Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics

• Published in: Journal of athletic training 2022-09, Vol.57 (9-10), p.911-920
• Main Authors: Grooms, Dustin R, Diekfuss, Jed A, Slutsky-Ganesh, Alexis B, DiCesare, Christopher A, Bonnette, Scott, Riley, Michael A, Kiefer, Adam W, Wohl, Timothy R, Criss, Cody R, Lamplot, Joseph, Thomas, Staci M, Foss, Kim D Barber, Faigenbaum, Avery D, Wong, Phil, Simon, Janet E, Myer, Gregory D
• Format: Article
• Language: English
• Subjects: Anatomy; Anterior Cruciate Ligament Injuries - prevention & control; Athletes; Biofeedback; Biomechanical Phenomena - physiology; Biomechanics; Brain; Children & youth; Cohort Studies; Control Groups; Coordination; Exercise; Female; Females; Force; Humans; Injuries; Intervention; Joint and ligament injuries; Knee; Knee Joint; Laboratories; Mechanics (Physics); Medical imaging; Motion; Motor ability; Movement - physiology; Neurocognitive Factors; Neuroimaging; Neuronal Plasticity; Neuroplasticity; Prevention; Projection Equipment; Quality Assurance; Quality control; Real time; Sports injuries; Usability
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-0548.21

Neuromuscular training (NMT) facilitates the acquisition of new movement patterns that reduce the anterior cruciate ligament injury risk. However, the neural mechanisms underlying these changes are unknown. To determine the relationship between brain activation and biomechanical changes after NMT with biofeedback. Cohort study. Research laboratory. Twenty female high school soccer athletes, with 10 in an augmented NMT group and 10 in a control (no training) group. Ten participants completed 6 weeks of NMT augmented with real-time biofeedback to reduce knee injury-risk movements, and 10 participants pursued no training. Augmented neuromuscular training (aNMT) was implemented with visual biofeedback that responded in real time to injury-risk biomechanical variables. A drop vertical jump with 3-dimensional motion capture was used to assess injury-risk neuromuscular changes before and after the 6-week intervention. Brain-activation changes were measured using functional magnetic resonance imaging during unilateral knee and multijoint motor tasks. After aNMT, sensory (precuneus), visual-spatial (lingual gyrus), and motor-planning (premotor) brain activity increased for knee-specific movement; sensorimotor cortex activity for multijoint movement decreased. The knee-abduction moment during landing also decreased (4.66 ± 5.45 newton meters; P = .02; Hedges g = 0.82) in the aNMT group but did not change in the control group (P > .05). The training-induced increased brain activity with isolated knee movement was associated with decreases in knee-abduction moment (r = 0.67; P = .036) and sensorimotor cortex activity for multijoint movement (r = 0.87; P = .001). No change in brain activity was observed in the control group (P > .05). The relationship between neural changes observed across tasks and reduced knee abduction suggests that aNMT facilitated recruitment of sensory integration centers to support reduced injury-risk mechanics and improve sensorimotor neural efficiency for multijoint control. Further research is warranted to determine if this training-related multimodal neuroplasticity enhances neuromuscular control during more complex sport-specific activities.