Why some athletes are less likely to tear their ACLs


Sports medicine experts have advocated for years the importance of safe biomechanics and lower body strengthening and coordination training to prevent injuries, especially ACL.

But now some are exploring the brain-injury connection and believe that targeting the nervous system’s ability to adapt can help prevent and recover from injuries.

So many About 200,000 people in the United States strain or tear their ACL each year. And tears are rising among Young athletes. There are many factors involved. For prevention, researchers focus primarily on the physical. Despite some successes – prevention programs can cut back The risk of knee injury is greater than 50 percent High-speed running and cutting back and forth in sports such as soccer – non-contact injuries to the ACL still occur, even in fit and strong athletes.

Cognitive input, physical movement

Physical factors, such as how far the knee bends and slides inward during landing and cutting actions and hip and leg strength, are controlled and influenced by complex interactions of the brain and peripheral nerves. A growing body of research suggests that how the brain processes this sensory and cognitive input may influence movement patterns that increase injury risk—in other words, better, more efficient processing may translate into less risky movement.

Movement begins with a plan and continues. Instead of coordinating each movement in real time, neuroscientists believe the brain is constantly planning one step ahead.

“When you move, this internal model of your body’s position and environment is activated,” says neuroscientist and athletic trainer Dustin Grooms. and professor of physical therapy at Ohio University.

After the initial planning and decision-making, the motor cortex sends impulses to the muscles to execute the movement, Grooms says. “If everything goes according to plan, when the brain’s sensory projections match the environment, and movements occur as the brain predicts, you get a neurally efficient response that moves the body without excessive brain activity.”

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But if you’re having trouble integrating what you see and proprioception (the sense that tells you where your limbs are in space), watch out. If the prediction error is large, the cerebellum—the part of the brain that controls movement—cannot correct fast enough.

In this case, Grooms says, areas of the brain that are normally used to help with spatial processing, navigation and multisensory coordination are redirected to control a part of the body, such as a leg. Many competitive demands — during a competitive game — mean the brain can’t correct a misaligned knee or ankle position in the milliseconds it takes to tear a ligament.

“When you start putting athletes in dual-task situations or unexpected situations, you start to see more of some of these dangerous dynamics,” says Jason Avedacian, a biomechanist and director of sports science for Olympic sports at Clemson University. “Question, “They are [athletes] Paying enough attention to what is relevant and what is not?

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Although it is difficult for researchers to replicate the high-speed, dynamic conditions that athletes face in the laboratory, A recent study Attempted to detect brain activity differences in knee control between athletes with high and low injury-risk dynamics.

Neurological ability and injury risk

Researchers led by Grooms analyzed the knee dynamics of a group of female high school soccer players in conjunction with functional brain MRIs. When the motion is engaged Jumping from a 12-inch box was analysed, They found that brain regions are generally responsible for combining visual information, attention and body position.

In a sense, the risky group borrows brain power from cognitive processing areas to coordinate this move. It becomes problematic when these athletes try to navigate complex game environments, such as trying to avoid a defender on the soccer field.

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Basically, subjects who showed lower performance in their neural processing were more likely to exhibit dangerous dynamics.

“Everyday tasks and play environments require a balance of motor and cognitive demands, as we see and process information from our environment to inform how we move,” says Scott Monford, researcher and co-director of the Neuromuscular Biomechanics Laboratory at Montana State University. .

“Taking appropriate cues and responding to them is how efficient and safe moving is, whether it’s walking down a busy street or trying to avoid an opponent during a game,” he says.

Monfort examines how biomechanics can be dangerous when a movement is performed with additional cognitive control, such as avoiding an opponent.

His researchPublished in the American Journal of Sports Medicine, it looked at how cognitive ability was related to neuromuscular control in a group of 15 male college club soccer players.

In addition to cognitive assessments of visual and verbal memory, reaction time, and processing speed, subjects were asked to perform 45-degree run-to-cut tests with and without dribbling a soccer ball. Knee position during cutting motions was assessed and analyzed.

Researchers found that poor visual-spatial memory was associated with risky knee kinematics during ball dribbling when there were additional demands of tracking and planning soccer ball movement.

Although research indicates increased risk of injury when neural performance decreases during dynamic movement, the relationship may also be in the other direction. Knee injury or Ankle Alters neuromuscular control and further affects the risk of re-injury.

Monfort’s most recent collaborative research Grooms found the most obvious differences in single-leg balance when subjects undergoing ACL reconstruction surgery had to locate and remember information presented on a screen in front of them.

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But the relevance of cognitive-motor function in sports injuries and how it varies by age, experience level, or genetics remains to be determined.

“There is some evidence that more experienced athletes can demonstrate better performance in tasks that require balancing cognitive and motor demands and isolated tests of cognitive abilities,” Monfort says.

Training under conditions that mimic real-world scenarios that involve simultaneous cognitive and motor demands “may improve the ability to benefit real-world performance,” Monfort says.

A barrier to recovery from injury or surgery can come from rehabilitation programs themselves.

“Our own rehabilitation may reinforce this neurological compensatory strategy—think about staring at your quadriceps muscle—and instead we should be thinking about advancing this neurological aspect of rehabilitation. [attention, sensory processing, visual-cognition] As well as regular strength,” says Groom.

Processing skills can be enhanced by asking athletes to respond to visual stimuli such as jumping or sidestepping – such as adding numbers to flashcards or moving in response to different colored lights.

Sports and even most activities of daily life create unique nervous system demands, and standard exercise programs can prepare the muscles but not the nervous system, Groom says.

“We’re really good at thinking about what the joints need to do, what the muscles need to do,” Groom says. “But we have to try to think about what the nervous system needs to do and how it can adapt and accommodate the demand placed on it.”

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