Cross education and immobilisation: mechanisms and implications for injury rehabilitation

J Sci Med Sport. 2012 Mar;15(2):94-101. doi: 10.1016/j.jsams.2011.07.007. Epub 2011 Sep 15.


Objectives: Unilateral strength training produces an increase in strength of the contralateral homologous muscle group. This process of strength transfer, known as cross education, is generally attributed to neural adaptations. It has been suggested that unilateral strength training of the free limb may assist in maintaining the functional capacity of an immobilised limb via cross education of strength, potentially enhancing recovery outcomes following injury. Therefore, the purpose of this review is to examine the impact of immobilisation, the mechanisms that may contribute to cross education, and possible implications for the application of unilateral training to maintain strength during immobilisation.

Design: Critical review of literature.

Methods: Search of online databases.

Results: Immobilisation is well known for its detrimental effects on muscular function. Early reductions in strength outweigh atrophy, suggesting a neural contribution to strength loss, however direct evidence for the role of the central nervous system in this process is limited. Similarly, the precise neural mechanisms responsible for cross education strength transfer remain somewhat unknown. Two recent studies demonstrated that unilateral training of the free limb successfully maintained strength in the contralateral immobilised limb, although the role of the nervous system in this process was not quantified.

Conclusions: Cross education provides a unique opportunity for enhancing rehabilitation following injury. By gaining an understanding of the neural adaptations occurring during immobilisation and cross education, future research can utilise the application of unilateral training in clinical musculoskeletal injury rehabilitation.

Publication types

  • Review

MeSH terms

  • Adaptation, Physiological
  • Athletic Injuries / rehabilitation*
  • Female
  • Functional Laterality / physiology
  • Humans
  • Immobilization / physiology*
  • Male
  • Muscle Contraction / physiology
  • Muscle Strength / physiology
  • Muscle, Skeletal / innervation
  • Muscle, Skeletal / physiology
  • Resistance Training*