Effects of 2 Different External Loads on Joint Position Sense and the Relationship Between Muscle Strength and Force Sense

CONTEXT

Joint position sense (JPS) tests of proprioception lack ecological validity because the testing conditions are so different from the normal function that they can contribute little to understanding the role proprioception plays in daily and sporting activities.

OBJECTIVE

To evaluate the effect of low and high external load on the knee JPS and to investigate the relationship between maximum voluntary isometric contraction and force sense (FS).

DESIGN

Experimental study.

SETTING

Research laboratory.

PARTICIPANTS

A total of 47 volunteers with no history of knee pathology.

INTERVENTIONS

Three active JPS tests performed with no load, low load, and high load were compared at the 45° target angle. For isometric FS test, 50% load was used. For isotonic low load and high load JPS tests, 30% and 70% loads were applied, respectively.

MAIN OUTCOME MEASURES

To analyze obtained data set 2-way multiple analysis of variance, repeated measures of analysis of variance, paired sample t test, and the Pearson correlation coefficient were used.

RESULTS

JPS was not affected by gender (male and female) and activity levels (sedentary, recreational, and trained). Results of the repeated measure of analysis of variance demonstrated the significant main effect of loads (P = .001). Significant differences were found between no load, low load, and high load JPS (P = .001). A positive and significant correlation was found between maximum voluntary isometric contraction and FS error values (r = .41, P = .001).

CONCLUSIONS

The results suggest that as the load level increases, the knee JPS improves. Knee JPS assessed under external load may be a more appropriate alternative to the nature of the sport. Those with higher muscle strength have a worse FS.

Proprioception is not associated with lower extremity injuries in U21 high-level football players

Football is a contact sport with a significant risk of injury. Although proprioception is well studied in rehabilitation, little is known about the association between proprioception and the occurrence of sport injuries. The purpose of this study was to look into the association between ankle and knee proprioception and lower extremity injuries in young football players. Seventy-three football players from the highest U-21 league in Iran volunteered to participate in this study. Before the start of the 2017-2018 competitive season, joint position sense was measured at 30°, 60° and 90° knee flexion and at 10° and 15° ankle dorsiflexion, and inversion using the Biodex Isokinetic pro 4 system. The teams' medical staff recorded football-related lower extremity injuries. We used mixed effects Cox regression models to calculate hazard ratios (HRs) with 95% CIs, acknowledging the clustered data structure. Twenty-two players (30.1%) suffered one or more lower extremity injuries during the season. None of the proprioception measures examined was significantly associated with the risk of lower extremity injuries. Based on these results of our sample, joint position sense does not seem to be associated with lower extremity injuries in young male football players.

Effect of Force Sense to Active Joint Position Sense and Relationships between Active Joint Position Sense, Force Sense, Jumping and Muscle Strength

We aimed to investigate the effect of external load on the joint position sense (JPS) accuracy and its relation to the target jump height. The present study also aimed to explore the relationship between force sense (FS) and maximum voluntary isometric contraction (MVIC). Participants' MVIC levels were determined during the 45-degree knee extension task. Then, participants were asked to execute a knee JPS task with external load (EL-JPS) and with no-load (EL-JPS). To assess jumping accuracy participants were instructed to jump with their 50% of maximum jump height. Results indicated that EL-JPS error values were lower than NL-JPS. EL-JPS was correlated to jumping errors. However, the relationship between NL-JPS and jumping errors was not significant. A significant correlation was found between MVIC and FS errors.

The effects of knee direction, physical activity and age on knee joint position sense

BACKGROUND

Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18-82years to evaluate the effects of age, physical activity and knee direction.

METHODS

A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results.

RESULTS

Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15-29, 30-44, 45-59, 60-74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension.

CONCLUSIONS

The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability.

Reliability and measurement precision of concentric-to-isometric and eccentric-to-isometric knee active joint position sense tests in uninjured physically active adults

OBJECTIVES

Proprioception is important because it is used by the central nervous system to mediate muscle control of joint stability, posture, and movement. Knee active joint position sense (AJPS) is one representation of knee proprioception. The purpose of this study was to establish the intra-tester, inter-session, test-retest reliability of concentric-to-isometric (seated knee extension; prone knee flexion) and eccentric-to-isometric (seated knee flexion; prone knee extension) knee AJPS tests in uninjured adults.

