The effect of joint position sense therapy on chronic shoulder pain with central sensitization

BACKGROUND

Chronic shoulder pain is a common musculoskeletal problem associated with unreleased pain and functional dysfunction that can evolve into central sensitization. Some forms of manual therapy may exacerbate pain and central sensitization. This study investigated the impact of joint position sense therapy (JPST), a moderate joint proprioception training technique, on central sensitization, shoulder functional dysfunction, and pain in patients with chronic shoulder pain compared with more intense exercises or aggressive manual therapies.

METHODS

We assessed the pressure pain threshold (PPT) in 30 patients with and 30 patients without chronic shoulder pain. The assessment focused on 4 muscle sites: deltoid, upper trapezius, brachioradialis, and tibialis anterior. Thirty patients with chronic shoulder pain were randomly divided into the JPST and control groups. The JPST group underwent additional shoulder joint position-sense training. The efficiency outcomes were the disabilities of the arm, shoulder, and hand questionnaire, visual analog scale (VAS), and PPT, evaluated at baseline and after the intervention.

RESULTS

Significant differences were observed in the PPT values at the brachioradialis (P < .05), deltoid (P < .01), and trapezius (P < .001) among the non-chronic and chronic groups, but not in the tibialis anterior muscle (P > .05). Although both control and JPST interventions effectively improved the disabilities of the arm, shoulder, and hand questionnaire score, pain intensity, and PPT values in the upper limb, the outcomes in the JPST group were significantly different from those in the control group.

CONCLUSIONS

Generalized hyperalgesia changes limited to the upper limbs were observed in patients with chronic shoulder pain. JPST has beneficial effects on pain control and functional dysfunction in patients with chronic shoulder pain.

Reduced shoulder proprioception due to fatigue after repeated handball throws and evaluation of test-retest reliability of a clinical shoulder joint position test

Background

Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design.

Method

Forty participants repeated a shoulder joint position sense test to assess test-retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder.

Results

There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°-0.90°).

Discussion

The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic.

Handball players have superior shoulder proprioception: a prospective controlled study

BACKGROUND

Proper proprioceptive and neuromuscular control is crucial for the overhead athlete's performance. The aim of the present study was to evaluate the shoulder joint position sense (JPS) levels in overhead throwing athletes. The secondary aim was to confront the proprioceptive abilities with glenohumeral adaptive changes and pathologies among athletes.

METHODS

Ninety professional handball players and 32 healthy volunteers were recruited. JPS levels were measured by an electronic goniometer and expressed as values of an active reproduction of the joint position (ARJP) and as error of ARJP (EARJP) in 3 different reference positions for each movement (abduction and flexion at 60°, 90°, and 120°; internal [IR] and external rotation [ER] at 30°, 45°, and 60°).

RESULTS

Side-to-side differences revealed significantly better values of EARJP for the throwing shoulders in abduction at 90° and 120°, flexion at 90° and 120°, IR at 60°, and ER at 30° and 60° compared with the nonthrowing shoulders. Handball players showed significantly better proprioceptive levels in their throwing shoulder compared to the dominant shoulder of the control group in abduction at 90° (P = .037) and 120° (P = .001), flexion at 120° (P = .035), IR at 60° (P = .045), and in ER at 60° (P = .012).

DISCUSSION

Handball players present superior shoulder JPS in their dominant throwing shoulder at high range of motion angles when compared to a nonathlete population and to their own nondominant shoulder.

Investigation of Reaction Time, Proprioception, and Shaped Pathway Walking Performance in Older Patients with Total Knee Arthroplasty

OBJECTIVES

The existing literature on total knee arthroplasty (TKA) does not provide clear data on step reaction time and proprioception and gait in shaped pathways. This study investigated the relationship between proprioception and reaction time with walking performance in shaped pathways in older patients undergoing TKA.

DESIGN

A cross-sectional observational study.

SETTING AND PARTICIPANTS

An orthopedic outpatient clinic with 103 older patients with TKA after a minimum of 6 months after surgery.

