Anterior Cruciate Ligament (ACL) Rehab | How To “Train The Brain” (Exercises & Mistakes To Avoid)
Summary
TLDRThis video explains how an ACL injury not only affects the knee but also induces neuroplastic changes in the brain. These changes disrupt proprioception and increase reliance on the visual system, impacting movement and performance. The video emphasizes incorporating visual-motor training and dual-task exercises in ACL rehab to address these brain changes. Practical examples of exercises and strategies are provided to help athletes and individuals regain functional and automatic movement, ultimately enhancing their recovery and reducing the risk of re-injury.
Takeaways
- 🧠 An ACL injury induces neuroplastic changes in the brain, affecting its ability to adapt and change due to the injury.
- 🧐 Disruption in proprioceptive feedback from the knee leads to an increased reliance on the visual system for movement planning and execution.
- 🏃♂️ The brain compensates for impaired proprioception by using more of its processing power for muscle contractions and movement generation.
- 🤕 Arthrogenic muscle inhibition occurs post-injury, requiring more brain signals to contract muscles like the quadriceps, affecting movement initiation.
- 👀 The brain's shift towards visual reliance can decrease its ability to scan the environment and make quick, automatic adjustments during sports.
- 🏋️♀️ Compensatory movement strategies and certain rehab exercises can reinforce the brain's over-reliance on vision, affecting performance.
- 🎯 Visual motor training is crucial in ACL rehab, involving dual tasking to improve the brain's ability to scan and respond to the environment.
- 👓 Using tools like stroboscopic glasses or virtual reality can help in training the brain by obstructing vision or introducing environmental interactions.
- 🤹♂️ Incorporating brain training in rehab should be done holistically, starting from the acute stage through to the return to sport.
- 🚫 Common mistakes include neglecting these strategies or implementing them too late in the rehab process, potentially hindering true physical adaptations.
- 🌟 The video emphasizes the importance of understanding and addressing the neuroplastic changes in ACL rehab for improved function and reduced risk of re-injury.
Q & A
What is an ACL injury and why is it significant?
-An ACL injury refers to a tear in the anterior cruciate ligament, which is one of the key ligaments in the knee that provides stability. It's significant because it not only affects the knee's function but also leads to changes in the brain, impacting proprioception and motor control.
What is neuroplasticity in the context of an ACL injury?
-Neuroplasticity in the context of an ACL injury refers to the brain's ability to adapt and change as a result of the injury. The brain compensates for the disrupted proprioceptive signals from the knee by relying more heavily on the visual system for information about joint positioning.
How does an ACL injury affect the brain's reliance on the visual system?
-An ACL injury disrupts the proprioceptive signals that inform the brain about the knee's position. As a result, the brain starts to rely more on the visual system to determine the knee's positioning, leading to a shift in the way movements are planned and executed.
What is arthrogenic muscle inhibition and how does it relate to ACL injuries?
-Arthrogenic muscle inhibition is a phenomenon where the brain requires more signals than normal to contract the quadriceps muscles after an ACL injury. This makes it harder to initiate movement, and the brain compensates by using areas usually reserved for environmental response and movement planning to generate muscle contractions.
How does the brain's compensation for an ACL injury impact athletic performance?
-The brain's compensation for an ACL injury, such as increased reliance on vision and using more processing power for muscle contractions, can lead to decreased ability to make automatic adjustments and rapid movements. This can negatively affect an athlete's performance and increase the risk of further injury.
What is the importance of training the brain during ACL rehabilitation?
-Training the brain during ACL rehabilitation is crucial because it helps address the neuroplastic changes that occur due to the injury. It ensures that the brain can effectively process sensory input and plan movements without over-reliance on the visual system, which is necessary for automatic and responsive athletic performance.
What is visual motor training and how does it help in ACL rehab?
-Visual motor training involves training the system that helps scan the environment and produce movement in response. It can be achieved through dual tasking, which involves performing two tasks at once, and is essential in ACL rehab to improve the brain's ability to process information from the environment and make quick movement decisions.
Can you provide an example of how to incorporate visual motor training in early ACL rehab exercises like quad sets?
-In early ACL rehab, exercises like quad sets can be performed with visual motor training by closing the eyes or looking away from the leg to decrease reliance on vision. Alternatively, exercises can be performed when a specific color flashes on a screen, requiring the brain to respond without visual input of the leg.
What are some common mistakes made when implementing brain training strategies in ACL rehab?
-Common mistakes include being overwhelmed and not implementing the strategies at all, forgetting the basics and doing exercises that look fancy but don't create true adaptations for the physical qualities needed after an ACL injury, and simply adding an extra training session at the end without integrating it into the overall rehab program.
How can the principles of brain training be integrated into a holistic ACL rehab program?
