Researchers are investigating how the brain helps prevent knee injuries


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

But now some are researching the connection-brain injury and hope that the activation of the nervous system to adjust can prevent the injury and help with the recovery from them.

About 200,000 people in the United States suffer a torn ACL each year, and tears are on the rise among young athletes. The implications of this are many. For prevention, researchers focus more on the body. Despite some success – prevention programs can reduce the risk of knee injuries by more than 50 percent in sports such as football that require fast running and cutting back and forth – injuries that have not yet been linked to the ACL it happens, even in fit and strong athletes.

Enter the mind, the movement of the body

Physical factors, such as knee distance and knee bend during landing and cutting actions and hip and leg strength, are controlled and influenced by complex interactions between the brain and peripheral nerves. Emerging research suggests that the way the brain processes this sensory input can influence movement patterns that increase the risk of injury – in other words, better, more efficient performance can translate into less risky movement.

Movement begins, and continues, with structure. Instead of coordinating every movement in real time, neuropsychologists believe the brain is always planning one step ahead.

“When you move, you have this internal regulation of your body’s environment and environment,” says Dustin Grooms, neuroscientist and athletic trainer. and professor of physical education at Ohio University.

After the initial planning and decision, the motor cortex sends energy to the muscles to execute the movement, Groom said. “If everything goes according to plan, when the predictions of the brain match the situation and the movement happens as the brain predicted them, you will have a positive response that makes the body move, without any brain activity. “

But if a glitch occurs in connecting what you see and knowing what you see (the sense that tells you where your link is in space), look. And if the prediction error is too big, the cerebellum — the part of the brain that controls movement — can’t adjust quickly enough.

In this case, Groom said, areas that are normally used to help with spatial control, navigation and coordination are being pushed to control only one part of the body, such as the leg. With the demands of a lot of competition – such as during a competitive game – the brain may not be able to correct the wrong knee or ankle position in the millisecond it takes to tear a nerve.

“When you start putting players under dual-task situations or in unpredictable situations, you start to see some of these risk mechanics become more apparent,” said Jason Avedesian, an expert on biology and director of sports science for the Olympic Games at Clemson University. “The question is,” Is [athletes] Do you pay enough attention to what is appropriate and what is not?”

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Although it is difficult for researchers to replicate in the laboratory the high-speed, high-intensity conditions experienced by athletes, a recent study attempted to determine the differences in brain activity in knee management among athletes with high-risk mechanics and injuries.

Nerve compression and injury risk

The researchers, led by Grooms, studied, in conjunction with functional MRIs, the knee joints of a group of female high school soccer players. When the movement is involved Landing jumps from a 12-inch box were checked, they found that the areas of the brain usually responsible for integrating visual information, attention and body position showed increased activity in athletes with dangerous knee mechanics.

In other words, the risk group receives brain power from the cognitive control areas to regulate movement. This becomes a problem when these players are trying to navigate a complex sports situation, such as trying to avoid a goalie on a soccer field.

Importantly, subjects who showed less efficiency in their neural control were more likely to show risky mechanics.

“Daily activities and sports require us to balance motor and cognitive demands as we attend to and process information from our environment to inform how we move,” said Scott Monfort, a researcher and executive director of the University’s Biological Sciences Laboratory. neuromuscular biomechanics at Montana State University. .

“How we pick up the right signals and respond to them can influence how we walk safely and securely, whether it’s walking down a busy street or trying to avoid an opponent during sports,” he said.

Monfort examines how biotechniques become more dangerous when movements are made with more subtleties, such as avoiding an enemy.

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

In addition to assessment of visual and verbal memory, reaction time and processing speed, subjects were asked to perform a 45-step-to-cut test with and without soccer balls. The knee position was evaluated and analyzed during the cutting motion.

The researchers found that worse visuospatial memory was associated with riskier knee mechanics during the bowling process, when more demands were placed on tracking and planning the ball’s movement.

While research has shown an increased risk of injury when nerve impulses are reduced during vigorous movement, the relationship can be the other way around, as well. A knee or ankle injury can alter the neuromuscular control system, further affecting the risk of re-injury.

A recent collaborative study by Monfort and Grooms found more differences in individual leg measurements when subjects who underwent ACL reconstruction had to identify and remember information presented on a screen in front of them.

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But what is still not determined is the importance of cognitive-motor function in sports injuries, and how this can vary by age, level of experience or by genetics.

“There is some evidence that elite athletes can perform better on tasks that require balancing cognitive and motor demands and on separate tests of cognitive ability,” Monfort said.

Monfort said he believes training under conditions that reflect real-world situations, including concurrent cognitive and motor demands, “may increase the likelihood of real-world performance gains.”

And one problem for recovery from injury or surgery can come from self-repair programs.

“Our treatment can strengthen this neurological compensation mechanism – look and think about your quadriceps muscle – when instead we need to think about the development of this recovery process. [attention, sensory processing, visual-cognition] and courage,” said the groom.

To improve control skills can be as simple as asking players to respond to visual stimuli – such as adding numbers on flash cards or moving in response to different colored lights – while jumping or jumping from side to side.

Sports and even many activities of daily living create special demands on the nervous system, and standard exercise programs can prepare the muscles but not the nervous system, Groom said.

“We’re very good at thinking about what the joints are going to do, what the muscles are going to do,” Grooms said. “But we should try to think about what the nervous system should do and how it will need to adapt and adapt to the demand that is imposed.”

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