METHODS

Participants were evaluated with Figure-of-8 Walk Test (F8WT), L Test, Tinnetti Gait Test (TGT), proprioception measurement with an app-based inclinometer, and step reaction time (SRT) test. The same assessor carried out all evaluations.

RESULTS

F8WT showed a strong correlation with SRT-right, SRT-left, and Tinetti Gait Test (TGT), respectively (r1 = 0.628, r2 = 0.619, r3 = -0.615, P < .01). In addition, F8WT was moderately correlated with Right Leg Proprioception Test (RLPT) and Left Leg Proprioception Test (LLPT), respectively (r1 = 0.487, r2 = 0.439, P < .01). There was a moderate correlation between L Test with RLRT, LLRT, and TGT, respectively (r1 = 0.597, r2 = 0.584, r3 = -0.542, P < .01). Besides, there was a weak positive correlation between L Test with RLPT and LLPT, respectively (r1 = 0.394, r2 = 0.335, P < .01). A regression model showed that the L test was related to RLRT, LLRT, and TGT (R2 = 0.432, P < .001). The higher ability of the L test was weakly associated with higher levels of TGT (standardized β = -0.28, P = .0012). Besides, regression analysis also proved that F8WT was related to RLRT, LLRT, and TGT (R2 = 0.522, P < .001). The most highly associated parameter was LLRT (standardized β = 0.958, P = .003).

CONCLUSIONS AND IMPLICATIONS

Gait in shaped pathways is associated with proprioception, reaction time, and balance ability in older patients with TKA. Therefore, proprioception, reaction time, and balance should be considered to improve the shaped pathway walking performance of patients after bilateral, right, or left TKA surgery.

Acute effects of isotonic eccentric exercise on the neuromuscular function of knee extensors vary according to the motor task: impact on muscle strength profiles, proprioception and balance

Introduction

Eccentric exercise has often been reported to result in muscle damage, limiting the muscle potential to produce force. However, understanding whether these adverse consequences extend to a broader, functional level is of apparently less concern. In this study, we address this issue by investigating the acute and delayed effects of supramaximal isotonic eccentric exercise on neuromuscular function and motor performance of knee extensors during tasks involving a range of strength profiles, proprioception, and balance.

Methods

Fifteen healthy volunteers (23.2 ± 2.9 years old) performed a unilateral isotonic eccentric exercise of the knee extensors of their dominant lower limb (4 × 10 reps at 120% of one Repetition Maximum (1RM)). The maximum voluntary isometric contraction (MVC), rate of force development (RFD), force steadiness of the knee extensors, as well as knee joint position sense and mediolateral (MLI) and anteroposterior stability (API) of the dominant lower limb, were measured pre-, immediately, and 24 h after the eccentric exercise. The EMG amplitude of the vastus medialis (VM) and biceps femoris (BF) were concomitantly evaluated.

Results

MVC decreased by 17.9% immediately after exercise (P < 0.001) and remained reduced by 13.6% 24 h following exercise (P < 0.001). Maximum RFD decreased by 20.4% immediately after exercise (P < 0.001) and remained reduced by 15.5% at 24 h (P < 0.001). During the MVC, EMG amplitude of the VM increased immediately after exercise while decreasing during the RFD task. Both values returned to baseline 24 h after exercise. Compared to baseline, force steadiness during submaximal isometric tasks reduced immediately after exercise, and it was accompanied by an increase in the EMG amplitude of the VM. MLI and knee joint position sense were impaired immediately after isotonic eccentric exercise (P < 0.05). While MLI returned to baseline values 24 h later, the absolute error in the knee repositioning task did not.

Discussion

Impairments in force production tasks, particularly during fast contractions and in the knee joint position sense, persisted 24 h after maximal isotonic eccentric training, revealing that neuromuscular functional outputs were affected by muscle fatigue and muscle damage. Conversely, force fluctuation and stability during the balance tasks were only affected by muscle fatigue since fully recovered was observed 24 h following isotonic eccentric exercise.