-The principles of brain training can be integrated into a holistic ACL rehab program by incorporating dual tasking and visual motor training into exercises at various stages of rehab. This can be done by varying exercises, using visual obstructions, or environmental interactions, and ensuring that these interventions are not overly complex or separate from the main rehab goals.
What are some examples of exercises that can be used to train the brain in the late stage of ACL rehab?
-In the late stage of ACL rehab, exercises like jumping variations, change of direction tasks, and plyometric activities can be used to train the brain. These can be made more complex by adding dual tasking elements such as jumping in response to a moving target or performing reactive movements in response to a visual stimulus.
Outlines
🧠 Neuroplastic Changes After ACL Injury
An ACL injury not only affects the knee but also induces changes in the brain. This video explains the neuroplastic changes post-ACL injury, their impact on function and sport performance, and how to incorporate brain training into ACL rehab. Neuroplasticity allows the brain to adapt to new experiences or injuries. Post-ACL injury, proprioception (joint position sense) messages to the brain become disrupted, leading to a reliance on the visual system. This shift affects the brain's ability to scan the environment and requires more effort to contract muscles, leading to increased brain power usage for simple movements and less automatic movement response.
🛠️ Addressing Neuroplastic Changes in ACL Rehab
Grooms and colleagues recommend addressing neuroplastic changes by incorporating visual motor training in ACL rehab. Visual motor training helps the brain scan the environment and produce movement responses through dual tasking, such as visual obstructions and environmental interactions. Techniques include using stroboscopic glasses, performing movements with eyes closed, or using augmented/virtual reality. Environmental interactions involve performing movements while observing the surroundings. The video outlines how to integrate these practices into a comprehensive ACL rehab program from the acute stage to the return to sport.
🏋️ Early and Mid-Stage ACL Rehab
In the early stage of ACL rehab, the focus is on reducing swelling, increasing range of motion, and preventing muscle loss. Exercises like quad sets, heel slides, and straight leg raises should be performed without over-reliance on visual input. Visual motor training can involve responding to specific cues on a screen. In the mid-stage, goals include muscle hypertrophy, movement quality, and maintaining a quiet knee. Techniques to reduce visual reliance include closing eyes during exercises, using external visual cues, and performing dual tasking activities. Creativity in these methods can help enhance brain and muscle coordination.
🏃 Late-Stage ACL Rehab and Cognitive Training
The late stage of ACL rehab emphasizes strength and power development, including plyometric and change of direction activities. Dual tasking can involve jumping in response to visual stimuli or engaging in reactive movements. Virtual reality and partner-based games can enhance these activities. Common mistakes include neglecting cognitive training or waiting until late-stage rehab. The video stresses the importance of incorporating brain training throughout the rehab process to address neuroplastic changes and improve overall performance and injury prevention.
Mindmap
Keywords
💡ACL Injury
💡Neuroplasticity
💡Proprioception
💡Visual Motor System
💡Arthrogenic Muscle Inhibition
💡Quadriceps Muscles
💡Compensatory Movement Strategies
💡Dual Tasking
💡Visual Obstructions
💡Environmental Interactions
💡Holistic Rehabilitation Program
Highlights
An ACL injury affects not just the knee but also induces neuroplastic changes in the brain.
Neuroplasticity allows the brain to adapt and change in response to new experiences or injuries.
Disruption in proprioceptive signals post-ACL injury leads to increased reliance on the visual system.
Arthrogenic muscle inhibition post-ACL injury requires more brain signals for muscle contraction.
Brain compensates for impaired proprioception by using visual input and motor planning areas for muscle control.
Compensatory movement strategies and rehab exercises can perpetuate reliance on vision after ACL injury.
Training the brain during ACL rehab is crucial for automatic movements required in sports.
Visual motor training through dual tasking can help address neuroplastic changes post-ACL injury.
Dual tasking can be achieved with visual obstructions or environmental interactions.
Stroboscopic glasses, blindfolded conditions, or virtual reality can be used for visual obstructions in training.
Incorporate environmental interactions by performing movements while looking around.
Neuroplastic changes should be addressed from the acute stage to return to sport in a holistic rehab program.
Early ACL rehab exercises like quad sets should be performed with minimal visual reliance.
Mid-stage rehab focuses on muscle hypertrophy, movement quality, and maintaining a quiet knee.
Late-stage rehab emphasizes strength, power, plyometric activities, and change of direction tasks.
Common mistakes in rehab include being overwhelmed and neglecting the basics for fancy exercises.
Brain training interventions can be integrated into a holistic ACL rehab program without being overly complex.
