Department of Health and Exercise Science, Appalachian State University, 111 Rivers St., ASU Box 32071, Boone, NC, 28608, USA.
Department of Kinesiology, University of Connecticut, Storrs, CT, USA.
Sports Med. 2017 Jul;47(7):1271-1288. doi: 10.1007/s40279-016-0666-y.
The array of dysfunction occurring after ligamentous injury is tied to long-term clinical impairments in functional performance, joint stability, and health-related quality of life. To appropriately treat individuals, and in an attempt to avoid sequelae such as post-traumatic osteoarthritis, investigators have sought to better establish the etiology of the persistent dysfunction present in patients who have sustained joint ligament injuries to the lower extremities. Recent evidence has suggested that changes within the brain and central nervous system may underlie these functional deficits, with support arising from direct neurophysiologic measures of somatosensory dysfunction, motor system excitability, and plasticity of neural networks. As research begins to utilize these findings to develop targeted interventions to enhance patient outcomes, it is crucial for sports medicine professionals to understand the current body of evidence related to neuroplasticity after ligamentous injury. Therefore, this review provides (1) a comprehensive and succinct overview of the neurophysiologic techniques utilized in assessing central nervous system function after ligamentous injury, (2) a summary of the findings of previous investigations utilizing these techniques, and (3) direction for further application of these techniques in the prevention and rehabilitation of joint injury.
韧带损伤后出现的一系列功能障碍与长期的功能表现、关节稳定性和健康相关生活质量的临床损害有关。为了适当治疗患者,并试图避免创伤后关节炎等后遗症,研究人员试图更好地确定下肢关节韧带损伤患者持续存在的功能障碍的病因。最近的证据表明,大脑和中枢神经系统内的变化可能是这些功能缺陷的基础,直接的躯体感觉功能、运动系统兴奋性和神经网络可塑性的神经生理学测量提供了支持。随着研究开始利用这些发现开发针对提高患者结果的靶向干预措施,运动医学专业人员了解与韧带损伤后神经可塑性相关的当前证据至关重要。因此,本综述提供了(1)用于评估韧带损伤后中枢神经系统功能的神经生理技术的全面而简洁的概述,(2)利用这些技术进行的先前研究结果的总结,以及(3)这些技术在预防和康复关节损伤方面的进一步应用方向。