Neuromuscular Deficit Test: Return to Play Just Got Fun

By |2022-11-10T15:01:16-05:00February 21st, 2019|Latest Articles|

After an injury, return to play is the ultimate goal for athletes of all ages, and standard return to sport evaluations are tried and true. However, one thing they don’t explore is the impact of neuromuscular activity on the ability to return to sport. Beyond strength and range of motion, it is crucial to understand the health of the neuromuscular pathway in muscles that have undergone trauma and rehabilitation before sending a patient back into the game.

The research is thorough on the effects of quadricep strength deficits after anterior cruciate ligament (ACL) injury, for example. Aside from increasing re-injury risk and limiting return to play capabilities, strength deficits of >20% can compromise a person’s gait, knee motion, and daily activities. (1)

Biodex testing has long been the gold standard for measuring strength deficits of both the upper and lower extremity. While larger institutions and medical center are often fortunate enough to have access to this equipment, most of the rehabilitation world cannot afford such a luxury machine. That being said, the importance of neuromuscular deficit testing does not loose significance. Clinicians need an easy and convenient way to test and tract neuromuscular and strength deficits that persist after an injury. mTrigger’s neuromuscular deficit testing feature may have an integral role here.

mTrigger’s Neuromuscular Deficit Test (NMDT) measures the neuromusclar activity and function of the impaired limb as compared to that of the healthy limb. While the goal may not always be 100% symmetry – i.e. 0% deficit – in athletes with lateral dominance, the NMDT protocol embedded in mTrigger’s interface provides a quick, clear picture of neuromuscular performance. “Patients walk away from a session with a number they can see improving over time, and that speaks to the power of understanding your activation. This is something with real impact that patients can understand and draw motivation from,” says founder Russ Paine, who coined the protocol.

Strength deficits of the involved side are expected after both major and minor injury. For instance, plantar flexion (gastroc) deficit after Achilles injury (2), hamstring deficit after hamstring strain injury (3), glute deficits after hip injury (4,5), and like previously mentioned, quad deficits after and ACL/knee injury.(1)

With a built in one-minute test, patients and providers have an idea of how far they’ve come and how far there is to go on the journey through rehabilitation.  The value of a concise progress measurement is universal, applying to everyday orthopedic patients as well as athletes. Truly, anyone looking to get back to normal life stands to benefit from such an evaluation.

Stay tuned for detailed reports on normative measurement standards for this.



  1. Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(1):216-224. doi:10.1177/0363546512459638
  2. Yow BG, Tennent DJ, Dowd TC, Loenneke JP, Owens JG. Blood Flow Restriction Training After Achilles Tendon Rupture. J Foot Ankle Surg. 2018;57(3):635-638. doi:10.1053/J.JFAS.2017.11.008
  3. Nara G, Samukawa M, Oba K, et al. The deficits of isometric knee flexor strength in lengthened hamstring position after hamstring strain injury. Phys Ther Sport. 2022;53:91-96. doi:10.1016/J.PTSP.2021.11.011
  4. Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000;10(3):169-175. doi:10.1097/00042752-200007000-00004
  5. Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med. 2005;15(1):14-21. doi:10.1097/00042752-200501000-00004



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