DESIGN

Descriptive.

SETTING

University laboratory.

PARTICIPANTS

Six males, six females (age 26.2 ± 5.7 years; height 171.1 ± 9.6 cm; mass 71.1 ± 16.6 kg).

MAIN OUTCOME MEASURES

Mean absolute error (AE; °); intraclass correlation coefficient (ICC) (2,1); standard error of measurement (SEM; °).

RESULTS

Mean AE ranged from 3.18° to 5.97° across tests. The ICCs and SEMs were: seated knee extension 0.13, 1.3°; prone knee flexion 0.51, 1.2°; seated knee flexion 0.31, 1.7°; prone knee extension 0.87, 1.4°.

CONCLUSIONS

The prone knee flexion and prone knee extension tests demonstrated moderate to good reliability. Prone knee flexion and prone knee extension AJPS tests may be useful in cross-sectional studies estimating how proprioception contributes to knee functional joint stability or prospective studies estimating the role of proprioception in the onset of knee injury.

Reproducibility of a knee and hip proprioception test in healthy older adults

BACKGROUND

Proprioception can be assessed by measuring joint position sense (JPS). Most studies have focused on JPS of the knee joint while literature for other joints especially for hip JPS is scarce. Although some studies have evaluated proprioception of the knee joint, the reproducibility of methods has rarely been investigated.

AIMS

To estimate intrasession reliability and agreement of an active-active JPS test for hip flexion/abduction and knee flexion in healthy older adults.

METHODS

Nineteen healthy older adults participated in this study. The proprioception of the hip (flexion and abduction) and knee (flexion) were assessed in both legs using the "active-active" reproduction technique. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and limits of agreement (LOA) were estimated for relative angular error (RE), absolute angular error (AE), and variable angular error (VE).

RESULTS

Reliability of our JPS test was substantial to almost perfect for the RE for both joints and legs (ICC values ranging from 0.75 to 0.93). We also found that the ICC values for AE were substantial for knee flexion and hip abduction of the left and right leg. The ICC results of VE showed poor reliability for hip and knee joints. SEM and LOA values for hip abduction were generally lower than for hip and knee flexion, indicating lower measurement error or more precise scores for the proprioception test of hip abduction.

CONCLUSION(S)

Proprioceptive acuity of the knee and hip joints in healthy older adults can be reliably assessed with an active-active procedure in a standing position with respect to relative and absolute error.

A systematic review to determine the reliability of knee joint position sense assessment measures

BACKGROUND

The assessment of joint position sense (JPS) is the most widely used measurement of knee proprioceptive capability within the literature. However, it remains unclear what the most reliable method is to assess this. The purpose of this study was to determine the intra- and inter-rater reliability of the various methods used to assess knee JPS.

METHODS

A systematic review of published and unpublished literature sources was conducted up to June 2012. All studies principally assessing the reliability (intra- or inter-rater) or reproducibility of a JPS of the knee were included. The methodological quality of each study was reviewed using the Critical Appraisal Skills Programme tool.

RESULTS

A total of 18 studies were eligible, assessing the reliability of JPS with 456 knees. The reliability of four methods of JPS has been recorded: position replication using a model, image recorded angulation, electrogoniometry and dynamometry/angular motion chair. Intra-rater reliability was good for the assessment of JPS using photographs and digital images, and replicating knee position using a paper model, this was good but variable when electrogoniometry was used, and moderate but variable when assessed using dynamometry/angle motion chairs. The assessment of JPS by image recorded angulation, electrogoniometry and dynamometry/angular motion chair has demonstrated good inter-rater reliability.

CONCLUSIONS

Whilst JPS methods appear to have variable reliability, the four assessment methods should be further assessed with pathological populations such as those following patellar dislocation or anterior cruciate ligament rupture. This will better facilitate the generalisability of JPS assessment methods to inform clinical practice.