Transcripts
did you know that an ACL injury not only
affects your knee but also creates
changes in your brain in this video I'm
going to tell you what actually changes
in your brain after an ACL injury
explain how those changes might impact
your function or sport performance and
show you how to incorporate training the
brain into your ACL rehab program let me
start by explaining the neuroplastic
changes that occur after an ACL injury
neuroplasticity is your brain's ability
to to adapt and change this happens as a
result of new experiences learning new
things or in this case injury if you're
sitting down right now chances are you
don't have to look at your knee to know
that it's bent that's because there are
receptors in the joint that send
information to your brain about how your
joint is positioned this sensation of
joint position is called
proprioception if you decide to stand up
and walk away your brain will take it
information about the environment around
you like if there are any obstacles in
your way and then create a plan to
produce the necessary
movements using visual input to plan and
produce movements is done by the visual
motor system and this all happens
automatically without you having to
think about it when the anterior
cruciate ligament or ACL is injured the
messages about proprioception become
disrupted as a result the brain starts
to rely more heavily on the visual
system to tell it information about the
knee's positioning since the brain is
compensating for this impaired
proprioception by increasing its
Reliance on Vision it loses some of its
ability to scan the environment and look
for obstacles in the way in addition to
this there's something called
arthrogenic muscle inhibition that
occurs after an ACL injury this just
means that it requires more signals than
normal from from your brain to your
quadriceps muscles for them to contract
and initiate movement in other words
it's harder to make your quads work your
brain compensates for this by using the
areas that usually respond to the
environment and plan movement to help
generate a quad contraction instead you
end up spending more brain power to
perform simple movements which takes
away from the brain's ability to make
last minute adjustments and move
automatically all of this essentially
means that there's less information
coming from your knee to your brain your
brain adapts by trying to get that
information elsewhere mostly from your
visual system the brain also starts
using more of its processing power to
generate muscle contractions around the
knee and produce movement it does this
by hijacking some of the areas of the
brain that are usually reserved for
planning and coordinating
movements not only not only do these
neuroplastic changes occur as a result
of the injury but they're further
perpetuated by the compensatory movement
strategies after an ecl injury as well
as certain aspects of the rehabilitation
program itself for example an exercise
you might do very early after an ACL
reconstruction is quad sets it might be
tempting to stare at your knee and thigh
while performing this exercise to make
sure you're Contracting your
quads however since your knee is now
sending disrupted messages to your brain
about its positioning the brain is
already relying too much on vision for
this information staring at your knee
and thigh during this exercise just
perpetuates that Reliance it's okay to
look at your leg initially when you
first begin this exercise but you should
eventually try to do it without looking
another example is doing exercises like
squats or lunges in front of a mirror it
might be helpful at first but eventually
you have to take that mirror away so you
don't become reliant on that visual
input it's important to address these
neuroplastic changes and train the brain
during ACL rehab because functional and
sporting tasks require automatic
movements in response to the environment
you can't be dependent on watching your
knee while you're trying to run jump or
player sport an athlete like a soccer
player needs to be able to scan the
environment take in information about
where they are in relation to the goal
their opponents their teammates and the
ball listen to their coach and teammates
and make quick movement decisions in
response to all of these things after an
e injury the parts of the brain normally
dedicated to processing visual feedback
from the environment are now being used
for feedback about knee joint
positioning and the areas of the brain
that are meant to make rapid motor
Corrections like cutting away from a
Defender at the last second now have
decreased activity this could have an
array of negative consequences including
poor performance and increased risk of
yet another injury so how do you
actually train the brain in ACL rehab
Grooms one of the leading researchers in
this field and his colleagues in 2015
state that an ACL rehab program should
aim to address the neuroplastic changes
that occur with an ACL injury by
implementing visual motor training
visual motor training refers to training
the system that helps you scan the
environment and produce movement in
response it can be done through dual
tasking which is essentially performing
two tasks at once the most important
ways to perform dual tasking are with
either visual obstructions or
environmental
interactions visual obstructions can be
created with the use of stroboscopic
glasses which have lenses that flicker
between clear and opaque to obstruct
Vision eyes closed or blindfolded
conditions or through the use of
augmented or virtual reality you can
include environmental interactions by
performing a movement while having to
look around you it sounds like a lot but
I'm going to show you how these
neuroplastic changes can be addressed
embedded within a holistic
rehabilitation program from the acute
stage all the way through to return to
sport keep in mind that these are merely
suggestions and this is not an
exhaustive list of all the many ways you
can train the brain in ACL rehab the top
priorities right after ACL
reconstruction are decreasing effusion
or swelling and increasing range of
motion while trying to decrease the rate
of atrophy or muscle loss some of the
most commonly performed exercises are
quad sets heel slides and straight leg
raises as I mentioned earlier it's
tempting to want to look at your knee as
you perform these exercises in order to
decrease Reliance on Vision close your
eyes or at least look away from your leg
you can include visual motor training
