Applied Psychophysiology and Biofeedback

, Volume 37, Issue 1, pp 45–51 | Cite as

Increased Muscle Activation Following Motor Imagery During the Rehabilitation of the Anterior Cruciate Ligament

  • Florent Lebon
  • Aymeric Guillot
  • Christian ColletEmail author


Motor imagery (MI) is the mental representation of an action without any concomitant movement. MI has been used frequently after peripheral injuries to decrease pain and facilitate rehabilitation. However, little is known about the effects of MI on muscle activation underlying the motor recovery. This study aimed to assess the therapeutic effects of MI on the activation of lower limb muscles, as well as on the time course of functional recovery and pain after surgery of the anterior cruciate ligament (ACL). Twelve patients with a torn ACL were randomly assigned to a MI or control group, who both received a series of physiotherapy. Electromyographic activity of the quadriceps, pain, anthropometrical data, and lower limb motor ability were measured throughout a 12-session therapy. The data provided evidence that MI elicited greater muscle activation, even though imagery practice did not result in pain decrease. Muscle activation increase might originate from a redistribution of the central neuronal activity, as there was no anthropometric change in lower limb muscles after imagery practice. This study confirmed the effectiveness of integrating MI in a rehabilitation process by facilitating muscular properties recovery following motor impairment. MI may thus be considered a reliable adjunct therapy to help injured patients to recover motor functions after reconstructive surgery of ACL.