Difference in knee joint position sense in athletes with and without patellofemoral pain syndrome

PURPOSE

The purpose of this study was to evaluate knee joint position sense (JPS) in athletes with patellofemoral pain syndrome (PFPS) and compare it with healthy participants under non-weight bearing (sitting) and weight bearing (standing) conditions.

METHODS

Twenty patients and 20 healthy athletes participated in this study. JPS was evaluated by active replication of knee angles with visual cues eliminated. Two target angles in sitting and one in standing were tested. Each test and replication was repeated three times. By subtracting the test angle from the replicated angle, the absolute error was calculated as a dependent variable.

RESULTS

No significant difference in knee JPS was found between groups either in the sitting or in the standing tests.

CONCLUSION

It seems that PFPS does not affect the knee JPS in athletes. The lack of deficiency in patients could possibly be attributed to their severity of knee pathology, pain intensity and their physical activity level.

LEVEL OF EVIDENCE

Case-control study, Level III.

Force sense deficits in functionally unstable ankles

The purpose of this study was to determine whether participants with functional ankle instability have deficits in force sense reproduction compared to uninjured participants. Twenty participants with no history of injury and 20 with functional ankle instability volunteered for this investigation. Participants in the instability group had a history of at least one ankle sprain and frequent episodes of giving way. Ankle force sense testing was performed at 10, 20, and 30% of eversion maximal voluntary isometric contraction. Ten trials were performed at each force. Absolute and variable errors were then calculated. We observed significant (p < 0.05) main effects for group for absolute and variable errors. Force sense absolute error was significantly greater in the functionally unstable ankles (3.7 +/- 2.2 N) compared to uninjured ankles (2.8 +/- 1.1 N). Variable error was also significantly greater in the functionally unstable ankles (3.2 +/- 1.8 N) than the uninjured ankles (2.4 +/- 0.8 N). Functional ankle instability is associated with deficits in an individual's ability to accurately reproduce a given force. This deficit may impair an individual's ability to set appropriate muscle force levels to provide stability to the joint.

The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report

Objective: To investigate the effects of a sensorimotor training programme in osteoarthritic patients.

Design: Randomized, single-blind, controlled trial.

Setting: Kinesiology laboratory at School of Physical Therapy.

Participants: A total of 60 patients were randomly assigned to the training group and the control group. Only 29 patients (training group, 15; control group, 14) completed the study.

Intervention: The training group underwent a sensorimotor training programme using a sling suspension system complemented by a routine physical therapy. The control group underwent a routine physical therapy.

Main measures: Active joint repositioning, functional testings, and self-reported function with the Western Ontario & McMaster Universities Arthritis Index before and after the eight-week intervention.

Results: There were significant differences between the two groups with respect to the improvement in proprioception as measured by active joint repositioning (the changes in the absolute error were 1.9± 1.7°, training group versus 0.1 ± 2.8°, control group (P<0.05), and in self-reported functional difficulty (33.2 ±35.1, training group versus 8.0± 10.2, control group; P<0.05)). There was no significant difference between the two groups in other outcomes.

Conclusion: A sensorimotor training using a sling suspension system improved the patients' proprioception in the knee joints and their self-reported function. Thus, these exercises may serve as an exercise programme for patients with knee osteoarthritis.

Hip and Knee Proprioception in Elite, Amateur, and Novice Tennis Players

OBJECTIVES

The purposes of this study were: (1) to show the differences of lower limb proprioception in three different groups of normal male subjects-elite, amateur, and novice tennis players-and between the skill-dominant and stance-dominant hip and knee and (2) to test the sensitivity of closed-chain reposition test in the three groups.

DESIGN

There were 22, 20, and 20 subjects in the three groups, respectively. Proprioception was tested with the closed-chain reposition method. Absolute error and variable error were calculated. One-way analysis of variance and Tukey's test were used to test the differences.

RESULTS

The proprioception of the hip joints of the elite players was significantly better than that of the other two groups in absolute error (P < 0.0167). In variable error analysis, the proprioception of the stance-dominant leg of the elite players was significantly better than that of the novice players (P < 0.0033).

