It might not be all in your knee.
It might also be partially in your brain.
That’s a new theory on knee rehabilitation that is being studied by medical professionals across the country.
A new study out of The Ohio State University (OSU) Wexner Medical Center concludes that patients recovering from knee injuries may benefit from physical therapy that re-wires their brain.
“It won’t replace surgery, but it could fundamentally change how we do therapy,” Dustin Grooms, Ph.D., A.T.C., C.S.C.S., a lead researcher researcher for the study as a doctoral student at OSU's Health and Rehabilitation Sciences program and now an assistant professor at Ohio University, told Healthline.
Studying brain-body connection
For the study, Grooms and other researchers looked at 15 patients with anterior cruciate ligament (ACL) injuries and 15 people with healthy knees.
They put both groups through rehab programs while taking images of their brains.
The researchers said people who had ACL injuries relied more on visual cues when using their knee and didn’t move as naturally as the folks without an injury.
Grooms said they noticed several differences between the two sets of subjects.
One difference involved the part in the back of the brain that deals with visual images. This is the bridge between the eyes and the muscles.
Changes in these sensors caused the injured patients to move more cautiously, as if they were walking in the dark.
There were also differences in the parts of the brain that read pain and control motor functions.
All in all, Grooms said, the injured patients’ brains were reacting to the injured parts of their knees.
That was preventing the folks with ACL problems from moving instinctively like they did before they were injured.
Dr. Christina Allen, a professor of orthopedic surgery at the University of California, San Francisco (UCSF), said the idea of a “brain-body interface” when dealing with injuries has been around for a while.
She said this study takes the research a bit further by focusing on the knee and introducing potential new types of treatments.
“It makes sense,” Allen told Healthline. “There is definitely a psychological rehab component.”
Utilizing virtual reality
Grooms and the other researchers employed virtual reality as part of their therapy routines.
One of the implements they used were strobe glasses that modulated patients’ visual interactions.
The goal was to re-wire the brain back to its pre-injury status when a person doesn’t think about walking when they’re moving. They just do it.
Grooms said the post-injury brain can encourage people to favor one leg over the other, or move too cautiously.
He said you even see this cautious reaction with professional athletes.
This can actually cause re-injury to the knee or even prompt an injury to the other knee.
Allen said the idea is to distract the brain from its post-injury mode and get it back to responding automatically.
She said this can give patients, athletes in particular, more confidence as they gradually get back into shape.
Dr. Nirav Pandya, the director of the Sports Medicine Center for Young Athletes at UCSF’s Benioff Children’s Hospital, told Healthline he thinks the Wexner researchers are “absolutely on the right track.”
“This is an area neglected in a lot of rehab,” he said. “This is perhaps the best way to get the mind and body connected. It can re-train the brain to do complex things.”
Pandya said some of these techniques are being tried out at his centers, which specialize in youth sports injuries.
He said an ACL injury is different from a broken bone or other injury. It’s in a crucial joint of the body, and in many cases during surgery pieces of ligaments from another part of the body are inserted into the knee to replace the damaged ligament.
This can really throw the brain off track.
“I think this is an area where we can make a lot of progress,” he said.
Allen said the key will be to perfect these techniques, and then make them applicable to mainstream treatments.
“It sounds like a great idea,” she said. “The question is can it transition to physical therapy.”