Today’s quick thought:
“Put all your eggs in one basket, and then watch that basket.” – Andrew Carnegie
Andrew Carnegie went from being a dead broke immigrant to one of the most influential men in American history, and the thought of diversification made him sick.
Carnegie exited the stock market because he would wake up in the morning and the first thing he would do was check the status of his stocks.
He didn’t like that there was any period of time that he wasn’t thinking about his business.
In fact, a lot of the most powerful people of all time fall into a similar bucket.
When Warren Buffett had dinner with Bill Gates and his mom, Gates’ mom asked what the single most important factor in each of their success was. They both answered, “Focus.”
Find what’s important to you.
Cut the distractions.
And hunt it down.
What your ACL rehab is missing…
Title: Combining Neurocognitive and Functional Tests to Improve Return-to-Sport Decisions Following ACL Reconstruction Authors: Dustin R. Grooms, et. al. https://www.jospt.org/doi/10.2519/jospt.2023.11489
What is it?
A viewpoint article examining the problem of why those who clear return to sport (RTS) testing before 8-9 months still have a higher re-injury risk than those who delay RTS.
What factors does our current RTS testing gauntlet not capture that contributes to the elevated re-injury risk?
Why does it matter?
ACL re-injury rates are no bueno, to put it lightly.
It’s commonly stated that the only injury more devastating for an athlete than an ACL tear is a second ACL tear.
We’re clearly missing something big here and we need to figure it out ASAP.
What problem(s) did they find?
- After ACLR, athletes have “elevated cognitive and cross-modal neural activity to maintain basic knee motor control.”
- This is just fancy talk for saying their brain has to work harder and they have to focus more on tasks that usually happen on autopilot. They’re calling this phenomenon “neurocognitive reliance.”
- One of the most simple examples of neurocognitive reliance is how a new ACLR patient has to go fully Jimmy Neutron brain blast mode when they’re trying to activate the quad.
- Current RTS testing assesses the injured limb in a controlled, isolated environment. Which is a little different than what a running back experiences on game day when they’re trying to avoid the 11 jacked dudes hunting him down.
How do they want to solve it?
- Quantify how much neurocognitive demands alter motor outputs (does thinking/reacting make your movement worse?), using the dual-task paradigm:
- (Baseline performance – Dual task performance)/ Baseline performance
- Choose tests that include the common mechanism seen in ACL injuries; responding to visual cues with a corresponding movement.
- One example is to do standard SL hop testing, then do SL hop testing that’s triggered by a certain visual stimulus (like a light).
- Use 10% dual-task cost (doing 10% worse with dual-task vs baseline) as a soft guideline for making RTS decisions. It’s way too early to draw hard conclusions, but some good old fashioned guesstimating makes 10% work for now.
My thoughts.
I’m all in.
This is a movement that’s been brewing for awhile in the PT world and I’m at the edge of my seat waiting for the data of future studies to see if tests including neurocognitive measures are more predictive of reinjury. (Given that we’re usually looking at a 2-year timeline for reinjury studies, Imma be here for a while.)
How can you use it?
- Follow the “How do they want to solve it?” section.
- Don’t wait for the research to validate things here- there’s no harm in incorporating it immediately.
Best,
Zach
Dr. Zach Guiser, PT, DPT, CSCS