Proprioceptive Acuity Assessment in Multiple Directions Across Multiple Joints in the Upper Limb

Proprioception is essential for precise movement as it helps the body transmit important data about its surroundings to the central nervous system for maintaining body posture and position. This study aimed to investigate the effect of direction and joint angle on upper limb proprioception. Thirty individuals (all males) completed a position reproduction activity in 13 directions and three joint angles. It was discovered that upper limb proprioception is dependent on joint angle, direction, and range of motion. The position reproduction error was found to be dependent on the direction, which had a significantly lower accuracy in the direction with a larger range of motion. In addition, upper limb repositioning errors increased at greater limb elevation angles. Our findings also showed that the joint angle did not significantly affect the absolute error of elbow flexion. With an increase in the elbow flexion, the increase of the gravitational moment of the upper arm and hand coupled with the increase of the muscle arm of the biceps brachii possibly causes slight changes in muscle length perceived by spindles or muscular force perceived by Golgi tendon organs.

Postoperative Recovery of Gait Function at Early Phase Is Delayed in Patients with Spinal Tumors with Impairment of the Joint Position Sense in the Big Toe: A Retrospective Cohort Study

Introduction

We investigated the effect of preoperative joint position sense in the big toe on the postoperative recovery of gait function after spinal tumor surgery.

Methods

Seventy-three patients with spinal tumors who underwent surgery at our hospital between 2014 and 2019 and could be followed for at least 6 months after surgery were included. The patients were divided into the cervical spinal (41 cases) and thoracic spinal (32 cases) groups according to the localization of the tumor. These groups were further classified into an Impaired group (cervical spinal, 34 cases; thoracic spinal, 19 cases) and an Intact group (cervical spinal, 7 cases; thoracic spinal, 13 cases) according to the presence or absence of preoperative joint position sense in the big toe. The amount of change in ambulatory function from the preoperative period to 3 and 6 months postoperatively was compared between the Impaired and Intact groups within each tumor localization category.

Results

Impaired preoperative joint position sense in the big toe in patients undergoing thoracic spinal tumor surgery delayed the recovery of gait function in the early postoperative period.

Conclusions

In patients with thoracic spinal tumor surgery, the absence of preoperative joint position sense in the big toe delayed the recovery of postoperative gait function.

A Cross-Sectional Study Investigating Lumbar Proprioception Impairments in Individuals with Type 2 Diabetes Mellitus: Correlations with Glycated Hemoglobin Levels

Impaired proprioception is a recognized complication in individuals with type 2 diabetes mellitus (T2DM), contributing to balance deficits and increased risk of falls. However, limited research has focused on lumbar proprioception in this population. This study aimed to investigate lumbar proprioception in individuals with T2DM, as well as healthy individuals. Additionally, this study aimed to examine the correlation between lumbar proprioception and glycated hemoglobin (HbA1c) levels, which is a marker of long-term glycemic control in T2DM. A cross-sectional study was conducted, comparing lumbar joint reposition errors (JRE) between a T2DM group (n = 85) and a healthy group (n = 85). Lumbar JRE was assessed in flexion, extension, lateral bending left, and lateral bending right using a dual inclinometer device. HbA1c levels were measured as an indicator of glycemic control. Significant differences in lumbar JRE were found between the T2DM and healthy groups, with individuals with T2DM exhibiting larger JRE values, indicating impaired lumbar proprioception (p < 0.001). The correlation analysis revealed significant positive associations between HbA1c levels and lumbar JRE. Higher HbA1c levels were correlated with greater joint JRE in flexion (r = 0.49, p < 0.001), extension (r = 0.51, p < 0.001), left lateral bending (r = 0.45, p < 0.001), and right lateral bending (r = 0.48, p < 0.001) in the T2DM group. This study provides evidence of impaired lumbar proprioception in individuals with T2DM, as evidenced by larger lumbar JRE compared to the healthy group.

Age-Related Decline in Cervical Proprioception and Its Correlation with Functional Mobility and Limits of Stability Assessed Using Computerized Posturography: A Cross-Sectional Study Comparing Older (65+ Years) and Younger Adults

Cervical proprioception and its implications on postural stability are crucial in older adults. Understanding their relationship is important in understanding and preventing falls in older adults. This research aims to evaluate the proprioceptive, functional mobility, and limits of stability (LOS) variables among two age groups: individuals aged 65 and above and those below 65. A secondary goal of the study is to analyze the relationship between cervical proprioception, functional mobility, and the LOS.

