Does ‘proximal control’ need a new definition or a paradigm shift in exercise prescription?

NewsBot · Dec 5, 2017

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Editorial
Does ‘proximal control’ need a new definition or a paradigm shift in exercise prescription? A clinical commentary
Steven L Dischiavi, Alexis A Wright, Eric J Hegedus, Kevin R Ford, Chris Bleakley
BMJ

What constitutes proximal control?
There is level 1 evidence that ‘proximal control’ exercises are effective in the management of common musculoskeletal injuries of the lower extremity.1 2 However, there is little agreement on what ‘proximal control’ entails. A meta-analysis by Sugimoto et al2 examined neuromuscular training for ACL injury prevention and found that exercises incorporating a ‘proximal control’ component (OR 0.33, 95% CI 0.23 to 0.47) were comparable to strength-based exercise or ‘multiple exercise’ interventions. Sugimoto et al2 chose a global definition of proximal control (any exercise involving segments proximal to the knee joint) which included full-body dynamic warm-up programmes with plyometrics, jumps/hops, bounding, and various running and agility movements. One might argue that while these full-body interventions represent an integrated holistic approach, calling them ‘proximal control’ is inaccurate, as they fail to incorporate hip-specific exercises as the next ‘proximal’ link in the kinetic chain.
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