Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

Abstract

There are numerous physical, social, and psychological benefits of exercise, sport and play for youth athletes. However, dynamic activities come with a risk of injury that has yet to be abated, warranting novel therapeutics to promote injuryresistance and to keep an active lifestyle throughout the lifespan. The purpose of the present manuscript was to summarize the extant literature and potential connecting framework regarding youth brain development and neuroplasticity associated with musculoskeletal injury. This review provides the foundation for our proposed framework that utilizes the OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning to elicit desirable biomechanical adaptations to support injury prevention (injury risk reduction), rehabilitation strategies, and exercise performance for youth physical activity and play across all facets of sport (Prevention Rehabilitation Exercise Play; PREP). We conclude that both young male and females are ripe for OPTIMAL PREP strategies that promote desirable movement mechanics by leveraging a unique time window for which their heightened state of central nervous system plasticity is capable of enhanced adaptation through novel therapeutic interventions.

Targeted Application of Motor Learning Theory to Leverage Youth Neuroplasticity for Enhanced Injury-Resistance and Exercise Performance: OPTIMAL PREP

“…However, we emphasize that this age range is intended to be largely inclusive of pre-adolescence, adolescence, and early adulthood, and not restricted to any chronological age or sex despite growth/ maturational factors [17,137,148]. Though we do support the notion that OPTIMAL PREP effects could be amplified if implemented during pre-to early-adolescence to capitalize on neurologic, developmental-related factors (e.g., synaptic pruning) [56], longitudinal data is needed to confirm a more refined age window. We also premise this review by operationally defining motor performance as temporary, transient changes in a motor skill; whereas motor learning is defined as the relatively permanent changes in a motor skill as a direct result of practice or experience [200,244].…”

“…We frame our neurophysiologic mechanisms and examples of OPTIMAL PREP strategies in the context of ACL injury, but emphasize their potential utility across a range of youth musculoskeletal disorders and for exercise performance, injury risk reduction, injury rehabilitation, and play more generally. To note, "youth" is discussed as encompassing both males and females between the approximate ages of 6 and 25 years, congruent with previous OPTIMAL PREP literature [56]. However, we emphasize that this age range is intended to be largely inclusive of pre-adolescence, adolescence, and early adulthood, and not restricted to any chronological age or sex despite growth/ maturational factors [17,137,148].…”

“…CNS changes associated with ACL injury and motor development, make the implementation of strategies that promote injury-resistant adaptive neuroplasticity potentially even more impactful in pediatrics [56]. Neuroscientific data indicate that youth may be of an ideal age to intervene and promote positive neuroplastic adaptations by capitalizing on the malleability of the human brain throughout the lifespan [96,120,168,207,218].…”

“…Notably, various components of motor learning have gained considerable attention as a means to induce neuroplasticity [45,79], with a recent framework (Optimizing Performance Through Intrinsic Motivation and Attention for Learning; OPTIMAL) proposing three specific motor learning factors/principles (i.e., "pillars") theorized to enhance motor performance and learning by leveraging individuals' capacity for CNS plasticity through adaptive neuroplasticity [240]. The pillars of OPTIMAL theory-enhanced expectancies, autonomy support, and an external focus of attention-could potentially elicit desirable biomechanical adaptations in youth to optimize injury prevention strategies (specifically the reduction of injury risk), injury rehabilitation, exercise performance, and play across all facets of sport (Prevention Rehabilitation Exercise Play; PREP) [56].…”

Editorial

“…This is followed by a systematic review from Pedley et al that reviews the utility of various kinetic and kinematic jumping and landing variable for predicting at heightened risk of injury [10]. Next is a narrative review from Diekfuss et al that examines whether central nervous system plasticity can be targeted to reduce lower limb injury risk in young athletes [4]. Following these reviews, a series of empirical studies are presented that address different aspects of developing young athletes.…”