METHODS

In this cross-sectional study, 100 participants each were included in the older and younger groups. Researchers employed the target reposition technique to assess cervical proprioception and measured the joint position error (JPE) in degrees. Functional mobility was estimated using the Berg balance scale (BBS) and timed up-and-go test (TUG). In addition, dynamic posturography was utilized to evaluate variables related to the LOS, including reaction time, maximum excursion, and directional control.

RESULTS

The magnitudes of the mean cervical JPE are larger (p < 0.001), and functional mobility (p < 0.001) and the LOS (p < 0.001) are impaired in older individuals compared to the younger ones. The cervical proprioception is significantly associated with functional mobility (p < 0.001), and the LOS (p < 0.001).

CONCLUSION

In older adults aged above 65 years, cervical proprioception, functional mobility, and the LOS are impaired. Older adults with greater cervical JPE had more impaired functional mobility and LOS parameters. When evaluating or treating older adults with problems with their balance or falls, these factors should be considered.

Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study

BACKGROUND

In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.

Grip force makes wrist joint position sense worse

Background

The purpose of this study was to investigate how grip force affects wrist joint position sense.

Methods

Twenty-two healthy participants (11 men and 11 women) underwent an ipsilateral wrist joint reposition test at 2 distinct grip forces [0 and 15% of maximal voluntary isometric contraction (MVIC)] and 6 different wrist positions (pronation 24°, supination 24°, radial deviation 16°, ulnar deviation 16°, extension 32°, and flexion 32°).

Results

The findings demonstrated significantly elevated absolute error values at 15% MVIC (3.8 ± 0.3°) than at 0% MVIC grip force [3.1 ± 0.2°, t(20) = 2.303, P = 0.032].

Conclusion

These findings demonstrated that there was significantly worse proprioceptive accuracy at 15% MVIC than at 0% MVIC grip force. These results may contribute to a better comprehension of the mechanisms underlying wrist joint injuries, the development of preventative measures to lower the risk of injuries, and the best possible design of engineering or rehabilitation devices.

Mediation Effect of Kinesiophobia on the Relationship between Cervical Joint Position Sense and Limits of Stability in Individuals with Fibromyalgia Syndrome: A Cross-Sectional Study Using Mediation Analysis

(1) Background: Individuals with fibromyalgia syndrome (FMS) may experience proprioceptive and balance impairments. Kinesiophobia is a factor that can mediate the relationship between cervical joint position sense (JPS) and limits of stability. The objectives of this study were to (1) compare the cervical JPS and limits of stability between FMS and asymptomatic individuals, (2) assess the relationship between cervical JPS and limits of stability, and (3) assess the mediation effect of kinesiophobia on the relationship between cervical JPS and limits of stability in FMS individuals. (2) Methods: In this comparative cross-sectional study, 100 individuals with FMS and 100 asymptomatic individuals were recruited. Cervical JPS was assessed using a cervical range of motion device, limits of stability (reaction time, maximum excursion, and direction control) were assessed using dynamic posturography, and FMS individuals' kinesiophobia was assessed using the Tampa scale of kinesiophobia (TSK). Comparison, correlation, and mediation analyses were performed. (3) Results: The magnitude of the mean cervical joint position error (JPE) was significantly larger in FMS individuals (p < 0.001) compared to the asymptomatic individuals. The limits of the stability test showed that FMS individuals had a longer reaction time (F = 128.74) and reduced maximum excursion (F = 976.75) and direction control (F = 396.49) compared to the asymptomatic individuals. Cervical JPE showed statistically significant moderate-to-strong correlations with reaction time (r = 0.56 to 0.64, p < 0.001), maximum excursion (r = -0.71 to -0.74, p < 0.001), and direction control (r = -0.66 to -0.68, p < 0.001) parameters of the limits of the stability test. (4) Conclusions: Cervical JPS and limits of stability were impaired in FMS individuals, and the cervical JPS showed a strong relationship with limits of stability variables. Moreover, kinesiophobia mediated the relationship between JPS and limits of stability. These factors may be taken into consideration when evaluating and developing treatment strategies for FMS patients.

