Anterior cruciate ligament (ACL) injury has been shown to cause changes in the brain that may not be sufficiently targeted with current rehabilitation approaches. |
Using principles of motor learning may have the potential to support neuroplastic processes to reduce second ACL injury risk and the incidence of early osteoarthritis. |
1 Introduction
2 Knowledge from Motor Learning
2.1 External Focus of Attention Improves Motor Learning
2.1.1 Neural Correlates of External Focus of Attention
2.1.2 Clinical Examples
Goal: improve postural stability | Internal focus | External focus |
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Instructions | Try to keep your knee aligned over your second toe | Try to keep the bar horizontal |
Try to minimize movements of your feet | Try to minimize movement of the bars on the balance board | |
Try to keep your balance by stabilizing your body | Try to keep your balance by stabilizing the platform |
2.2 Implicit Learning Enhances Movement Execution in Sports
2.2.1 Neural Correlates of Implicit Learning
2.2.2 Clinical Examples
Task | Explicit instructions | Implicit instructions |
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Squat | Stand with your feet shoulder-width apart | Stance: Think about keeping a big ball between your knees |
Lower down so your thighs are as parallel to the floor as possible, with your knees over your ankles | Imagine you’re picking up a heavy box from the floor | |
Imagine you’re going to sit down on a chair | ||
Running | Bend your knees while landing | Imagine you run like a feather |
Land softly | ||
Try to make as little noise as possible | ||
Vertical jump | Bend your knees before you jump Explosively extend hips, knees, and ankles, and propel off balls of feet to jump straight up Landing: bend knees during landing Keep your knees over your toes | Imagine you’re landing on eggs and you don’t want to crack them Push yourself off the floor as hard as possible Pretend you are a rocket that launches |
Countermovement jump | Stand with your feet shoulder width apart Bend your knees before you jump Explosively extend hips, knees, and ankles, and pull your thighs towards your trunk Land with your knees bent | Imagine you’re jumping on hot coals and don’t want to burn your feet Push yourself off the floor as hard as possible Pretend you are a rocket that launches |
2.3 Differential Learning Supports Self-Organized Learning Process
2.3.1 Neural Correlates of Differential Learning
Variations of the double-legged jump task | Change of environment | Change of athlete |
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Jump as far as you can. While you are jumping: Before jumping, 2–3 bunny hops, skipping both legs, skipping left leg, skipping right leg, high knees, left high knee, right high knee, butt-kicks both legs, butt-kicks left leg, butt-kicks right leg, zig-zag, shuffle to left, shuffle to right Make a full turn to left, to right before you jump While jumping, keep arms across the chest, behind back, raise left arm, raise right arm, circle both arms, circle left arm, circle right arm Move your head to left, to right Close left eye, close right eye While landing, one arm in front of and the other arm behind you Land with a very wide stance or with a very narrow stance Land on toes while landing | Exercises in dark Exercises on sand With shoes or without shoes In an environment with loud music or noise from audience in stadium In a virtual reality environment | Perform exercises with fatigue Perform exercises without fatigue Perform exercises with weighted vest |