Motor imagery Anterior cruciate ligament Electromyography Motor rehabilitation 


  1. Badia, X., Monserrat, S., Roset, M., & Herdman, M. (1999). Feasibility, validity and test–retest reliability of scaling methods for health states: The visual analogue scale and the time trade-off. Quality of Life Research, 8, 303–310.PubMedCrossRefGoogle Scholar
  2. Binkley, J. M., Stratford, P. W., Lott, S. A., & Riddle, D. L. (1999). The lower extremity functional scale (LEFS): Scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Physical Therapy, 79, 371–383.PubMedGoogle Scholar
  3. Bodian, C. A., Freedman, G., Hossain, S., Eisenkraft, J. B., & Beilin, Y. (2001). The visual analog scale for pain: Clinical significance in postoperative patients. Anesthesiology, 95, 1356–1361.PubMedCrossRefGoogle Scholar
  4. Christakou, A., & Zervas, Y. (2007). The effectiveness of imagery on pain, edema, and range of motion in athletes with a grade II ankle sprain. Physical Therapy in Sport, 8, 130–140.CrossRefGoogle Scholar
  5. Christakou, A., Zervas, Y., & Lavallee, D. (2006). The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain. Human Movement Science, 26, 141–154.PubMedCrossRefGoogle Scholar
  6. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum.Google Scholar
  7. Cramer, S. C., Orr, E. L. R., Cohen, M. J., & Lacourse, M. G. (2007). Effects of motor imagery training after chronic, complete spinal cord injury. Experimental Brain Research, 177, 233–242.CrossRefGoogle Scholar
  8. Cupal, D. D., & Brewer, B. W. (2001). Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabilitation Psychology, 46, 28–43.CrossRefGoogle Scholar
  9. Decety, J., Perani, D., Jeannerod, M., et al. (1994). Mapping motor representations with positron emission tomography. Nature, 371, 600–602.PubMedCrossRefGoogle Scholar
  10. Derscheid, G. L., & Feiring, D. C. (1987). A statistical analysis to characterize treatment adherence of the 18 most common diagnoses seen at a sports medicine clinic. Journal of Orthopaedic and Sports Physical Therapy, 9, 40–46.PubMedGoogle Scholar
  11. Dowling, J. J. (1997). The use of electromyography for the noninvasive prediction of muscle forces: Current issues. Sports Medicine, 24, 82–96.PubMedCrossRefGoogle Scholar
  12. Drechsler, W. I., Cramp, W. C., & Scott, O. M. (2006). Changes in muscle strength and EMG median frequency after anterior cruciate ligament reconstruction. European Journal of Applied Physiology, 98, 613–623.PubMedCrossRefGoogle Scholar
  13. Driediger, M., Hall, C., & Callow, N. (2006). Imagery used by athletes: A qualitative analysis. Journal of Sports Science, 24, 261–271.CrossRefGoogle Scholar
  14. Ekblom, A., & Hansson, P. (1988). Pain intensity measurements in patients with acute pain receiving afferent stimulation. Journal of Neurology, Neurosurgery and Psychiatry, 51, 481–486.CrossRefGoogle Scholar
  15. Evans, L., Hare, R., & Mullen, R. (2006). Imagery use during rehabilitation from injury. Journal of Imagery Research in Sport and Physical Activity, 1, 1–21.CrossRefGoogle Scholar
  16. Green, L. B. (1992). The use of imagery in the rehabilitation of injured athletes. Sport Psychology, 6, 416–428.Google Scholar
  17. Guillot, A., & Collet, C. (2008). Construction of the motor imagery integrative model in sport: A review and theoretical investigation of motor imagery use. International Review of Sport Exercise Psychology, 1, 31–44.CrossRefGoogle Scholar
  18. Häkkinen, K. (1994). Neuromuscular adaptation during strength training, aging, detraining and immobilization. Critical Reviews in Physical and Rehabilitation Medicine, 6, 161.Google Scholar
  19. Hale, B. D. (1982). The effects of internal and external imagery on muscular and ocular concomitants. Journal of Sport Psychology, 4, 379–387.Google Scholar
  20. Heil, J. (1993). Mental training in injury management. In J. Heil (Ed.), Psychology of sport injury. Champaign, IL: Human Kinetics.Google Scholar
  21. Hermens, H. J., Freriks, B., Disselhorst-Klug, C., & Rau, G. (2000). Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology, 10, 361–374.PubMedCrossRefGoogle Scholar
  22. Hoher, J., Munster, A., Klein, J., Eypasch, E., & Tiling, T. (1995). Validation and application of a subjective knee questionnaire. Knee Surgery, Sports Traumatology, Arthroscopy, 3, 26–33.PubMedCrossRefGoogle Scholar
  23. Holmes, P. S., & Collins, D. J. (2001). The PETTLEP approach to motor imagery: A functional equivalence model for sport psychologists. Journal of Applied Sport Psychology, 13, 60–83.CrossRefGoogle Scholar
  24. Hortobagyi, T., Dempsey, L., Fraser, D., Zheng, D., Hamilton, G., Lambert, J., et al. (2000). Changes in muscle strength, muscle fibre size and myofibrillar gene expression after immobilization and retraining in humans. Journal of Physiology, 524, 293–304.PubMedCrossRefGoogle Scholar
  25. Ievleva, L., & Orlick, T. (1991). Mental links to enhanced healing: An exploratory study. Sport Psychology, 5, 25–40.Google Scholar
  26. Jeannerod, M. (1995). Mental imagery in the motor context. Neuropsychologia, 33, 1419–1432.PubMedCrossRefGoogle Scholar
  27. Kaneko, F., Murakami, T., Onari, K., Kurumadani, H., & Kawaguchi, K. (2003). Decreased cortical excitability during motor imagery after disuse of an upper limb in humans. Clinical Neurophysiology, 114, 2397–2403.PubMedCrossRefGoogle Scholar
