Changes in Brain Structure and Activation May Augment Abnormal Movement Patterns: An Emerging Challenge in Musculoskeletal Rehabilitation

A Novel Approach to Evaluate Brain Activation for Lower Extremity Motor Control

“…Thus, a reliable neuroimaging leg press paradigm could provide a neural assay to examine the neural mechanisms contributing to improved motor control or identify barriers in nonresponses for clinical populations with lower extremity musculoskeletal disorders. Further, such a paradigm can identify possible neural activity contributing to dysfunctional movement in those with injury . As prior investigations have reported altered motor cortex excitability with transcranial magnetic stimulation and brain activation patterns for engaging the quadriceps muscle after knee joint injury, this multijoint leg press motion may provide further insights into the neuroplasticity for motor control related to joint injuries.…”

“…Further, such a paradigm can identify possible neural activity contributing to dysfunctional movement in those with injury. 67 As prior inves-tigations have reported altered motor cortex excitability with transcranial magnetic stimulation and brain activation patterns for engaging the quadriceps muscle after knee joint injury, 68 this multijoint leg press motion may provide further insights into the neuroplasticity for motor control related to joint injuries. Also, the good to high reliability provides a foundation for studying changes in neural function related to neuromuscular training and rehabilitation, providing neurophysiologic therapeutic targets in addition to the current standard of muscle or functional targets.…”

Real‐time biofeedback integrated into neuromuscular training reduces high‐risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation

“…Not only do these data reveal how the brain may be adapting in response to aNMT, but they may help guide researchers who have called for a paradigm shift toward “brain‐training” in musculoskeletal rehabilitation (Armijo‐Olivo, ). In addition to ACL injury prevention, aNMT may be useful for other painful musculoskeletal disorders (e.g., patellofemoral pain) that exhibit alterations in brain structure and function (Silfies et al, ). Simple biofeedback modifications (e.g., adjusting the relative gain of visual and sensory information) could potentially leverage neuroplastic mechanisms for enhanced injury prevention and rehabilitation efforts.…”

“…Motor progression success is often assessed through biomechanical assessment (Hopper, Haff, Joyce, Lloyd, & Haff, ; Myer et al, ), and while current NMT practices are often beneficial in reducing risk of ACL injury (Petushek, Sugimoto, Stoolmiller, Smith, & Myer, ), our data support that neural progression should also be considered as part of current standards of care (Gokeler, Neuhaus, Benjaminse, Grooms, & Baumeister, ). Clinicians could potentially leverage motor learning principles (Gokeler et al, ; Lewthwaite & Wulf, ; Wulf & Lewthwaite, ) to engage the appropriate neural networks distinct to various musculoskeletal ailments (Diekfuss, Grooms, Nissen, et al, in press; Diekfuss, Grooms, Yuan, et al, ; Grooms et al, ; Silfies, Vendemia, Beattie, Stewart, & Jordon, ).…”

Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

“…Compounding the injured limbs relative strength deficits, the uninjured limb typically also suffers decrements in strength and power post-surgery, potentially leading to altered biomechanics and masking of limb to limb deficits [49,117,119]. Emerging neuromechanical evidence shows that post-injury altered biomechanics could, in part, result from unresolved alterations throughout the central nervous system (CNS) that affect both involved and uninvolved limbs following ACL injury and subsequent surgical reconstruction [81,101,145]. For instance, patients following ACLR exhibit differential knee-related brain activation in regions important for attention, vision, and sensorimotor integration compared to their non-injured peers [7,8,63], indicating aspects of normal CNS function may not be fully restored through rehabilitation.…”