An exercise in NEMEX
The Neuromuscular Exercise (NEMEX) program aims to improve sensorimotor control and achieve functional joint stability by addressing the quality of motion in all three planes of motion. For patients with mild to severe pain with activity, NEMEX is the viable procedure. bouncing However, these activities were not considered feasible in clinical trials in 2017. 
- It’s part of the GLA:D® program (Living Well with Arthritis: Denmark), an education and exercise program developed by Danish researchers for people with symptoms of hip or knee osteoarthritis (OA).
- The GLA:D program is an eight-week program that includes education and exercise. Overseen by a certified GLA:D physical therapist, the program is designed to help patients manage their OA symptoms.
- For patients undergoing severe hip and knee replacement surgery
- Improve function and quality of life
- Reduced pain (associated with reduced use of analgesics) and sick leave
In short, the NEMEX program consists of 11 exercises (mainly performed in closed kinetic chains) focusing on the following parts:
- Proper functional performance and alignment where the knee lines up over the second toe without dropping inward when the knee is bent.
- Postural Control: Perform voluntary movements without losing your posture.
- Strength of lower extremity
- Functional stability of the trunk and knees.
- Perform each leg, but focus on the affected leg.
- Allows progression 4 difficulty levels to choose from
- Progression is made when the physical therapist feels that the movement can be performed with good sensorimotor control and good quality (by visual inspection) and the patient feels that they can perform the movement with minimal effort and controlled movement. 
- They are usually multi-joint exercises performed in functional closed-chain weight-bearing positions.
This 3 minute video provides an overview of the NEMEX program. In short
- Training is supervised by an experienced physiotherapist
- Consists of three parts: warm-up circuit program and cool-down
- Training session are 60 minutes long.
- The quality of motion in each exercise is important for the proper positioning of the joints relative to each other, i.e. hip knee and foot alignment. 
Fundamentals of neuromuscular exercise
Neuromuscular control is defined as the involuntary training response of muscles to signals concerning dynamic joint stability. Lower body movements including knee joints are controlled by this system, which needs to provide correct information for purposeful movement . A neuromuscular training program should address several aspects of sensorimotor function and functional stability to improve target function and relieve symptoms.
- Emphasizes quality of motion and emphasizes joint control of all three biomechanical/motor planes. 
- It has an effect on the functional performance biomechanics and muscle activation patterns of peripheral joint musculature .
- Addresses the time lag of the neuromuscular response leading to dynamic joint instability and recurrent episodes of joint subluxation and degeneration. 
Mechanisms for Sensorimotor Deficiency
Sensorimotor dysfunction may play a role in the initiation and progression of degenerative joint disease .
Impairments exist at different levels of the sensorimotor system:
- Sensory input integration and processing of information in the central nervous system
- Motor output (critical for performing voluntary movement and maintaining postural control)
- Neuroinhibition (damage to sensory receptors in joints caused by pain, swelling, inflammation, joint laxity, etc.) may prevent muscles from being fully activated by altering the excitability of spinal and supraspinal pathways. 
- Sensorimotor deficits were also found in the uninjured leg, which may be due to lack of physical activity following injury, inherent poor function and/or disturbed sensory feedback from the injured joint, while there was also muscle activation on the uninjured side inhibition.
- Clausen B, Holsgaard-Larsen A, Roos EM. An 8-week neuromuscular exercise program for patients with mild to moderate knee osteoarthritis: a case series drawn from a registered clinical trial. Journal of Athletic Training. 2017 Jun;52(6):592-605. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488851/(accessed 28.5.2022)
- Trek NEMEX Available:https://nemex.trekeducation.org/ (accessed 28.5.2022)
- Glad Australia NEMEX-TJR training program Available:https://gladaustralia.com.au/wp-content/uploads/2018/09/Ageberg-et-al-Appendix-Feasibility-NEMEX-TJR-2010.pdf (accessed 26.11.2022)
- Target Physio GLA:D Hip and Knee Osteoarthritis Info Video Available:https://www.youtube.com/watch?v=-Xkiad0x7_I(accessed 28.5.2022)
- Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC musculoskeletal disorders. 2010 Dec;11(1):126.
- Clausen B. Neuromuscular exercise as treatment for knee osteoarthritis in middle aged patientsNeuromuscular exercise as treatment for knee osteoarthritis in middle aged patients(Doctoral dissertation), Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet).
- Risberg MA, Mørk M, Jenssen HK, Holm I. Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction. Journal of Orthopaedic & Sports Physical Therapy. 2001 Nov;31(11):620-31.
- Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease. Exercise and sport sciences reviews. 2015 Jan 1;43(1):14-22.
- Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. InSeminars in arthritis and rheumatism 2010 Dec 1 (Vol. 40, No. 3, pp. 250-266). WB Saunders.