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

Context: 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.
Objective: To determine the relationship between brain activation and biomechanical changes after NMT with biofeedback.
Design: Cohort study.
Setting: Research laboratory.
Patients or Other Participants: Twenty female high school soccer athletes, with 10 in an augmented NMT group and 10 in a control (no training) group.
Main Outcome Measure(s): 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.
Results: 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).
Conclusions: 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.
(© by the National Athletic Trainers' Association, Inc.)