Neural-Targeted Rehabilitation Strategies to Address Neuroplasticity After Joint Injury

In patients with musculoskeletal injury, changes have been observed within the central nervous system that contribute to altered movement planning. This maladaptive neuroplasticity potentially explains the clinical disconnect where residual neuromuscular dysfunction and high rates of reinjury are often observed even after individuals clear return-to-activity functional testing. An improved understanding of these neural changes could therefore serve as a guide for facilitating a more complete recovery and minimizing risk of reinjury. Therefore, we propose a paradigm of neural-targeted rehabilitation to augment commonly used therapeutic techniques targeting sensorimotor function to better address maladaptive plasticity. Although most treatments have the capability to modify neural function, optimizing these treatments and combining them with integrative therapies (eg, implementation of motor learning strategies, transcranial direct current stimulation) may enhance neural efficiency and facilitate return to activity in patients with musculoskeletal injury. To complete this model, consideration of affective aspects of movement and associated interventions must also be considered to improve the durability of these changes.