ACL rehab and injury prevention programs focus on strengthening, plyometrics, and balance exercises. Studies have shown this approach works, however ACL injuries are unfortunately still common and there is a high incidence of re-injury or injuring the other knee.
So are we missing something in training and rehabbing these athletes? Maybe it’s not just the muscle strength but the connection from the brain to the muscle (i.e, the coordination of the muscle or “muscle memory” – something that us PT’s call “neuromuscular control) We have known this for quite some time, but it’s possible we aren’t coaching our athletes properly during neuromuscular training.
Recently, studies have shown this to be true. Think about when you learned to ride a bike or swim- and how those skills never really go away, even without doing those activities regularly. When re-training athletes to jump/land and plant/cut properly for injury prevention, we need to make sure those changes in technique stay just as permanent.
So how can we do that? Well let’s take a look at the science behind learning a skill. Skills are learned in two ways
- Internal focus of control: the athlete thinks of the position of their body throughout the movement without paying attention to the environment around them (for example- a basketball player focuses on if his foot is pointed inward or outward when driving off his leg for a layup- instead of thinking about where to place the ball for his shot)
- External focus of control: attention is directed to the environment (the basketball player is focusing on where to place the ball versus his leg).
When focusing on an external factor (such as the ball) instead of the athlete’s own movement; the movement actually becomes automatic. When an athlete uses too much of an internal focus, the brain almost “overthinks” the skill and does not keep the information. Think of a game-like situation- athletes don’t have time to focus on their own movements- they have to worry about an opponent, the position of their teammates, or the ball.
Coaching athletes to focus on external factors is likely the missing link in ACL injury prevention- it may cause long-term reductions some risk factors for injury. And, recent studies have even shown these coaching methods to improve sports performance such as vertical jump height– so training the correct way is a “win-win” for athletes to get #BETTER in every way.