Real‐time biofeedback integrated into neuromuscular training reduces high‐risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation.

Prospective evidence indicates that functional biomechanics and brain connectivity may predispose an athlete to an anterior cruciate ligament injury, revealing novel neural linkages for targeted neuromuscular training interventions. The purpose of this study was to determine the efficacy of a real‐time biofeedback system for altering knee biomechanics and brain functional connectivity. Seventeen healthy, young, physically active female athletes completed 6 weeks of augmented neuromuscular training (aNMT) utilizing real‐time, interactive visual biofeedback and 13 served as untrained controls. A drop vertical jump and resting state functional magnetic resonance imaging were separately completed at pre‐ and posttest time points to assess sensorimotor adaptation. The aNMT group had a significant reduction in peak knee abduction moment (pKAM) compared to controls (p =.03, d = 0.71). The aNMT group also exhibited a significant increase in functional connectivity between the right supplementary motor area and the left thalamus (p =.0473 after false discovery rate correction). Greater percent change in pKAM was also related to increased connectivity between the right cerebellum and right thalamus for the aNMT group (p =.0292 after false discovery rate correction, r2 =.62). No significant changes were observed for the controls (ps >.05). Our data provide preliminary evidence of potential neural mechanisms for aNMT‐induced motor adaptations that reduce injury risk. Future research is warranted to understand the role of neuromuscular training alone and how each component of aNMT influences biomechanics and functional connectivity. Emergent evidence indicates that the risk of anterior cruciate ligament (ACL) injury is, in part, due to central nervous system alterations that could be targeted using neural mechanistic sensorimotor‐based treatments. Young female athletes completed 6 weeks of neuromuscular training while interacting with a real‐time, visual biofeedback stimulus. Our training was designed to reduce the risk of by (a) promoting injury‐resistant movement and (b) strengthening brain functional connectivity. Our data not only indicated that athletes' biomechanics and brain connectivity were improved following training, but the observed biomechanical improvements were related to distinct, strengthened connectivity within regions important for sensorimotor control. This study supports the use of real‐time biofeedback systems to reduce the risk of ACL injury by leveraging neuroplasticity. [ABSTRACT FROM AUTHOR]