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*NEW* EDITORIAL:
Explicit motor learning interventions are still relevant for ACL injury rehabilitation: do not put all your eggs in the implicit basket!
@BJSM_BMJ
http://dx.doi.org/10.1136/bjsports-2020-103643
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Explicit motor learning interventions are still relevant for ACL injury rehabilitation: do not put all your eggs in the implicit basket!
@BJSM_BMJ
http://dx.doi.org/10.1136/bjsports-2020-103643
Thread*
PLEASE RT
1/
Neuromuscular rehab programs after ACL injury are only moderately effective, and risk of re-injury remains high. https://doi.org/10.1177%2F0363546515621554
Neuromuscular rehab programs after ACL injury are only moderately effective, and risk of re-injury remains high. https://doi.org/10.1177%2F0363546515621554
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Recently there has been a big push to radically change how motor learning is applied in ACL rehab.
https://doi.org/10.1007/s40279-019-01058-0 https://doi.org/10.1186/s40634-018-0137-5
Recently there has been a big push to radically change how motor learning is applied in ACL rehab.
https://doi.org/10.1007/s40279-019-01058-0 https://doi.org/10.1186/s40634-018-0137-5
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Main idea is athletes should not explicitly think about *how* to move while practicing motor skills.
Instead, it is emphasised to use *implicit* learning interventions that minimise attention to movement - for instance using external focus
(eg https://doi.org/10.1007/s40279-019-01058-0)
Main idea is athletes should not explicitly think about *how* to move while practicing motor skills.
Instead, it is emphasised to use *implicit* learning interventions that minimise attention to movement - for instance using external focus
(eg https://doi.org/10.1007/s40279-019-01058-0)
4/
Why would this be beneficial?
Theoretically: implicit learning -> more automaticity -> more robust motor performance, espec. in conditions in which ACL injuries often occur (attention demanding, rapidly changing environments)
(also see our review: https://doi.org/10.1371/journal.pone.0203591)
Why would this be beneficial?
Theoretically: implicit learning -> more automaticity -> more robust motor performance, espec. in conditions in which ACL injuries often occur (attention demanding, rapidly changing environments)
(also see our review: https://doi.org/10.1371/journal.pone.0203591)
5/
Sounds great – but what’s the evidence? Well not much:
- No studies investigated effects of implicit learning on ACL re-injury rates
- It may improve proxy outcomes (knee biomechanics)
- But: mostly small studies & not always clear if implicit learning actually took place
Sounds great – but what’s the evidence? Well not much:
- No studies investigated effects of implicit learning on ACL re-injury rates
- It may improve proxy outcomes (knee biomechanics)
- But: mostly small studies & not always clear if implicit learning actually took place
6/
We also highlight 2 key reasons why *explicit* learning could benefit ACL rehab:
1) Individual constraints (e.g. proprioceptive deficits) may warrant a (relatively more) explicit approach to motor learning
We also highlight 2 key reasons why *explicit* learning could benefit ACL rehab:
1) Individual constraints (e.g. proprioceptive deficits) may warrant a (relatively more) explicit approach to motor learning
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2) Context matters!: Explicit learning could be particularly effective to improve habitual, problematic movements https://doi.org/10.1007/s13164-020-00505-6
2) Context matters!: Explicit learning could be particularly effective to improve habitual, problematic movements https://doi.org/10.1007/s13164-020-00505-6
8/
So, overall, our key message therefore is:
There is no strong evidence to support the claim that implicit learning should always be the preferred motor learning intervention in ACL rehab.
So, overall, our key message therefore is:
There is no strong evidence to support the claim that implicit learning should always be the preferred motor learning intervention in ACL rehab.
9/
Key clinical recommendation: A blend of implicit and explicit strategies tailored to the athlete in front of you is most likely best.
To help guide decision-making, we summarised key factors & prelim guidance in the attached table.
Key clinical recommendation: A blend of implicit and explicit strategies tailored to the athlete in front of you is most likely best.
To help guide decision-making, we summarised key factors & prelim guidance in the attached table.
