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Cognitive Training in Injury prevention


“In the United States, competitive and recreational athletes reported 8.6 million injuries annually with up to 42% of them involving the lower extremity “(Reyes et. al 2022). Injury risk reduction is a huge topic of concern and research here at Made 2 Move: it’s at the top of our list in terms of priorities.


One of Made 2 Move’s previous blogs dived into neuromuscular training and control in reducing the risk of ACL tear (or any injury for that matter). But there is another component of injury prevention programs that must be included alongside neuromuscular, cardiovascular, strength, and power training. This missing component is cognitive complexity.



This blog is going to delve into this often missing component of rehab and injury prevention programs that undoubtedly plays a huge role in an athlete’s success.


What is cognition?

Cognition refers to the many processes that the brain must perform to allow us to function appropriately as humans. Some of the components of cognition include language, intelligence, social functioning while ones more related to sport include: visual attention, self-monitoring, agility, fine motor performance, processing speed, and reaction time (Reyes et. al 2022). These are some of the variables that are screened for in our Made 2 Move injury screens and in traditional concussion testing. But what if we screened and trained these abilities in our regular sessions in order to optimize skill on the field?

For sport, multiple aspects of cognition are imperative. One important aspect is an athlete’s cognitive ability, or the baseline level of attention they can access. “The cognitive process by which the brain selects scene information for processing, ignoring all the rest, is attention” (Huddleston et. al 2023). One’s attention plays into their ability to access motor patterns and choose the right one. For example, if you have a lower attentional capacity, you may get tunnel vision and not see the opponent coming at you. Or your brain may become overstimulated and not utilize the most appropriate motor pattern for the task. These factors display the interrelatedness of cognition and injury risk.

The good news? Attention and cognitive ability are incredibly trainable aspects of cognition. They are not finite skills that you’re either born with or aren’t. How quickly can you react to the ball coming towards you? How broad is your attentional capacity, or view of the field? How quickly can you decide which of your teammates to pass to or how to get open to receive the ball? These are all components of return to sport, performance, and rehab programs we utilize here at Made 2 Move.

Another vital component of cognition is cognitive load, and these are the external factors typically outside of an athletes’ control: the ball, opponents, surface, or the fans cheering. These are less controllable factors but can be simulated in the rehab clinic with the right physical therapist.


How does cognitive training relate to rehab?

“Cognition most likely contributes to lower extremity injuries when the system is taxed beyond capacity. Exceeding cognitive limits can occur either due to limited cognitive ability or to increased task demands” (Reyes et. al 2022). We preach this concept here at Made2Move that when load exceeds capacity, injury can occur. Thus, if we can expand our athlete’s cognitive capacity, then they will ideally be able to handle more load, both physically and cognitively.

Cognitive challenges are not just useful for the athlete trying to return to sport. Anyone can benefit from cognitive challenges and complexity being incorporated into training, especially as we age and lose our ability to mulitask.

Cognitive training is a unique tool that coaches can build into injury prevention programs. At Made 2 Move, we incorporate cognitive challenges into the end stages of rehab, especially with any atheltes attempting to return to sport. Our athletes who train at our ACL Performance Lab know the drill!

Cognitive training is also unique because it is trainable in a way that often is not very fatiguing, so can be used as a way to improve skill development without overwhelmingly increasing training load.

While we can’t control what an athlete will experience on the field, we can work on increasing our athlete’s baseline cognitive ability which contributes to their overall capacity.


Simulating the game

More research is needed to define the best ways in which to cognitively challenge an athlete for the greatest injury risk reduction. But at Made 2 Move, we like to just bring it back to the basics. We can challenge an athlete’s reaction time. This could look like setting up colored cones and having the athlete shiffule or sprint to the called out color.

We can perform dual task performance. If I just strengthen your rotator cuff with bands or train your balance on a Bosu ball, I am not doing my due diligence as a PT. Dual task training mimics what athletesexperience in sport. This should be the next step in injury prevention after the movement pattern has been primed and learned. For example, if you are a basketball player learning proper landing mechanics post ACL tear, our therapists will initially have you focus soley on that task to gain motor control and awareness in a position that you haven’t felt in a while. However, as our rehab goes on, you can bet you’ll be throwing the ball to me (or in the basket), or getting a slight push as you jump down in order to progress your jumping mechanics. Regardless of the means, including cognitive challenges are simpler than you think and must be included in training.

Our Made 2 Move therapists will simulate what you as an athlete may experience on the field. Whether it’s an injury prevention program, screen, or rehab for returning to sport, the cognitive component must be addressed. We will essentially widen an athlete’s “window” to how much information they can process to be the most successful in their sport.

Most typical training sessions and gym session are very structured. There isn’t the unpredictability and complexity that we typically see on the field or in real game time.

“In sport, the environment is constantly shifting and changing, and the athlete must shift and change with it to achieve their desired outcome” which contrasts with sport in which, “the environment is constantly shifting and changing, and the athlete must shift and change with it to achieve their desired outcome” (Huddleston et. al 2023).

Sports are complex! While we often only think about the physical athleticism required to be successful, the attentional and cognitive component plays a huge role in an athletes’ success as well. Many different inputs (an opponent coming at them, which of their teammates is open to pass to, where the goal is) must be quickly processed to make a decision and accomplish the task (score a goal, get the ball from your opponent, etc).

At Made 2 Move, we preach that your rehab should look very similar to the sport or activity you are trying to return to. This concept applies to injury prevention programs as well. What if we could make our gym sessions, to some extent, mimic the more complex environment that athletes experience on the field or court?


How do we train cognition?

It is simply not enough to address an athlete’s strength, balance, power, or mobility. These are vital factors to consider, but a piece of the puzzle is missing. Cognition. We can’t look at our athletes as one body part. Humans are complex, multifaceted beings and as we always say here at Made 2 Move: you are more than your injury.

At Made 2 Move, we will incorporate cognitive complexity in your rehab or injury prevention program because we believe this most accurately simulates what you will experience on the field. This will not only build you confidence in your abilities, but it will widen your attentional window and capacity and be FUN, as we will be doing parts of your sport in clinic. Come see us today! Or if you are a youth athlete, come join us at our injury risk reduction camps this summer. Email frontdesk@made2movept.com today to set up an initial evaluation.



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