Is RPE appropriate following ACLR?

Soccer Football – Women’s Super League – Reading v Arsenal – Madejski Stadium, Reading, Britain – January 17, 2021 Arsenal’s Jill Roord in action with Reading’s Kristine Leine who goes down after sustaining an injury Action Images via Reuters/Andrew Couldridge
Paper title: Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After
ACL Reconstruction?
Publication: Sports Health
Publication date: September, 2021
INTRODUCTION
Quadriceps weakness is a barrier to anterior cruciate ligament reconstruction (ACLR) rehabilitation. In addition, neural inhibition causes arthrogenic muscle inhibition (AMI). The management of AMI includes strength and proprioception exercises. Rating of perceived effort (RPE) is a simple, easy, safe, and widely used method for monitoring loads and prescribing resistance exercise intensity during ACLR rehabilitation.
The function of the ACL is to provide knee mechanical stability and neurosensory joint motor control. The intact ACL has mechanoreceptors that provide information to the CNS related to joint movements. The neural adaptations after ACL rupture and reconstruction involve brain areas responsible for RPE; however, it is unclear whether these adaptations interfere with RPE. Therefore, this conceptual paper aims to describe the neural adaptations after ACL rupture and reconstruction and the possible implications on RPE for exercise intensity prescription.
RATING OF PERCEIVED EXERTION MODELS
There are three models to explain RPE neurophysiology:
- The afferent feedback model suggests that RPE integrates sensory inputs from musculoskeletal and cardiorespiratory systems to the somatosensory cortex.
- The corollary discharge model suggests RPE is independent of peripheral sensory input. Instead, RPE is generated by motor cortex information to the peripheral muscles via corticospinal pathways, and the somatosensory cortex receives “copies” of these impulses.
- The combined model suggests that both the afferent feedback and the corollary discharge are directly and indirectly related to RPE.
ADDITIONAL NEURAL CONTRIBUTORS TO RPE
The brain areas related to memory, previous experiences, emotions, motivation, pain, and awareness influence RPE. Pain is an emotional and affective experience that involves the somatosensory, cingulate, and prefrontal cortex. In addition, kinesiophobia represents the fear of movement associated with painful and emotional experiences. Patients who undergo ACLR can not inhibit areas of the brain associated with pain and fear when visualizing sport-specific tasks. Therefore, since pain and kinesophobia induce alterations in the same emotional-related brain areas responsible for generating RPE, it is reasonable to hypothesize that RPE could be affected.
CONCLUSION
Rating of perceived exertion is a simple and easy-to-use tool to monitor load and prescribe exercise intensity during ACLR rehabilitation. However, ACL injury could alter RPE. Therefore, clinicians should re-evaluate RPE reliability in this cohort. The authors suggest that until evidence supports the use of RPE in ACLR rehabilitation, clinicians should use objective measures to assess exercise intensity.
Related
in Anatomy, Diagnose & Treat, Improve, Prevent, Sports psychology
Researchers obtain qualitative data through first-hand observation, interviews, questionnaires, and other non-numerical sources of information. Jason Tee explores how clinicians can utilize the qualitative data and the athlete’s voice to improve rehabilitation outcomes. Sports injury research is clinical, impartial, and objective. It reduces athlete injuries to numbers and figures, removing the stories of the athletes... MORE
in Acute injuries, Diagnose & Treat, Hip injuries, Knee injuries, Leg injuries, Musculoskeletal injuries, Prevent, Strength, Uncommon injuries
An injury will, directly and indirectly, affect the entire kinetic chain. Therefore, practitioners should develop holistic clinical assessment and rehabilitation plans. Cameron Gill reviews the complex interplay between the hamstring injury and ACL rupture risk to aid clinical judgment and decision making. Over his first eight seasons, NBA sharpshooter Klay Thompson never missed more than... MORE
in Ankle and foot injuries, Diagnose & Treat, Improve, Knee injuries, Pre-hab and post-surgical rehab, Prevent
Artificial playing surfaces are contentious and remain a talking point in Sports and Exercise Medicine. Marianke van der Merwe uncovers the artificial surface injury risk and provides recommendations to mitigate the risk factors for athletes. Artificial turf was first introduced in the 1960s and has evolved significantly. There are three reasons for artificial turf. Firstly,... MORE
in Acute injuries, Diagnose & Treat, Improve, Musculoskeletal injuries, Overuse injuries, Pre-hab and post-surgical rehab, Prevent
Groin pain remains a challenging sports injury to manage. The complex regional anatomy provides practitioners with the unenviable task of diagnosing and managing athletes with groin pain. However, a universal terminology and taxonomy would assist practitioners in diagnosing and managing these athletes through the return to play process. In part I, Candice MacMillan discusses the... MORE
in Email Newsletters, Improve, Musculoskeletal injuries, Pre-hab and post-surgical rehab, Prevent, Strength
An acute hamstring injury is the most common muscle injury involving high-speed running in sports. The financial, physical, and psychological burden on athletes and teams is significant. Furthermore, the reinjury rate is high. Therefore, effective hamstring injury rehabilitation is essential to reduce the risks and optimize individual and team performance. Researchers at the Copenhagen University... MORE
in Acute injuries, Diagnose & Treat, Female Athletes, Other, Pre-hab and post-surgical rehab
Sports-related concussions (SRC) occur in most sports at all levels. However, female athletes experience more concussions and worse outcomes than their male counterparts, yet these gender differences are unknown in clinical practice. Tracy Ward explores the pathophysiology, implications, and management of SRC in female athletes. Sports-related concussion (SRC) management is at the forefront of sports... MORE