Original article written by Philip Brazalovich, Janel Simon, Cody Criss and colleagues
Background
Effective injury rehab programmes progressively expose athletes to challenge, allowing them to build up their capacity to return to the dynamic demands of competition.
Virtual Reality (VR) can potentially be used as a tool to benefit the rehab process in a couple of different ways:
- Overload: to challenge sensory processing through varying an athlete’s visual environment
- Specificity: to help better mimic the real-world conditions that the athlete is preparing to return to.
Recent advances in technology mean that VR interventions are more affordable (<$20!) and easier to use with athletic movement than ever. Headsets are smaller, lighter, and wireless, while displays have greater resolution and can be easily controlled and programmed by our smartphones.
Playing around in VR might be a novel way to keep athletes engaged through the boredom that tends to accompany rehab, but what if it could also help accelerate their return-to-play?
What the authors did
To understand how VR manipulation of the environment changes knee landing biomechanics, the authors recruited 29 military officers in-training (22 male, 7 female) to perform three drop landing trials from a 31cm box.
3D motion capture (12 Vicon cameras) measured knee kinematics and kinetics across 3 conditions:
- Eyes-open
- Eyes-closed
- VR (a 360° photo of a steep drop, e.g., a cliff face)
What the authors found
VR increased lower-limb injury risk biomechanics from a drop landing jump compared to eyes-open and eyes-closed conditions:
- Less knee flexion at initial contact
- More knee abduction at initial contact
- Increased peak vertical ground reaction force
- More knee abduction at maximum flexion (vs. eyes-open only)
- Higher Landing Error Scoring System scores (LESS is a validated screening tool commonly used by clinicians to identify athletes at risk of injury)
In a nutshell, VR provided a greater challenge to the neuromuscular system in a common athletic movement task vs the standard intervention for visual disruption (closing our eyes).
Limitations
The participants here were military recruits, not top athletes, and consequently wore combat boots for the task. Athletes landing in athletic footwear on competition surfaces may have different results.
While previous research suggests sex-specific landing kinematics exist, this study probably didn’t have enough females in it to properly examine the effects of VR on landing biomechanics by sex.
Since the VR images used here were deliberately selected to be visually disruptive, it’s also unknown whether images with real-world sporting or competition scenarios would elicit similar effects.
What this means for coaches
VR seems to offer a novel and safe way to create progressive challenge through the injury rehab process and help athletes potential return-to-play more quickly. A few of the potential use cases include:
- Re-training the use of proprioception for body and limb control, while limiting reliance on vision.
- Increasing exposure to neuromuscular challenge by manageably increasing the injury risk of sporting movement patterns.
- Improving athlete engagement in the rehab process. Where 100 repetitions of an essential exercise might previously have been tedious and hard to stick to, varying the visual environment via VR each time could help keep compliance high.
- Mentally preparing athletes for return-to-play via simulated exposure to competition environments.
- Rehab from specific injuries where sensory calibration errors often exist, e.g., ACL injuries.
On the flipside, there are a few caveats to beware of. Athletes who are susceptible to motion sickness might not fare well in VR generally. Some athletes may also be naturally better at dealing with the mismatches in visual and proprioceptive feedback that VR creates, so VR interventions may be less effective for them.
Reviewer’s comments
If you’ve ever been injured, you’ll probably relate to how dull repeating the same basic rehab exercises day-in-day-out can be. If VR adds nothing else other than something fun that can keep athletes on track and help ‘gamify’ the rehab process, I’d argue it’s worth a crack. Although still early days, when used in a thoughtful way as part of a well-managed rehab programme, it looks like there may be numerous potential physical benefits worth tapping into as well.
While VR has been around for years, until recently it hasn’t been accessible, affordable, and usable enough to provide much value beyond being something fun to try out once or twice. Now those barriers are disappearing, we should see more and more athletes and teams starting to experiment with it, for injury rehabilitation and beyond.
Imagine first-time Olympians using VR to mentally prepare and acclimatize to the chaos and overwhelm of an Olympic Village, for example. Perhaps it’s not too far-fetched to think that we might even see our first athletic competition held in VR in the not to-distant future!
Recommended resources
Purchase – Google Cardboard – Under $20 VR product
Article – A systematic review of the application of interactive virtual reality to sport – David Neumann, Robyn Moffitt, Patrick Thomas and colleagues.