Monday, July 6, 2020

Neuroplasticity and ACLR Rehab - Part V

Last week we talked about some specific training strategies we could used based on the most current research.  Strategies that will work on external focus (result of the movement) versus internal focus (focus on the movement itself).  We gave two specific examples of exercises that will work on external focus and which will create neuroplasticity in the higher centers and reduce risk of reinjury with return to sport. 

Working with multiple centers around the US and attempting to create consistency in the way that this training is applied can sometimes be difficult which results in a significant variance in outcomes from center to center, state to state and nationally.  As such,  we have recently identified a technology that allows us to create more consistency.  By using this technology, we can implement this type of training, standardize how it is implemented and through the use of specific protocols, create much more consistency in the results we get regardless of the clinician.   

Quick Board, LLC is a company that developed a sensor board that will Bluetooth to an Ipad.  The Ipad has the Quick Board app that communicates to the sensor board.  This large sensor board has five circles on it, spaced apart all of which contain sensors underneath.    The app has a diagram that is positioned and looks identical to the sensor board.  For each test, the athlete watches a standardized video instruction which shows the athlete what the test is and exactly how it is performed. 

After watching the video, the athlete is instructed to keep their eyes on the Ipad.  The Ipad will highlight one of the targeted circles that the athlete is to touch.  Without looking, the athlete is to reach and touch the corresponding circle.  As soon as the athlete touches the circle, the sensor is activated.  This will record not only the time it takes to touch the circle (from time appeared on the app to actual touch) but also the accuracy (did they touch the right circle).  From this, there are a lot of things that can be measured including:

  • Average reaction time for each sensor location for:
    • Single color exercises 
    • Discrimination tasks - only touch blue versus red (or another color)
    • Go or no go tasks - measuring error rate and reaction time with
  • Average contact time for each sensor location - how long the foot is on the sensor 
  • Accuracy - measure of correct touches versus errors
  • Vertical jump (based on fight time and body weight)
    • Jump height 
    • Reactive strength 
Limb symmetry index (LSI) can also be measured in all of these measures.  This way you can see the variance in the operative and non-operative time as they progress through the rehab process.  This was developed by a strength and conditioning coach and found a lot of success in using this in performance training. Athletes that would improve their performance on these measures were also improving their sprint speed and power.  Based on these results, there has been a large adoption of this technology in professional sports from basketball to football.  

However, this also has huge applications in lower kinetic chain rehabilitation.  I use this with all my lower kinetic chain rehab but specifically with my ACLs.  In addition to seeing the changes that occur in sprint speed and vertical jump, we are also seeing huge improvements in:

  • Performance on TSK-11 - improved scores indicating decreased fear of reinjury
  • Improve performance on the ViPerform AMI.  Specific areas of improvement:
    • Improved control of frontal plane motion (degree of motion and speed) on:
      • Single leg squat
      • Single leg hop
      • Single leg hop plant
    • Improved LSI across all measures 
    • Improved scores on full return to sport testing at 9 and 12 months 

I have no financial tie to this product nor incentive to say this other than it works.  If you are looking for something to address neuroplasticity training and incorporate with your ACLR rehab, then this is an ideal tool.  We are currently conducting several studies looking at the impact of implementing this training device with our ACLR athletes.  Based on the things we know that matter and that we measure, how is this training impacting those results? 

By using this technology, we are seeing a direct impact on the biomechanics that we measure with our wearable sensor technology (ViPerform AMI) and on the TSK-11 numbers we see in our athletes.  We know when these numbers improve on our assessment and the TSK-11 that risk of reinjury with return to sport goes down.  We know by improving LSI that risk goes down and athletic performance goes up.  We know improvement on our return to sport assessment (ViPerform AMI and 3D Sprint Assessment) equates to decreased risk of reinjury and improved athletic performance.  We also know that we can create more consistency in the way that this type of training is implemented from site to site regardless of the clinician (as long as they follow the simple instructions...). 

Whether you choose to implement this device or not, addressing neuroplasticity is and should be a critical part of your rehab, especially with ACLR.  We now know there are changes that occur in the higher centers that DO NOT self correct and we MUST do targeted interventions to address.  If we don't do that, we are returning our athlete to the field and competition with a heightened level of risk. 

I hope you found this a valuable series.  As always, I appreciate all our followers and hope you find the information we provide useful in your practice with your athletes.  If you do, please follow me on instragram @bjjpt_acl_guy and Twitter @acl_prevention.  I also just launched a new website,  My vision is to create a movement revolution in the world of ACL rehab.  Check it out, hear more about my story and where we are headed.  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 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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