Anterior Cruciate Ligament (ACL) Rehab | How To “Train The Brain” (Exercises & Mistakes To Avoid)

Summary

This 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

00:00

🧠 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.

05:01

🛠️ 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.

10:02

🏋️ 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.

Keywords

💡ACL Injury

An ACL injury refers to damage to the anterior cruciate ligament, which is one of the four main ligaments in the knee that connects the femur (thigh bone) to the tibia (shin bone). In the video, it is mentioned that such an injury not only affects the knee but also leads to significant changes in the brain, impacting proprioception and movement planning.

💡Neuroplasticity

Neuroplasticity is the brain's ability to adapt and change as a result of new experiences, learning, or injury. The script explains that after an ACL injury, neuroplastic changes occur in the brain, which affects how it processes sensory input from the knee and plans movements.

💡Proprioception

Proprioception is the sense of the relative position of one's own parts of the body and the strength of effort being employed in movement. The video script discusses how ACL injuries disrupt proprioceptive messages, causing the brain to rely more on the visual system for information about the knee's positioning.

💡Visual Motor System

The visual motor system is responsible for using visual input to plan and produce movements. The script illustrates that after an ACL injury, the brain compensates for impaired proprioception by increasing its reliance on this system.

💡Arthrogenic Muscle Inhibition

Arthrogenic muscle inhibition is a phenomenon where it requires more signals from the brain to contract muscles, such as the quadriceps, after an injury. The video explains that this inhibition makes it harder to initiate movement, and the brain compensates by using areas usually dedicated to environmental response and movement planning.

💡Quadriceps Muscles

The quadriceps muscles are four muscles at the front of the thigh responsible for extending the knee. The script mentions that after an ACL injury, there is increased difficulty in contracting these muscles, which the brain compensates for by altering its usual processes.

💡Compensatory Movement Strategies

Compensatory movement strategies refer to the behaviors adopted by the body to compensate for an injury or weakness. The video script notes that these strategies, along with the rehabilitation program, can further perpetuate the neuroplastic changes that occur after an ACL injury.

💡Dual Tasking

Dual tasking involves performing two tasks simultaneously and is used as a method to train the brain in the context of ACL rehabilitation. The script suggests using dual tasking to improve the visual motor system and reduce reliance on vision for movement planning.

💡Visual Obstructions

Visual obstructions are techniques used to limit or disrupt visual input during training, such as using stroboscopic glasses or blindfolds. The video script recommends these as part of dual tasking to train the brain to rely less on vision after an ACL injury.

💡Environmental Interactions

Environmental interactions involve performing movements while engaging with the surroundings, which can be part of dual tasking. The script provides examples such as performing movements while catching an object or reacting to a visual stimulus.

💡Holistic Rehabilitation Program

A holistic rehabilitation program addresses various aspects of recovery, including physical, cognitive, and sensory components. The video script emphasizes incorporating brain training into a comprehensive ACL rehab program, rather than as a separate entity.

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