Brain-Focused Approaches to Training and Injury Recovery

A Conversation with Dr. James Onate, PhD

Posted Jul 09, 2018

James Onate is Chair of Graduate Studies in Health and Rehabilitation Sciences at The Ohio State University, Co-Director of OSU Sports Medicine's Movement Analysis & Performance (MAP) research program, a Research Consultant to Naval Special Warfare groups, and Director of Sports Performance at Bo Jackson Elite Sports.

The Social Brain Blog sat down recently with Dr. Onate at the Third Annual Brain Health and Performance Summit presented by The Ohio State University Wexner Medical Center Neurological Institute and The Stanley D. and Joan H. Ross Center for Brain Health and Performance.

OSU, used with permission.
Source: OSU, used with permission.

Social Brain Blog: You have posed a provocative question asking people how they can use two tennis balls to help rehabilitate an Anterior Cruciate Ligament (ACL) tear. How do you apply insights from brain science and brain research into injury recovery, and how are tennis balls connected to that?

James Onate: As clinicians, we’ve lost imagination, and we need to get it back. Multitasking or taking on a heavier cognitive load while you’re doing another thing are both part of rehabilitation. What can I do with two tennis balls to challenge a person in a movement pattern—simple juggling, for example—while also developing a cognitive pattern, and trying to get all those things intermixed? We should use our imagination to combine cognitive and musculoskeletal, orthopedic aspects of rehabilitation.

We use sophisticated measurement tools to look at aspects of force control and force production. But I also think we have to just utilize some simpler tools, too. If I were to stand here and just try to keep my hand on your shoulder, even something as rudimentary as that can be useful for roughly assessing balance and force control.

We know what works for injury rehab: balance training, coordination. The piece that we need is the implementation science. Coaches have to understand that we need to use these techniques. Coaches need to carve out 15 more minutes a day to do these new exercises regularly prior to doing the things that the kids love to do which is playing, competing, and winning.

We’re also studying aspects of the brain and their relationship to the musculoskeletal system, and really putting those two things together….For instance, we found that Anterior Cruciate Ligament tear patients are often trying to control movement by utilizing or sparking their visual system when they don’t need to. They’ll look at their injured knee a lot during rehab exercises, for example. We don’t know why that is—it could be something that the rehab process actually causes. It’s the chicken-and-the-egg problem right now, though. I do think we need to change some of our rehabilitation paradigm where we may be introducing some movement control parameters that aren’t always conducive to recovery.

SBB:  What are some of the biggest questions that you have about your field of research?

JO: One of the things that we’re looking at is how we can combine the study of various types of health events in our research. Right now, the musculoskeletal injury component, the sport-related concussion component, the mental health component and the sudden death component—heat illness, cardiac events in high school—are all researched separately. I really want to look at exploring those things from a holistic athlete standpoint. But we need multiple funders, multiple players, and multiple researchers who really want to share across their silos, which I think is possible now in a way that it wasn’t just a few years ago.

And I don’t just want to limit this to athletes. It’s also important to look at kids early, track them over time, and then try to eventually intervene.

SBB: Are there gender differences in the prevalence of sports injuries? How has that factored into your work?  

JO: Take the ACL tear, for example: We constantly think about this as a teenage female issue. But we’re seeing that injury in a lot of adult males, too. Our behavioral approach has to be slightly different, though. I’m going to tell a 15-year-old female volleyball player something different than I’m going to tell a 15-year-old female basketball player. Those sports may have two totally different cultures of how they do things. Needless to say, I’ll say something different to that 25-year-old NFL player who’s torn his ACL in a non-contact fashion. Often we’re mistakenly trying to create general guidelines for everybody when we’re really talking about personalized, individualized situations.

SBB: What should coaches be doing to teach athletes the basics and help prevent them from getting hurt?

JO: For kids, if we’re trying to promote more athleticism, more exercise and more movement, we should have ways to assess them each year. Right now our assessments are on the level of: Can you touch your toes and can you do some other very simple things?

A lot of the time athletes do a training program and then play for nine months. That’s off track in my consideration: If a dentist said you’ll be fine brushing your teeth for just three months out of the year, would you believe that? Of course not. Then why would we think an intervention for three months is going to last over an entire nine-month playing season? We have to continue to stay healthy during the season. We have to brush our teeth daily. We have to have our movements and exercises daily. And I’m not saying to go get assessed every day on fancy machines but rather, can you integrate training on a regular basis.