Investigating Knee Joint Proprioception and Its Impact on Limits of Stability Using Dynamic Posturography in Individuals with Bilateral Knee Osteoarthritis-A Cross-Sectional Study of Comparisons and Correlations

(1) Background: Proprioception and limits of stability can significantly impact static and dynamic balance. Knee proprioception and limits of stability may be impaired in individuals with knee osteoarthritis (KOA). Impaired knee proprioception may impact the limits of stability, and understanding the associations between these factors is important for formulating treatment strategies in this population. The objectives of this study are to (a) compare the knee joint position error (JPE) and limits of stability between KOA and asymptomatic individuals and (b) assess the correlation between knee JPE and the limits of stability in KOA individuals. (2) Methods: This cross-sectional study included 50 individuals diagnosed with bilateral KOA and 50 asymptomatic individuals. Knee JPE was measured using a dual digital inclinometer at 25° and 45° of knee flexion (in the dominant and nondominant legs). The limits of stability variables, including reaction time (s), maximum excursion (%), and direction control (%), were evaluated using computerized dynamic posturography. (3) Results: The magnitude of the mean knee JPE is significantly larger in KOA individuals (p < 0.001) compared to asymptomatic individuals assessed at 25° and 45° of knee flexion in both the dominant and nondominant legs. The limits of stability test showed that KOA group individuals had a longer reaction time (1.64 ± 0.30 s) and reduced maximum excursion (4.37 ± 0.45) and direction control (78.42 ± 5.47) percentages compared to the asymptomatic group (reaction time = 0.89 ± 0.29, maximum excursion = 5.25 ± 1.34, direction control = 87.50 ± 4.49). Knee JPE showed moderate to strong correlations with the reaction time (r = 0.60 to 0.68, p < 0.001), maximum excursion (r = -0.28 to -0.38, p < 0.001) and direction control (r = -0.59 to -0.65, p < 0.001) parameters in the limits of stability test. (4) Conclusions: Knee proprioception and limits of stability are impaired in KOA individuals compared to asymptomatic individuals, and knee JPE showed significant relationships with the limits of stability variables. These factors and correlations may be considered when evaluating and developing treatment strategies for KOA patients.

Test-Retest Reliability of a Passive Joint Position Sense Test After ACL Reconstruction: Influence of Direction, Target Angle, Limb, and Outcome Measures

Background:

The joint position sense (JPS) is an element of proprioception and defined as an individual’s ability to recognize joint position in space. The JPS is assessed by measuring the acuity of reproducing a predetermined target angle. The quality of psychometric properties of knee JPS tests after anterior cruciate ligament reconstruction (ACLR) is uncertain.

Purpose/Hypothesis:

The purpose of this study was to evaluate the test-retest reliability of a passive knee JPS test in patients who underwent ACLR. We hypothesized that the passive JPS test would produce reliable absolute error, constant error, and variable error estimates after ACLR.

Study Design:

Descriptive laboratory study.

Methods:

Nineteen male participants (mean age, 26.3 ± 4.4 years) who had undergone unilateral ACLR within the previous 12 months completed 2 sessions of bilateral passive knee JPS evaluation. JPS testing was conducted in both the flexion (starting angle, 0°) and the extension (starting angle, 90°) directions in the sitting position. The absolute error, constant error, and variable error of the JPS test in both directions were calculated at 2 target angles (30° and 60° of flexion) by using the angle reproduction method for the ipsilateral knee. The standard error of measurement (SEM), smallest real difference (SRD), and intraclass correlation coefficients (ICCs) with 95% Cis were calculated.

Results:

ICCs were higher for the JPS constant error (operated and nonoperated knee, 0.43-0.86 and 0.32-0.91, respectively) compared with the absolute error (0.18-0.59 and 0.09-0.86, respectively) and the variable error (0.07-0.63 and 0.09-0.73, respectively). The constant error of the 90°-60° extension test showed moderate to excellent reliability for the operated knee (ICC, 0.86 [95% CI, 0.64-0.94]; SEM, 1.63°; SRD, 4.53°), and good to excellent reliability for the nonoperated knee (ICC, 0.91 [95% CI, 0.76-0.96]; SEM, 1.53°; SRD, 4.24°).

