After you sustain an injury, your brain starts to rewire and rely primarily on your eyes. The concern with this is less efficiency of movement, re-injury risk, and decreased performance. Training the brain is essential to transfer gains from rehabilitation to the sport you will return to. `
An injury, such as an ACL tear, damages the joint receptor information provided to the brain leading to the brain needing to adapt, which it does by over-relying on vision. Research by Lepley with brain scans shows smaller cells in the area of the brain that controls the knee after injury, leading to decreased efficiency and coordination. Per research by Kakavas, neuroimaging that looked at brain activation after an ACL injury showed increased activation of the visual processing, motor planning, and pain and sensory processing, meaning decreased efficiency and reaction time and possible quadriceps activation. Visual dominance might be fine for everyday tasks, but the brain has enormous demands in a complex environment like a soccer field or ski slope. Studies show when vision is obstructed, patients with an ACL injury do significantly worse with movement than those without an injury. These movement impairments persisted even five years after surgery. Considering weakness also continues years after surgery, even with professional athletes, it is not surprising that re-injury occurs at a higher than desired rate.
In physical therapy, there is a focus on training the brain by decreasing the use of vision and increasing the use of proprioception‒ the ability to sense joint position without looking at the body. In treatment, vision can be obstructed or confused during exercise. Initially, the eyes can be closed during an activity. Afterward, it progresses to confusing visual input, such as using strobe glasses that flash at a constant or varying rate, training the joint and balance systems by decreasing the reliance on vision, and increasing brain processing speed for motor planning.
Courtesy of Senaptec
Courtesy of Senaptec
Another form of training the brain involves dual tasks during which an exercise is completed concurrent with another task, such as counting, saying the alphabet backward, or calling out flashcard colors held in front of the patient during training and functional activities. Virtual reality goggles worn during an exercise create a sensation of movement, requiring the brain to process information while maintaining balance. Virtual reality exercise can also replicate sports-specific movements. Devices that light up and make an audio sound like A-Champs ROX or Fit Lights also tax the brain to process what is seen or heard and create a movement in response and can record reaction time.
Courtesy of A-Champs
Post-concussion is another injury that benefits from training the brain. A systematic review led by Jildeh in 2022 showed lower extremity injury risk increases after a concussion for up to one year. Injury is likely due to the slower processing of the brain and decreased motor control, mechanics, and balance. Increasing processing efficiency and reaction time through dual-task training is crucial to reduce additional injury to the knee or ankle.
Restoring strength is crucial for joint health. Also essential is training the brain to handle the input from your joint, eyes, and balance systems to ensure the body moves properly and efficiently, decreases injury risk, and increases your performance.
If you are still determining whether you are ready to return to your sport after injury, contact Rose City Physical Therapy at 503.966.8563.