CONCLUSIONS

Findings of this study supported that the proprioception of elite players was the best. The closed-chain reposition test had good discriminating power between the elite players and the others.

Functional measurement of knee joint position sense after anterior cruciate ligament reconstruction

OBJECTIVE

To examine for differences in joint position sense (JPS) between knees with reconstructed anterior cruciate ligaments (ACLs) and uninjured knees by using a functional weight-bearing measurement method.

DESIGN

Two-way repeated-measures in a convenience sample.

SETTING

An Australian university rehabilitation laboratory.

PARTICIPANTS

Nine subjects presenting at 12 to 16 months after unilateral ACL reconstruction using the semitendinosus/gracilis graft who were recruited from 2 orthopedic surgeons.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

JPS of the reconstructed and uninjured knees was examined by using the Peak Motus motion measurement system to record target joint angles and to calculate reproduced angles after limb movement into flexion and extension, performed in a weight-bearing position.

RESULTS

There were no significant differences in JPS between reconstructed and uninjured knees (P=.68) or between the flexion and extension tasks (P=.47).

CONCLUSION

There was no deficit in knee JPS 12 to 16 months after ACL reconstruction, as measured by a functional weight-bearing method. Further studies should examine the clinical utility of the method as a way to evaluate functional aspects of knee joint proprioception.

Weight-Bearing and Non-Weight-Bearing Knee-Joint Reposition Sense and Functional Performance

Objective:

To determine the relationship between weight-bearing (WB) and non-weight-bearing (NWB) joint reposition sense (JRS) and a functional hop test (FH) and to compare performance on these parameters between athletes and nonathletes.

Design:

Repeated-measures ANOVA and Pearson correlations.

Setting:

Research laboratory.

Participants:

40 men (age = 20.8 ± 1.7 y; ht = 176.9 ± 5.8 cm; wt = 82.6 ± 9.5 kg): 20 lacrosse players and 20 nonathletes.

Main Outcome Measures:

Ability to actively reproduce 30° of knee flexion in the WB and NWB conditions and functional performance on a single-leg crossover-hop test.

Results:

No significant correlations were observed between JRS and FH in athletes and nonathletes. No significant differences were observed between athletes and nonathletes in JRS. All participants were significantly more accurate at WB than at NWB JRS.

Conclusions:

There appears to be no relationship between WB or NWB JRS and functional performance, regardless of one’s physical activity level

The role of weightbearing in the clinical assessment of knee joint position sense

Knee joint position sense was assessed by active tests with active limb matching responses in supine lying and in unilateral weightbearing (WB) stance using (re)positioning of the whole limb whilst focusing on the knee, and in supine lying using (re)positioning confined to the knee. Following five tests at approximately 45 degrees knee flexion in all three test conditions, position sense was found to be significantly more accurate and reliable following the WB procedure. Possible explanations are, first, that during WB the subjects were more able to assist identification of the test positions using cues obtained during movement of the knee to and from these positions. Second, a larger volume of proprioceptive afferent information may have been derived from sources outside the examined knee, and even outside the examined limb. Whilst WB joint position sense assessments are more functional, the obtained results may not characterise the capacity of the proprioceptors in and around the examined (knee) joint. Since the WB and NWB results were not correlated, one procedure cannot be used to predict results from the others. Also, predominantly unilateral WB stance is often impractical for subjects with limited balance or WB pain.

Spinal position sense is independent of the magnitude of movement

STUDY DESIGN

Position sense in the spine was recorded at T1, T7, L1, and S2 in three incremental angular ranges of flexion and on return to upright standing from these movements.

OBJECTIVES

To determine the effect of angular range of movement on position sense. The main purpose was to establish a protocol for whole spine assessment of position sense in healthy and pathologic spines.

SUMMARY OF BACKGROUND DATA

Position sense is one dimension of proprioception, classically assessed by the ability to reproduce preselected target positions. This approach was used in the current study to determine whether spinal position sense is affected by the magnitude of movement traversed in repositioning tasks.

