Neuroscience Principles for ACL Rehabilitation and Reinjury Risk Reduction

Abstract

The study of combined biomechanical and neurological approaches to anterior cruciate ligament (ACL) injury rehabilitation is a relevantly new area of research and clinical implementation. The classical view of orthopedic-focused ACL rehabilitation has been to treat the local knee joint and proximal hip and core structures to create improved stability and mobility for enhanced joint control. This approach has led to a predominately biomechanical centric focus on ACL rehabilitation that has yielded immense strides in understanding the mechanics associated with injury, yet ACL reinjury rates still remain high. The inability of current biomechanically focused interventions to fully optimize movement is readily apparent when athletes engage in cognitively challenging and sensory rich sport environments, because the rate of motor coordination errors increases under these complex field-based conditions. In this chapter, an overview is provided for the foundation of neuroscience integration into musculoskeletal rehabilitation. The initial overview begins with the association of neuromuscular control/injury and musculoskeletal knee injury. Next, we review the current status of neurocognitive and neurophysiological influences on ACL injury mechanism and its implication for movement control. Novel neurocognitive training approaches utilizing visual-motor function, multi-task paradigms, and sport specific neuroloading will be explored to provide sports medicine clinicians with advanced integrative practical knowledge to formulate new techniques for ACL rehabilitation and injury prevention plans.