Monday, June 15, 2020

Neuroplasticity and ACLR Rehabilitation - Part II

Last week, we started our discussion about neuroplasticity and how there may be changes in the higher centers of the brain that occur following an injury.  One of the studies we mentioned was the study by Grooms et al J Orthop Sport Phys Ther 2017.  The purpose of this study was to compare differences in brain activity during knee flexion and extension exercises in those that had an ACLR compared to matched controls.

15 athletes who were average of 38 months post ACLR where compared to 15 matched controls.  Healthy matched controls were matched on age, sex, height, mass, extremity dominance, education level, sport participation and physical activity level.  All subjects filled out an IKDC (international knee documentation committee) questionnaire. 

Each subject had a functional MRI performed while they performed a unilateral leg extension/flexion exercise depicted below.  Each subject performed the task for 30 seconds rested 30 seconds and performed 4 blocks of movement and 5 blocks of rest.  Brain activity was mapped during the course of the exercise and comparisons to matched controls were made.

ACLR patients had significantly lower scores on the IKDC when compared to matched controls.  The ACLR group had increased activation in the contralateral motor cortex, contralateral lingual gyrus and ipsilateral somatosensory area.  There was also diminished activation in the ipsilateral motor cortex and ipsilateral cerebellum. 

What this tells us is that there is altered activation in regions of the brain that are responsible for sensory, motor and sensory-visual-spacial processing.  Obviously these are key areas and proper functioning is a key part of successful return to sport performance as well as mitigating injury risk with return to sport.  If you consider the two studies I spoke about last week, this may be one reason we still see these biomechanical deficits so far out from surgery despite the fact that they have had surgery.  The fact that these subjects are 38 months post op, tells you that these deficits DO NOT self correct. 

One perfect example is a lateral shift.  As much as we think we catch it, correct it and prevent it in our ACL rehab, the reality is that there are a lot of therapist that do not.  The fact that we see this in mass physicals with college athletes who had an ACLR back in high school some 3 years ago tells us we did not catch it then.  The reality is, we have to do ACL rehab better.  Addressing the neuroplastic changes is a perfect example.   

Next week, we will take a look at a case study of an athlete with an athlete that is 11 months post ACLR.  The athlete was being evaluated for RTSport and we will see what the results were.  We will follow this up by some motor learning studies with ACL rehab to get some specific examples of exercise techniques we can deploy as a part of rehab.

Have you followed my instragram @bjjpt_acl_guy lately?  If not, you are missing out.  I am constantly posting the latest research in injury prevention and sports medicine.  Don't miss out and please share with your colleagues, athletes and training partners and please be sure to follow us on instagrm @ bjjpt_acl_guy and twitter @acl_prevention.  Train hard and stay well.  #ViPerformAMI #ACLPlayItSafe

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI,  ViPerform AMI RTPlay, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent also a Brazilian Jiu Jitsu purple belt and complete BJJ/MMA junkie. 

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