Conclusion:

The test-retest reliability of the passive knee JPS tests after ACLR varied depending on the test angle, direction, and outcome measure (absolute error, constant error, or variable error). The constant error appeared to be a more reliable outcome measure than the absolute error and the variable error, mainly during the 90°-60° extension test.

Clinical Relevance:

As constant errors have been found reliable during the 90°-60° extension test, investigating these errors—in addition to absolute and variable errors—to reflect bias in passive JPS scores after ACLR is warranted.

The Effect of Ice on Shoulder Proprioception in Badminton Athletes

This study aims to analyze the influence of the application of cryotherapy on shoulder proprioception in badminton athletes. Thirty federated badminton athletes were included in this study, all of whom belonged to three of the teams currently competing in national competitions (Portugal). Their mean ages were 21.00 ± 5.60 years, and their experience in the modality was 8.40 ± 6.93 years. They practiced in an average of 2.93 ± 1.26 training sessions per week. All of them used their right hand to hold the racket. Each participant's dominant shoulder joint position and force senses were evaluated for four consecutive time points through the isokinetic dynamometer Biodex System 3. The experimental procedure consisted of applying ice for 15 min and the control procedure consisted of no therapeutic intervention. The proprioception outcomes were expressed using the absolute error, relative error, and variable error. All statistical analysis was performed using PASW Statistics 18 software (IBM-SPSS Statistics). There were no statistically significant changes in the joint position and force senses after the intervention, as well as during the subsequent 30 min. We conclude that, after this cryotherapy technique, there is no increased risk of injury associated with a proprioception deficit that prevents athletes from immediately returning to badminton practice.

A Reliability of Active and Passive Knee Joint Position Sense Assessment Using the Luna EMG Rehabilitation Robot

Joint position sense (JPS) is the awareness of joint location in space, indicating accuracy and precision of the movement. Therefore, the aim of the present study is to determine the reliability of active and passive JPS assessment regarding the knee joint. This was carried out using the Luna EMG rehabilitation robot. Further analysis assessed whether the examination of only the dominant site is justified and if there are differences between sites. The study comprised 24 healthy male participants aged 24.13 ± 2.82 years, performing sports at a recreational level. Using the Luna EMG rehabilitation robot, JPS tests were performed for the right and left knees during flexion and extension in active and passive mode, in two separate sessions with a 1-week interval. Both knee flexion and extension in active and passive modes demonstrated high reliability (ICC = 0.866-0.982; SEM = 0.63-0.31). The mean JPS angle error did not differ significantly between the right and left lower limbs (p < 0.05); however, no between-limb correlation was noted (r = 0.21-0.34; p > 0.05). The Bland-Altman plots showed that the between-limb bias was minimal, with relatively wide limits of agreement. Therefore, it was concluded that the Luna EMG rehabilitation robot is a reliable tool for active and passive knee JPS assessment. In our study, JPS angle error did not differ significantly between left and right sides; however, the slight asymmetry was observed (visible in broad level of agreement exceeding 5° in Bland-Altman plots), what may suggest that in healthy subjects, e.g., active athletes, proprioception should always be assessed on both sides.

Comparisons and Associations between Hip-Joint Position Sense and Glycosylated Hemoglobin in Elderly Subjects with Type 2 Diabetes Mellitus-A Cross-Sectional Study