METHODS

Spinal position sense was assessed in 20 healthy subjects during repeated flexion movements carried out in one-third, half, and two thirds of the full range of movement in the sagittal and coronal planes. During each movement, the 3-Space Fastrak (Polhemus Inc., Colchester, VT) was used to record angular movement of the spine at four sensor locations (T1, T7, L1, and S2). The absolute difference in the sensor angles between repeated trials was calculated for each flexed position and on return to upright standing from these. These absolute differences were used as a measure of position sense.

RESULTS

Absolute position sense after one-third angular movements was accurate to within 4.30 degrees +/- 2.84 degrees in flexed positions and 2.70 degrees +/- 2.20 degrees in upright postures. Corresponding results for two-thirds movements were 4.75 degrees +/- 2.63 degrees and 3.33 degrees +/- 2.60 degrees, respectively. Range of movement had no significant influence on the accuracy of position sense.

CONCLUSIONS

1) Healthy individuals are able to reposition their spine accurately under conditions of incremental increases in angular range. 2) Range-related variations in position sense are small and unlikely to be of clinical significance.

Changes in Muscle Activation during Wall Slides and Squat-Machine Exercise

Closed kinetic chain exercises are commonly used in strengthening and rehabilitation programs. Altering positions of body segments and supports might affect the way these exercises are performed. The purpose of this study was to compare gluteal, quadriceps, hamstring, and plantar flexor muscle activations during wall-slide (WS) vs. squat-machine (SM) exercise. In addition, the effects of support location and foot position were investigated. Twenty women performed 8 exercises, to 60° of knee flexion. Results indicated that placing the foot forward caused an increase in all muscle activations except in the plantar flexors, which showed an increase with the foot placed in line with the hip. This effect was exaggerated during WS for the plantar flexors and quadriceps and during SM for the hamstrings. When the support was located at the scapular level, hamstring and gluteal activations were greater, and quadriceps activity was less during SM than during WS. These results could be used to target specific muscle groups during strengthening exercise.

Joint reposition sense in subjects with unilateral osteoarthritis of the knee

OBJECTIVE

To identify the sensory deficit of partial weight-bearing joint repositioning sense in subjects with unilateral osteoarthritis (OA) of the knee. The methodology was developed to incorporate measures made easily in a clinical setting. In OA, local degenerative changes can affect the function of sensory receptors and mechanoreceptors. As a result, appreciation of limb position as well as function may be compromised. Because proprioceptive sense plays an important role in reflex muscle contraction and stabilization of the joint, functional stability and joint integrity may be at risk if proprioception is impaired.

DESIGN

Twenty subjects with unilateral OA of the knee were age-matched with 20 controls for the purpose of this study. The difference in degrees between a target angle of knee flexion and a reposition angle was measured during a partial weight-bearing test. A Dualer (electronic dual inclinometer) was used to measure the joint reposition sense (JRS) of the knee. Both sides were tested with six repetitions on each side. A mixed-model ANOVA was applied to the data for analysis.

RESULTS

Comparison of the JRS between groups revealed a significant difference, with OA subjects having higher JRS error (JRSE) (p <0.001) than controls. There was no significant difference in JRSE for either side, regardless of group.

CONCLUSIONS

Subjects with unilateral OA of the knee demonstrated poorer performance on both legs in a partial weight-bearing reposition test than did control subjects.

Comparison of Weight-Bearing and Non-Weight-Bearing Conditions on Knee Joint Reposition Sense

In this study, joint reposition sense of the knee in a non-weight-bearing (NWB) state and that in a weight-bearing (WB) state were compared, and it was determined whether a significant relationship existed between knee displacement (KD) and joint reposition sense. The dominant knees of 8 male and 12 female subjects (age 19–26 years, M ±SD= 21.5 ± 2.06) who had no previous history of knee dysfunction were tested for accuracy of angular reproduction in the WB and NWB states. There was a significant difference in the accuracy of angular repositioning between the two conditions, with the WB test having less deviation from the predetermined angle. There was a weak relationship between KD and the ability to reproduce specific angles of the knee. These results suggest that the WB or closed chain state of the knee was more accurate in the determination of joint position sense than the NWB or open chain condition.