  28. Kosslyn, S. M., Segar, C., Pani, J., & Hillger, L. A. (1990). When is imagery used in everyday life? A diary study. Journal of Mental Imagery, 14, 131–152.Google Scholar
  29. Law, B., Driediger, M., Hall, C., & Forwell, L. (2006). Imagery use, perceived pain, limb functioning and satisfaction in athletic injury rehabilitation. New Zealand Journal of Physiotherapy, 34, 10–16.Google Scholar
  30. Liepert, J., Tegenthoff, M., & Malin, J. P. (1995). Changes of cortical motor area size during immobilization. Electroencephalography and Clinical Neurophysiology, 97, 382–386.PubMedCrossRefGoogle Scholar
  31. Lotze, M., Montoya, P., Erb, M., Hülsmann, E., Flor, H., Klose, U., et al. (1999). Activation of cortical and cerebellar motor areas during executed and imagined hand movements: An fMRI study. Journal of Cognitive Neuroscience, 11, 491–501.PubMedCrossRefGoogle Scholar
  32. Louis, M., Collet, C., & Guillot, A. (2011). Differences in motor imagery times during aroused and relaxed conditions. Journal of Cognitive Psychology, 23, 374–382.CrossRefGoogle Scholar
  33. Milne, M., Hall, C., & Forwell, L. (2005). Self-efficacy, imagery use, and adherence to rehabilitation by injured athletes. Journal of Sport Rehabilitation, 14, 150–167.Google Scholar
  34. Mizner, R. L., Petterson, S. C., Stevens, J. E., Vandenborne, K., & Snyder-Mackler, L. (2005). Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. Journal of Bone and Joint Surgery, 87, 1047–1053.PubMedCrossRefGoogle Scholar
  35. Moseley, G. L. (2006). Graded motor imagery for pathologic pain: A randomized controlled trial. Neurology, 67, 2129–2134.PubMedCrossRefGoogle Scholar
  36. Moseley, G. L., Zalucki, N., Birklein, F., Marinus, J., van Hilten, J. J., & Luomajoki, H. (2008). Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain. Arthritis and Rheumatism, 59, 623–631.PubMedCrossRefGoogle Scholar
  37. Newsom, J., Knight, P., & Balnave, R. (2003). Use of mental imagery to limit strength loss after immobilization. Sport Rehabilitation, 2, 249–258.Google Scholar
  38. Ranganathan, V. K., Kuykendall, T., Siemionow, V., & Yue, G. H. (2002). Level of mental effort determines training-induced strength increases (abstract). Abstract of the Society for Neuroscience, 32, 768.Google Scholar
  39. Ranganathan, V. K., Siemionow, V., Liu, J. Z., et al. (2004). From mental power to muscle power-gaining strength by using the mind. Neuropsychologia, 42, 944–956.PubMedCrossRefGoogle Scholar
  40. Richardson, P. A., & Latuda, L. M. (1995). Therapeutic imagery and athletic injuries. Journal of Athletic Training, 30, 10–12.PubMedGoogle Scholar
  41. Roos, H., Ornell, M., Gardsell, P., Lohmander, L. S., & Lindstrand, A. (1995). Soccer after anterior cruciate ligament injury: An incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players. Acta Orthopaedica Scandinavica, 66, 107–112.PubMedCrossRefGoogle Scholar
  42. Rushall, B. S., & Lippman, L. G. (1998). The role of imagery in physical performance. International Journal of Sport Psychology, 29, 57–72.Google Scholar
  43. Sordoni, C., Hall, C., & Forwell, L. (2000). The use of imagery by athletes during injury rehabilitation. Journal of Sport Rehabilitation, 9, 329–338.Google Scholar
  44. Sordoni, C., Hall, C., & Forwell, L. (2002). The use of imagery in athletic injury rehabilitation and its relationship to self-efficacy. Physiotherapy Canada, 54, 177–185.Google Scholar
  45. Stinear, C. M., Byblow, W. D., Steyvers, M., Levin, O., & Swinnen, S. P. (2006). Kinesthetic, but not visual, motor imagery modulates corticomotor excitability. Experimental Brain Research, 168, 157–164.CrossRefGoogle Scholar
  46. Taylor, J., & Taylor, S. (1997). Psychological approaches to sports injury rehabilitation. Gaithersburg, MD: Aspen.Google Scholar
  47. Watson, C. J., Propps, M., Ratner, J., Zeigler, D. L., Horton, P., & Smith, S. S. (2005). Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. Journal of Orthopaedic and Sports Physical Therapy, 35, 136–146.PubMedGoogle Scholar
  48. Yeung, T. S., Wessel, J., Stratford, P., & Macdermid, J. (2009). Reliability, validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward. Journal of Orthopaedic and Sports Physical Therapy, 39, 468–477.PubMedGoogle Scholar
  49. Yue, G. H., & Cole, K. J. (1992). Strength increases from the motor program: Comparison of training with maximal voluntary and imagined muscle. Journal of Neurophysiology, 67, 1114–1123.PubMedGoogle Scholar
  50. Zijdewind, I., Toering, S. T., Bessem, B., van der Laan, O., & Diercks, R. L. (2003). Effects of imagery motor training on torque production of ankle plantar flexor muscles. Muscle and Nerve, 28, 168–173.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Florent Lebon
    • 1
  • Aymeric Guillot
    • 2
    • 3
  • Christian Collet
    • 2
    Email author
  1. 1.Applied Clinical Neuroscience, Neurology Research Group, Department of Medicine, Centre for Brain ResearchUniversity of AucklandAucklandNew Zealand
  2. 2.Centre of Research and Innovation in Sport, EA 647, Mental Processes and Motor PerformanceUniversity Claude Bernard Lyon I, University of LyonVilleurbanneFrance
  3. 3.Institut Universitaire de FranceParisFrance

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