Click name to view affiliation
Context: A limiting factor for reducing anterior cruciate ligament injury risk is ensuring that the movement adaptions made during the prevention program transfer to sport-specific activity. Virtual reality provides a mechanism to assess transferability, and neuroimaging provides a means to assay the neural processes allowing for such skill transfer. Objective: To determine the neural mechanisms for injury risk–reducing biomechanics transfer to sport after anterior cruciate ligament injury prevention training. Design: Cohort study. Setting: Research laboratory. Participants: Four healthy high school soccer athletes. Interventions: Participants completed augmented neuromuscular training utilizing real-time visual feedback. An unloaded knee extension task and a loaded leg press task were completed with neuroimaging before and after training. A virtual reality soccer-specific landing task was also competed following training to assess transfer of movement mechanics. Main Outcome Measures: Landing mechanics during the virtual reality soccer task and blood oxygen level–dependent signal change during neuroimaging. Results: Increased motor planning, sensory and visual region activity during unloaded knee extension and decreased motor cortex activity during loaded leg press were highly correlated with improvements in landing mechanics (decreased hip adduction and knee rotation). Conclusion: Changes in brain activity may underlie adaptation and transfer of injury risk–reducing movement mechanics to sport activity. Clinicians may be able to target these specific brain processes with adjunctive therapy to facilitate intervention improvements transferring to sport.
Grooms is with Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA; and the Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA. Kiefer, Ellis, Thomas, Kitchen, DiCesare, Bonnette, Gadd, Barber Foss, Galloway, Diekfuss, Berz, and Myer are with The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. Kiefer, Ellis, Yuan, and Myer are with the University of Cincinnati College of Medicine, Cincinnati, OH, USA. Kiefer, Riley, and Silva are with the Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH. Yuan is with Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. Galloway is also with Duke University School of Medicine, Durham, NC. Leach is with the Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. Myer is with the Department of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA; the Micheli Center for Sports Injury Prevention, Waltham, MA, USA; and the Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA.