Angela Jackson — Integrating Neurocognitive Rehab in to Return to Sport Protocols — Injury Rehab Network

The May Injury Rehab Network event with BASRaT featured a presentation from Angela Jackson, Chartered Physiotherapist. The online event took place on the evening of Monday, 13th May, with 195 sports rehabilitation practitioners in attendance.

Angela discussed the role of neurocognitive rehab in rehabilitation following ligament injuries. The recording is available to watch here.

Angela Jackson, Chartered Physiotherapist

Angela Jackson is a Chartered Physiotherapist who, over the last 35 years, has dedicated her career to understanding youth athlete injuries.

She owned a highly successful physiotherapy clinic for 30 years and has become an expert in youth injury risk factors, helping hundreds of children reach their athletic potential.

For almost two decades, she has worked as the Physiotherapist to the Cheshire Cricket Board and advises Premier League Football Academies across the globe. As a passionate educator, Angela lectures internationally, is the author of multiple online courses, and advocates for a specialised approach to rehabilitating injured young athletes through the platform, “Kids Back 2 Sport”.

Integrating Neurocognitive Rehab in to Return to Sport Protocols

Angela’s presentation considered how to train the brain, not just the sprain, in the rehabilitation of young athletes’ sports injuries.

To stimulate thought, Angela asked, “Is our rehab good enough after a ligament injury?”. Angela reinforced this point with statistics about reinjury and the challenges athletes face when returning to sport after a ligament injury, including the residual deficits that can occur following ligament reconstruction.

Mechanism of Injury

Angela considered the mechanism of non-contact injuries, which occur shortly after foot contact during:

• Deceleration
• Change of direction
• Rapid cutting/ pivoting
• Landing
• Perturbation
• Cognitively demanding tasks

Angela noted that injuries may occur when reserves of the brain have been exceeded. This could also be linked to head injury/ impact/ concussion.

Angela discussed the factors that might reduce brain reserves, such as a new sport or environment, post-concussion, neurodiversity, anxiety or distractions.

Return to Play Testing

Angela questioned whether traditional RTP testing addresses cognitive demands and encouraged practitioners to start with the end in mind, including the physical and cognitive demands of sport.

Angela discussed the unplanned and unanticipated elements of sport and the need to focus on these elements in rehab. Angela encouraged practitioners to move from physical-only rehab to physical and neurocognitive rehab to replicate the demands and chaos of sport. Rehab and RTP testing should, therefore, prepare athletes for the chaos of a live sports environment.

Techniques such as sensory reweighting can challenge athletes by disrupting one sensory system and amplifying another. Angela discussed the assessment of visual dominance in RTP testing and the use of stroboscopic glasses to dampen down vision.

Free up the Brain to Move Without Thinking

Angela discussed how the aim of rehab is to prepare athletes for replicating the chaos of the live sport/ game environment so they are able to compete under pressure in dual-task settings. They require movement variability to retain movement literacy learned in the treatment setting and be prepared to adapt those movement skills to the unpredictable.

Angela described the OPTIMAL theory of learning, which proposes three pillars:

1. Enhanced expectancies
2. Provide autonomy support
3. Promote an external focus of attention

Enhanced experiences build confidence through positive feedback. Athletes can be given autonomy through choice of exercises. The language used by practitioners helps to promote an external focus of attention.

Roll the DICE

Angela described the DICE acronym for learning:

• D = Differential learning through blocked, serial and random approaches.
• I = Implicit learning (without conscious awareness). Implicit is unintentional vs explicit, which is intentional.
• C = Contextual interference. Add physical perturbation or cognitive interference during a motor skill.
• E = External focus of attention

When athletes return to play, they need to be able to develop movement without conscious control. Introducing dual tasking can support this, and adding perturbation can help athletes learn to develop movement variability.

Providing an external focus rather than an internal focus may facilitate enhanced transfer of the skill and increase retention of the skill from the treatment room to the playing field, e.g. “Create a pizza shape to do a snow plough” = External or “Focus on keeping the Bosu ball level” = External vs “Focus on keeping your feet level” = Internal. Angela discussed how different methods can be used to promote an external focus of attention, including using lights or VR technology.

Practitioners, therefore, have an important role in coaching athletes through rehab and their return to sport.

Control to Chaos

Angela discussed research by Dr Matt Taberner around the control-to-chaos continuum and how this can be applied to return-to-play programmes. Angela described how RTP programmes should be sports and individual-specific.

Priorities in Rehab

Angela summarised the priorities in rehab, including:

• Reduce dependence on eyes
• Create movement variability
• Create the ability to adapt to the environment
• Do it without thinking
• Create chaos
• Replicate the demands of the sport

Angela stated that rehab strategies must promote adaptive sensorimotor brain activity.

Q&A

Angela kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for the insights from Angela to the questions.

Presentation Recording

The recording of Angela’s presentation is available to watch here

Online Course Offer

Get 10% off Angela’s online courses with the code steroplast. Details of all Angela’s courses are available on the Kids Back 2 Sport website

Follow Angela Jackson

• https://x.com/angiejphysio
• https://x.com/kidsback2sport
• Website https://angelajacksonphysio.com/
• Kids Back 2 Sport https://kidsback2sport.com/

2024 Injury Rehab Network events

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