Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk.

Jason M Avedesian, Harjiv Singh, Jed A Diekfuss, Gregory D Myer, Dustin R Grooms

Journal: Sports medicine (Auckland, N.Z.) 2021;51(11):2299-2309

PMID: 34339041

Abstract

Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.

Address: Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA. [email protected].; Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA. [email protected].; Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.; Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA.; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.; Emory Sports Medicine Center, Atlanta, GA, USA.; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.; Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.

DOI: 10.1007/s40279-021-01527-5