sensory organs, capable of monitoring relevant kinesthetic and proprioceptive data. 2. Excitatory and inhibitory reflex arcs from sensory organs within the ligaments recruit/de-recruit the musculature to participate in maintaining joint stability as needed by the movement type performed. 3. The synergy of the ligament and associated musculature allocates prominent role for muscles in maintaining joint stability. 4. The viscoelastic properties of ligaments and their classical responses to static and cyclic loads or movements such as creep, tension-relaxation, hysteresis and strain rate dependence decreases their effectiveness as joint restraint and stabilizers and as sensory organs and exposes the joint to injury. 5. Long-term exposure of ligaments to static or cyclic loads/movements in a certain dose-duration paradigms consisting of high loads, long loading duration, high number of load repetitions, high frequency or rate of loading and short rest periods develops acute inflammatory responses which require long rest periods to resolve. These inflammatory responses are associated with a temporary (acute) neuromuscular disorder and during such period high exposure to injury is present. 6. Continued exposure of an inflamed ligament to static or cyclic load may result in a chronic inflammation and the associated chronic neuromuscular disorder known as cumulative trauma disorder (CTD). 7. The knowledge gained from basic and applied research on the sensory - motor function of ligaments can be used as infrastructure for translational research; mostly for the development of "smart orthotic" systems for ligament deficient patients. Three such "smart orthosis", for the knee and lumbar spine are described. 8. The knowledge gained from the basic and applied research manifests in new physiotherapy modalities for ligament deficient patients. Ligaments, therefore, are important structures with significant impact on motor control and a strong influence on the quality of movement, safety/stability of the joint and potential disorders that impact the safety and health of workers and athletes.