Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase
# Background Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neuroco...
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| Format: | Article |
| Language: | English |
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North American Sports Medicine Institute
2024-12-01
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| Series: | International Journal of Sports Physical Therapy |
| Online Access: | https://doi.org/10.26603/001c.126270 |
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| _version_ | 1825197075398131712 |
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| author | Zachary M. Thomas Lewis Lupowitz Morgan Ivey Kevin E. Wilk |
| author_facet | Zachary M. Thomas Lewis Lupowitz Morgan Ivey Kevin E. Wilk |
| author_sort | Zachary M. Thomas |
| collection | DOAJ |
| description | # Background
Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury including altered proprioception, impaired motor control, muscle recruitment and heightened reliance on visual feedback. This suggests a shift from subconscious movement, to movements that require increased volitional control, which may contribute to increased risk of re-injury and thus impede return to sport.
# Clinical Question
Given the neurophysiological changes associated with anterior cruciate ligament (ACL) injury that persistent into the late stages of rehabilitation, does the integration of neurocognitive training into mid to late stage rehabilitation protocols improve functional outcomes and reduce the risk of re-injury following ACL reconstruction (ACLR) in athletes?
# Purpose
The purpose of Part 2 of this clinical commentary is to offer strategies to implement neurocognitive training elements into the traditional ACLR rehabilitation (in weeks 9+) and review updated testing metrics that may better discern an athletes readiness to return to competition. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve both long-term outcomes and return to sport testing, as well as diminishing re-injury risk.
# Conclusion
Updates to the traditional rehabilitation approach post ACLR, that include increased emphasis on neuroplastic, cognitive, and visual-motor capabilities exist. These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury.
# Level of Evidence
5 |
| format | Article |
| id | doaj-art-293c74267a7144fc98dc87ba0603b517 |
| institution | Kabale University |
| issn | 2159-2896 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | North American Sports Medicine Institute |
| record_format | Article |
| series | International Journal of Sports Physical Therapy |
| spelling | doaj-art-293c74267a7144fc98dc87ba0603b5172025-02-11T20:27:04ZengNorth American Sports Medicine InstituteInternational Journal of Sports Physical Therapy2159-28962024-12-011912Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport PhaseZachary M. ThomasLewis LupowitzMorgan IveyKevin E. Wilk# Background Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury including altered proprioception, impaired motor control, muscle recruitment and heightened reliance on visual feedback. This suggests a shift from subconscious movement, to movements that require increased volitional control, which may contribute to increased risk of re-injury and thus impede return to sport. # Clinical Question Given the neurophysiological changes associated with anterior cruciate ligament (ACL) injury that persistent into the late stages of rehabilitation, does the integration of neurocognitive training into mid to late stage rehabilitation protocols improve functional outcomes and reduce the risk of re-injury following ACL reconstruction (ACLR) in athletes? # Purpose The purpose of Part 2 of this clinical commentary is to offer strategies to implement neurocognitive training elements into the traditional ACLR rehabilitation (in weeks 9+) and review updated testing metrics that may better discern an athletes readiness to return to competition. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve both long-term outcomes and return to sport testing, as well as diminishing re-injury risk. # Conclusion Updates to the traditional rehabilitation approach post ACLR, that include increased emphasis on neuroplastic, cognitive, and visual-motor capabilities exist. These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury. # Level of Evidence 5https://doi.org/10.26603/001c.126270 |
| spellingShingle | Zachary M. Thomas Lewis Lupowitz Morgan Ivey Kevin E. Wilk Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase International Journal of Sports Physical Therapy |
| title | Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase |
| title_full | Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase |
| title_fullStr | Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase |
| title_full_unstemmed | Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase |
| title_short | Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase |
| title_sort | neurocognitive and neuromuscular rehabilitation techniques after acl injury part 2 maximizing performance in the advanced return to sport phase |
| url | https://doi.org/10.26603/001c.126270 |
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