Rewire the brain, protect the knee?

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The human brain has the remarkable ability to rewire itself. It is known as neuroplasticity: the synapses in the brain get stronger when they are faced with new behaviors or environmental factors.

Now, researchers are studying whether retraining the brain will help athletes and military servicemen and women protect damaged joints.

Twenty-one-year old Amir Miller was a freshman at Ohio University the first time he got injured playing football. The defensive end cut to make a tackle and felt his knee pop.

"I knew in my heart I tore it. I didn't want to believe it. But I kind of knew that I tore it," Miller recalled.

After surgery to repair his torn ACL and months of physical therapy, Miller returned to the team, only to retear the joint this fall.

But is there a way to improve rehab and cut the risk of reinjury?

"What happens after this injury is your brain starts to use vision for motion, because it's very accurate and very sensitive, and it's able to help guide your movement," Ohio University assistant professor of athletic training Dr. Dustin Grooms said.

During rehab, athletes use special strobe glasses to suppress vision, forcing them to rely on proprioception, the brain's ability to sense the knees without seeing them.

"And get that cognitive load or that thinking load during therapy," Grooms said. "That way, when their joints are ready to go back, their brains are as well."

Grooms' lab has also developed training scenarios for military servicemen and women with ACL tears.

"We do everything right in therapy, but when they go back to high-stress tactical situations, their ability to control their knee is not as good as they would want it to be," Grooms said.

What it amounts to is immersing soldiers and athletes in virtual reality to prepare their brains for normal movement after the body heals.

The U.S. Department of Defense has awarded Grooms' lab a $750,000 grant to continue to study virtual reality ACL rehabilitation.

Beginning in September, researchers will test 30 military patients who have had ACL reconstruction and follow their progress over three years, using virtual reality and other methods of physical therapy.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: REWIRE THE BRAIN, PROTECT THE KNEE?
REPORT: MB #4573

BACKGROUND: An ACL injury is a tear or sprain of one of the major ligaments of your knee called the anterior cruciate ligament (ACL). ACL injuries commonly occur in sports where sudden stops or changes in direction, jumping and landing are made, such as movements made in soccer or basketball. There is a variety of symptoms depending of the severity of the ACL injury and it is important that you see a doctor if any injury to your knee shows signs of being an ACL injury. Some of the most common causes are playing sports or performing fitness activities that put stress on your knee. Some of the risk factors include being female, wearing footwear that doesn't fit properly, and using poorly maintained sports equipment so it is important to take precautions before an injury happens (Source: https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738)

TREATMENT: Once you have a medical exam and have been diagnosed, you can begin to take steps to recovery. The treatment for ACL tears follows the R.I.C.E. model of self-care at home, this means: rest, ice, compression, and elevation. While this treatment will allow you to decrease swelling and pain, it does not stop here. Medical treatment for an ACL injury also involves rehabilitative therapy which could take several weeks. You may also need to wear a brace to stabilize your knee and even use crutches for a while to avoid putting too much weight on your knee. In severe cases surgery is recommended. In this procedure, a surgeon will remove the damaged ligament and replace it with a segment of a tendon from another part of your knee or from a deceased donor. After surgery you'll need to continue with rehabilitative therapy. Although there is no estimated time for athletes to return to play, it usually takes up to a year before they can do so safely. (Source: https://www.mayoclinic.org/diseases-conditions/acl-injury/diagnosis-treatment/drc-20350744)

CLINICAL TRIALS: Mayo Clinic is conducting a clinical study testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. The overall goal of the Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Athletes is to reduce risk of second anterior cruciate ligament (ACL) injury in active athletes between 14 to 24 years old. As about a third of athletes, who have a primary ACL injury and return to sport, experience a secondary injury; which could potentially end athletic careers and affect the quality of life for affected athletes. Before the appointment, patients must be prepared to answer questions about their injury. (Source: https://www.mayo.edu/research/clinical-trials/cls-20317444)