Neuroplasticity

The human brain is the most intricate system in the known universe. There are billions of nerve cells in our brains constantly communicating important information to various parts of the body. Neuroplasticity can be defined as the nervous system’s ability to change and adapt to stimuli by reorganizing its structures, functions, and or connections ¹. This concept of neuroplasticity is often talked about in relation to a neurological injury and or disease such as a traumatic brain injury or a stroke. However, I believe that this concept can be applied to all human movement patterns, especially when pain and or an injury is present. We have the incredible ability to learn and re-learn movement patterns, sometimes to our detriment but also to our great advantage.

     Think about this, if you sprain your ankle, the information from your ankle that travels to your brain, may be altered. The joint may be trying to protect itself by implementing different movement patterns, firing different muscles more intensely, which in turn changes the way you walk. “Limping” after an injury is a perfect example of the brain’s ability to change our movement patterns. On the other end of the spectrum, you can think about an individual who is recovering from a total joint replacement in the knee. As a protective mechanism, it is well known that the quadriceps have a much harder time activating and supporting the knee ². Because of neuroplasticity, we can train the quadriceps using specific principles that will in turn improve firing of the quadriceps and improve overall stability of the knee.

 Here are the principles we can use in rehabilitation programs to enhance neuroplasticity ³.

1. Use it or lose it: If you are bench pressing 225lbs today, then decide to take 3 months off from strength training. There is a pretty good chance, when you go to bench press in 3 months, 225lbs is going to feel a LOT more difficult if you can even do it at all. Neural circuits not engaged for a while can begin to degrade ⁴.

2. Use it and improve it: neural pathways can be built through extended practice! A great example is something called constraint induced movement therapy (CIMT). This is used in individuals who had a stroke and have significant weakness in one of their limbs. Technique involves constraining their stronger limb which forces more use of the affected limb. Example being trying to facilitate left hand muscle activation by constraining use of the right hand. This technique has been shown to increase blood flow velocity, enhance neuromuscular activity, and improve motor function tests ⁵. 

3. Specificity matters: training in ways that mimic an individual’s function is extremely important. If someone is trying to improve their cutting movements to the right side and they are a basketball player, it's imperative to train in ways that mimic that motion. 

4. Repetition matters: how many repetitions? ALOT is the answer, really drives home neural pathways. One of the newer treatment strategies in stroke rehabilitation is a concept called high intensity gait training. This involves training at not only high intensities (based on heart rate and exertional levels), but involves practicing specific movements time after time. Research comparing high intensity gait training groups to conventional therapies have individuals taking hundreds of more steps. This has been shown to improve gait speed and overall walking capacity ⁶. 

5. Intensity matters: We need to challenge ourselves! Training at high intensities only enhance the cardiometabolic effects we get from exercise ^7. 

6. Time matters: the earlier you train safely and appropriately after an injury, the better! Your brain wants you to recover. This can be highlighted by many research articles supporting early mobilization during hospital stays and after neurological injury ^8,9.  

7. Salience matters: it is important that the activities involved in training are important to the individual. This makes it easier to be attentive during sessions and remember movement partners learned within session ¹⁰. 

8. Age matters: this goes along the same lines as principle number 6. The younger brain has a greater ability to make new connections than the adult brain ¹¹. 

9. Transference: learning a specific task in one area, may transfer to improved performance in a different area ¹². An example would be learning the violin would improve fine motor skills and finger dexterity.

10. Interference: this last principle states that performance in one area may hinder performance in another ³. An example of this is developing poor posture. If you’ve been sitting in poor posture, 5 days a week for 10 years, it is going to be much harder to re-learn proper positioning and teach your brain and muscles how to sit more ergonomically.

     I recognize a lot of the research presented here involves neurological injuries. However, I believe these are important principles for ANY structured exercise program. Our bodies take the path of least resistance, if there is pain and or a weakness in one area of the body, another area is going to try to pick up the slack! Using these principles, we can drive change at the neuromuscular level, improving performance and overall physical function. 

References

1. Puderbaugh, Matt, and Prabhu D. Emmady. “Neuroplasticity.” StatPearls, StatPearls Publishing, 2025. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK557811/.

2. Mizner, Ryan L., et al. “Early Quadriceps Strength Loss After Total Knee Arthroplasty.” The Journal of Bone and Joint Surgery. American Volume, vol. 87, no. 5, May 2005, pp. 1047–53. PubMed Central, https://doi.org/10.2106/JBJS.D.01992.

3. Kleim, Jeffrey A., and Theresa A. Jones. “Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage.” Journal of Speech, Language, and Hearing Research, vol. 51, no. 1, Feb. 2008. DOI.org (Crossref), https://doi.org/10.1044/1092-4388(2008/018).

4. Ten Principles of Neuroplasticity | CNS TBI Rehabilitation. https://www.neuroskills.com/brain-injury/neuroplasticity/ten-principles-of-neuroplasticity/. Accessed 10 Feb. 2025.

5. Wang, Dong, et al. “The Mechanism and Clinical Application of Constraint-Induced Movement Therapy in Stroke Rehabilitation.” Frontiers in Behavioral Neuroscience, vol. 16, June 2022, p. 828599. DOI.org (Crossref), https://doi.org/10.3389/fnbeh.2022.828599.

6. Moore, Jennifer L., et al. “Implementation of High-Intensity Stepping Training During Inpatient Stroke Rehabilitation Improves Functional Outcomes.” Stroke, vol. 51, no. 2, Feb. 2020, pp. 563–70. DOI.org (Crossref), https://doi.org/10.1161/STROKEAHA.119.027450.

7. Sabag, Angelo, et al. “Low‐volume High‐intensity Interval Training for Cardiometabolic Health.” The Journal of Physiology, vol. 600, no. 5, Mar. 2022, pp. 1013–26. DOI.org (Crossref), https://doi.org/10.1113/JP281210.

8. Bergbower, Emily Anne Smith, et al. “A Novel Early Mobility Bundle Improves Length of Stay and Rates of Readmission among Hospitalized General Medicine Patients.” Journal of Community Hospital Internal Medicine Perspectives, vol. 10, no. 5, Sept. 2020, pp. 419–25. DOI.org (Crossref), https://doi.org/10.1080/20009666.2020.1801373.

9. Coleman, Elisheva R., et al. “Early Rehabilitation After Stroke: A Narrative Review.” Current Atherosclerosis Reports, vol. 19, no. 12, Dec. 2017, p. 59. DOI.org (Crossref), https://doi.org/10.1007/s11883-017-0686-6.

10. Treviño, Mario. “Associative Learning Through Acquired Salience.” Frontiers in Behavioral Neuroscience, vol. 9, Jan. 2016. DOI.org (Crossref), https://doi.org/10.3389/fnbeh.2015.00353.

11. Johnston, Michael V., et al. “Plasticity and Injury in the Developing Brain.” Brain & Development, vol. 31, no. 1, Jan. 2009, pp. 1–10. PubMed, https://doi.org/10.1016/j.braindev.2008.03.014.

12. Ludlow, Christy L., et al. “Translating Principles of Neural Plasticity Into Research on Speech Motor Control Recovery and Rehabilitation.” Journal of Speech, Language, and Hearing Research, vol. 51, no. 1, Feb. 2008. DOI.org (Crossref), https://doi.org/10.1044/1092-4388(2008/019).