Duke recently hosted Dustin Grooms, PhD, ATC, a professor from Ohio University, for an insightful presentation on the role of neuroplasticity in rehabilitation following ACL injury.
Dr. Grooms' research on using neuroscience to rehabilitate individuals with ACL damage captivated the audience, and he shared his journey into the field. “As I reflect on where I am now, I never intended to become a scientist, but I am fascinated by this work,” he said, highlighting how his career trajectory led him to explore the intersection of neuroscience and rehabilitation.
He emphasized the importance of the fundamentals of physical therapy (PT) while introducing the concept of neuroplasticity as an advanced layer that can significantly enhance rehabilitation outcomes. "The PT fundamentals you're learning and mastering now will be your primary treatment tools. Neuroplasticity is an augmented approach—it's a layer on top of what you’re fundamentally doing to treat an ACL injury,” he explained.
Reassessing the Standard of Care
One of the key points Dr. Grooms addressed was the disappointing failure rate of current ACL repair strategies despite patients receiving top rehabilitative care. He noted that approximately one-third of patients who return to sport will either experience a re-tear of the repaired ACL or will tear their intact ACL regardless of current surgical and rehabilitation advancements.
Dr. Grooms urged the audience to rethink current practices, considering these statistics. “We need to ask ourselves, ‘What are we missing?’”
The Carson Palmer Example
Dr. Grooms shared a compelling case study of former Cincinnati Bengals quarterback Carson Palmer, who tore his ACL in 2008. After undergoing surgery and completing rehabilitation, Palmer returned to the field in 2009. However, he suffered a second ACL tear during a non-contact play, an injury that raised questions about what went wrong.
Combining neuroscience with biomechanics research has revealed a key issue, Dr. Grooms explained: errors in the nervous system's communication with the muscles supporting the injured knee. “What we see is that the nervous system isn't working as efficiently as it should be,” he explained. "We need to work with patients to help them develop neural efficiency—challenging them enough to make movement errors that won't further damage the injured area." This idea of optimizing neural pathways was central to his talk and illustrated how the nervous system plays a pivotal role in recovery.
The Role of Attention and Cognition in Rehabilitation
Dr. Grooms also discussed the importance of cognitive factors, such as attention, in rehabilitation. He emphasized that patients' ability to focus on specific tasks or movements can influence their recovery. “Attention and cognition play a significant role in the impact tests,” he noted. "This is where you can prescribe exercises in a way that helps the patient stay mindful of the joint, ensuring they focus on correct movement patterns.” Interestingly, too much explicit attention can be detrimental to recovery of motor control thus requiring emphasis on the external environment and implicit learning strategies.
In addition to traditional rehabilitation strategies, Dr. Grooms and his research team have successfully used virtual reality (VR) methods to engage patients in rehabilitation. “We hope to have this VR strategy accessible to PTs so they can connect their patients to it in a clinical setting,” he said. As a rehabilitation tool, VR offers an immersive experience that can effectively challenge and retrain the nervous system.
Dr. Grooms also suggested low-tech alternatives to VR, including exercises that occupy a patient’s attention while they master certain skills or perform dual-task activities. These strategies aim to engage the brain, preventing its ability to compensate for the impaired proprioceptive sensation provided by the damaged ACL. This approach helps to ensure implicit learning of proper body movement during rehabilitation.
Looking Ahead
The seminar explored how integrating neuroplasticity into orthopaedic rehabilitation can transform ACL recovery and prevent future injuries. Dr. Grooms’ research underscores the critical importance of the nervous system and the mind in physical recovery, suggesting that neuroplasticity could be a game-changer in sports medicine and rehabilitation.
By leveraging cutting-edge technologies like virtual reality and low-tech alternatives, Dr. Grooms advocates for a more holistic approach to orthopaedic rehabilitation. He focuses on the knee's physical healing and strengthens the neural pathways that control movement. His innovative ideas offer exciting possibilities for optimizing patient outcomes and enhancing the return-to-sport process for athletes recovering from ACL injuries.
Learn more about the Duke Interdisciplinary Rehabilitation Research Group’s Seminar Series.