through an environmental interaction by
looking at a screen that flashes colors
and Performing the exercises when a
specific color comes up you can test
your brain even more by varying your
exercises for instance every time the
color green flashes on a screen you have
to do a straight leg raise every time
red flashes you have to do a heel slide
and every time yellow flashes you have
to do a quad set you can get as creative
as you want here the number one priority
is relying on your vision as little as
possible for these basic exercises
without sacrificing improvements in your
range of motion or quad activation in
the midstage of rehab the primary goals
are muscle hypertrophy movement quality
and keeping a quiet knee which means
minimizing swelling and maintaining
range of motion here are some common
exercises performed in this phase of
rehab and neurocognitive considerations
for each one knee extensions don't look
at your knee while performing instead
close your eyes look at an external
visual cue like a specific color or word
being shown on flash cards or a screen
to trigger the movement or wear virtual
reality goggles and perform the movement
in response to a cue there like kicking
a ball two squats movement quality is an
important aspect of this stage of rehab
it can initially be helpful to watch
yourself in a mirror when performing
exercises like squats to ensure the
movement is done with control however if
you want to decrease Reliance on the
visual system you should eventually try
to take the mirror away if you still
need help with the quality of your
movement there are other things you can
try for example you can attach a laser
pointer to your knee and try to keep it
pointed straight ahead if you don't have
laser pointers you can still use this
cue by imagining laser pointers coming
out from your kneecaps you can also try
to watch a video of someone else doing
the movement and mimic it instead of
watching yourself in a mirror three step
UPS or step Downs you can introduce dual
tasking with an environmental
interaction here here by stepping up or
down to catch an object being tossed to
you four standing balance it can be fun
to get creative during standing balance
challenges aside from the typical shoes
on shoes off and standing on unstable
surface conditions typically done in
rehab you can perform dual tasking by
juggling or solving cognitive challenges
like completing math problems on a
screen if you have the equipment you can
use use Virtual Reality goggles to watch
an immersive sport video like skiing or
surfing or even riding a roller coaster
while trying to maintain standing
balance a side note on balance exercises
try not to combine balance exercises
with exercises being used for strength
or hypertrophy being on more stable
footing is better for higher Force
production which is needed when trying
to gain muscle mass and strength also
also since regaining muscle mass is one
of the primary goals here you don't have
to incorporate all of these elements
into every set exercise or training
session for example you might
incorporate these principles into one or
two exercises per training session
rather than overhauling your entire
program at the expense of the other
specific adaptations important to ACL
rehab sometimes your focus just needs to
be on executing a movement to failure or
close to it in the late stage of rehab
the focus is pure strength and power you
can also begin to introduce plyometric
and change of Direction activities in
this phase this phase is really fun
because you can get creative in the
exercise prescription and there is a
seemingly Limitless way to incorporate
training the brain here are a few
examples one jumping variations you can
add dual tasking by jumping in respon
response to a moving Target like jumping
up to catch a ball or by having to react
to a visual stimulus like a flashing
light in order to perform the
jump while I wouldn't necessarily
recommend performing many jumping
variations blindfolded for safety
reasons your physical therapist might
have other tools such as stroboscopic
glasses to provide visual obstructions
while
jumping two change of Direction tasks
when performing change of Direction
tasks asks you typically begin with
pre-planned submaximum movements
progress into pre-planned maximum
movements then reactive submaximum
movements and finally into reactive
maximal effort movements a partner Chase
game or game of tag is a great way to
add a reactive component with dual
tasking because you have to watch and
respond to your partner while moving if
you have the equipment there is some
great virtual reality games that
incorporate reactive movements and
submaximal change of Direction tasks a
few of my favorites are resle player
Power Beats VR hollow point and eye of
the
temple common mistakes made when it
comes to implementing these strategies
are being overwhelmed and then not doing
them at all as a result forgetting the
basics and doing exercises that look
fancy at the detriment of creating true
adaptations for the phys IAL qualities
needed after ACL injury simply tacking
on an extra 15 minutes at the end of the
session to do it and waiting until late
stage rehab to start training the brain
I know I covered a lot here today the
main things I hope you take away from
this video are one that an ACL injury
affects more than just the tissues in
the knee it creates neuroplastic changes
that are A disruption to the sensory
input coming from the knee to the brain
which leads to an increased Reliance on
the visual system there is also
disrupted output from the brain to the
injured limb which leads to more of the
processing and motor planning areas of
the brain being needed to produce and
control movement which creates even more
of a need for visual input to help with
the processing and planning of movement
two there are specific ways that you can
train the brain during ACL rehab to
address these neuroplastic changes the
most important way to train the brain is
through dual tasking to address the
changes in the visual motor system after
an e injury three and finally these
interventions to train the brain do not
have to be overly fancy or their own
separate rehab sessions they can be
weaved into a holistic ACL rehab program
if you want to get a more in-depth look
at the science behind this topic IC go
check out the blog at E3 rehab.com if
you need help with your ACL rehab
consider our one-on-one coaching thanks
for watching
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