ABS 043: Integrating M1 neuromodulation with rehabilitation to reestablish high-precision motor control in athletes and musicians: An integrative review

Daniel Alter, Undergraduate Student ¹, Hridya Rajesh, Undergraduate Student ², Aryan Suri, Undergraduate Student ², Uchisda Ratheesh, Undergraduate Student ¹

¹ Faculty of Science, Western University, London, Ontario, Canada N6A 3K7
² Faculty of Health Sciences, Western University, London, Ontario, Canada N6A 3K7

The Van Wickle Journal (2026) Volume 2, ABS043

Introduction: Elite athletes and professional musicians rely on highly refined motor networks within the primary motor cortex (M1) to sustain the precision, timing consistency, proprioceptive integration, and force modulation required for elite performance. Following repetitive overuse or injury, these cortical representations may destabilize, resulting in maladaptive plasticity characterized by impaired sensorimotor integration, increased agonist-antagonist co-contraction, reduced movement efficiency, and erosion of fine motor accuracy. Current rehabilitation protocols primarily emphasize restoration of muscular strength, joint stability, range of motion, and gross functional movement through progressive loading and repetitive motor practice. Although these approaches frequently restore baseline physical function, many individuals fail to regain the cortical precision necessary for return-to-performance at elite levels, suggesting incomplete neural recovery despite apparent musculoskeletal rehabilitation. Emerging evidence demonstrates that M1-targeted neuromodulation may transiently enhance corticospinal excitability and amplify experience-dependent plasticity, creating a neurophysiological environment more responsive to motor relearning. Pairing neuromodulation with proprioceptively driven, task-specific retraining may therefore facilitate more effective cortical remapping and restoration of precision motor control. This targeted integrative review evaluates the mechanistic and functional effects of combining M1 neuromodulation with structured rehabilitation to improve high-precision motor recovery in athletes and musicians following injury or maladaptive cortical reorganization. Furthermore, this review proposes a conceptual shift from predominantly strength-based rehabilitation models toward neuroplasticity-driven rehabilitation frameworks that directly target cortical dysfunction underlying persistent performance deficits.

Methods: This targeted integrative review was conducted using a systematic informed framework for study identification, screening, eligibility assessment, and synthesis. Literature searches were performed using clinical neuroscience databases to identify studies investigating M1 neuromodulation, cortical plasticity, proprioceptive retraining, motor relearning, and precision motor recovery in athletes and musicians. Search terms included combinations of “M1 plasticity,” “tDCS,” “TMS,” “NMES,” “motor cortex excitability,” “sensorimotor integration,” “proprioception,” “musician dystonia,” “motor learning,” “athletes,” and “musicians.” Studies were included if they evaluated neuromodulatory interventions paired with movement-based rehabilitation or assessed neurophysiological and functional outcomes related to fine motor control. Following title, abstract, and full-text screening, data regarding stimulation modality, cortical plasticity measures, rehabilitation paradigms, and motor performance outcomes were extracted and synthesized qualitatively according to neural mechanism and functional effect.

Results: Anodal M1 stimulation increased corticospinal excitability to approximately 140–150% of baseline, whereas cathodal stimulation reduced excitability to 60–75%, demonstrating reliable bidirectional modulation of cortical activity. Greater and longer-lasting improvements occurred when stimulation was paired with slow, proprioceptively focused movement retraining rather than administered independently. Combined neuromodulation and rehabilitation improved joint-position accuracy by 2–12°, reduced timing variability by 10–35%, and restored smoother force modulation and movement efficiency in recovering athletes. Musicians demonstrated enhanced bidirectional plasticity, including larger LTP/LTD-like responses and steeper TMS input-output curves. In focal dystonia, combined stimulation and retraining promoted more stable cortical remapping and sustained motor improvements.

Discussion: The findings support a shift from predominantly strength-based rehabilitation models toward neuroplasticity-driven rehabilitation frameworks that directly target cortical dysfunction underlying impaired motor precision. Integrating movement-paired M1 neuromodulation into rehabilitation protocols may optimize adaptive cortical reorganization by coupling heightened excitability with proprioceptively demanding, task-specific retraining. This approach emphasizes restoration of sensorimotor integration, timing regulation, and movement efficiency in addition to conventional musculoskeletal recovery. Such a paradigm may better address the persistent neural deficits preventing athletes and musicians from returning to pre-injury performance despite functional rehabilitation. Future research should investigate individualized stimulation parameters and performance-specific models to optimize precise long-term motor recovery.