Hip-joint position sense (JPS) accuracy may be impaired in individuals with type 2 diabetes mellitus (T2DM). An impaired hip JPS can alter postural control and bodily balance. The objectives of this study are to (1) compare the hip JPS between T2DM and asymptomatic and (2) assess the relationship between hip JPS and glycosylated hemoglobin (HbAlc). This comparative cross-sectional study included 117 elderly individuals with T2DM (mean age: 59.82 ± 6.80 y) and 142 who were asymptomatic (mean age: 57.52 ± 6.90 y). The hip JPS was measured using a digital inclinometer. The individuals were repositioned to a target position with their eyes closed, and the magnitudes of matching errors were estimated as reposition errors. The hip JPS was evaluated in the flexion and abduction directions. The magnitude of reposition errors was significantly larger in the T2DM group in the right flexion (p < 0.001), the right abduction (p < 0.001), the left flexion (p < 0.001), and the left abduction (p < 0.001) directions compared to the asymptomatic group. HbA1c values showed a significant positive correlation with JPS in the right-hip flexion (r = 0.43, p < 0.001), the right-hip abduction (r = 0.36, p < 0.001), the left-hip flexion (r = 0.44, p < 0.001), and the left-hip abduction (r = 0.49, p < 0.001) directions. Hip JPS testing may be considered when assessing and formulating treatment strategies for individuals with type 2 diabetes. Future research should focus on how hip JPS can impact balance and falls in individuals with T2DM.

Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function

Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.

Evidence of distorted proprioception and postural control in studies of experimentally induced pain: a critical review of the literature

OBJECTIVES

Deficits in proprioception and postural control are common in patients with different musculoskeletal pain syndromes. It has been proposed that pain can negatively affect proprioception and postural control at a peripheral level, however research is limited to animal studies. Human studies have shown that it is more likely, that the link between pain and proprioceptive deficits, lies within changes in the central nervous system where noxious and non-noxious stimuli may overlap. In clinical studies, causality cannot be determined due to other factors which could confound the assessment such as pathophysiological features of the underlying musculoskeletal disorder and different psycho-social influences especially in patients with chronic pain. On the other hand, experimentally induced pain in healthy participants is able to control most of these confounding factors and perhaps offers an assessment of the effects of pain on proprioception and postural control. The aim of this paper is to critically appraise the literature related to the effect of experimentally induced pain on proprioception and postural control. Results from these studies are discussed and limitations are highlighted for future research.

METHODS

A search of databases (Medline, Scopus, PubMed) was conducted as well as reference check from relevant articles published since 2000. Fifteen studies which explored the effect of experimentally induced pain on postural control and ten studies which explored the effect of experimentally induced pain on proprioception were included.

RESULTS

We found that in the majority of the studies, postural control was negatively affected by experimentally induced pain. Results for proprioception were mixed depending on the body region and the way the painful stimuli were delivered. Kinesthesia was negatively affected in two studies, while in one study kinesthesia was enhanced. Joint position sense was not affected in four out of five studies. Finally, force sense was affected in three out of four studies.

CONCLUSIONS

From a clinical point of view, findings from the available literature suggest that experimentally induced pain impairs postural control and could potentially increases the risk for falls in patients. Interventions aiming to reduce pain in these patients could lead to preservation or improvement of their balance. On the other hand, the same conclusion cannot be drawn for the effect of experimentally induced pain on kinesthesia and joint position sense due to the limited number of studies showing such an effect.

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial

A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) post-intervention and at the 3-month follow-up (p < 0.003). Statistically significant differences between means were found in both the Quick-Dash and COPM post intervention (both, p < 0.001), as well as at the 3-month follow-up (both, p < 0.001). There was a significant time factor for the reduction of pain intensity over time but effect sizes between groups was small at the 3-month follow-up period. Proprioceptive training improves thumb JPS accuracy; however, it does not contribute to a reduction in pain intensity in the long term. The inclusion of a proprioceptive program may be beneficial for improving individuals with thumb CMC OA sensorimotor performance. The study was registered at ClinicalTrials.gov NCT04738201. No funding was provided for this study.

Association between Kinesiophobia and Knee Pain Intensity, Joint Position Sense, and Functional Performance in Individuals with Bilateral Knee Osteoarthritis

In current clinical practice, fear of movement has been considered a significant factor affecting patient disability and needs to be evaluated and addressed to accomplish successful rehabilitation strategies. Therefore, the study aims (1) to establish the association between kinesiophobia and knee pain intensity, joint position sense (JPS), and functional performance, and (2) to determine whether kinesiophobia predicts pain intensity, JPS, and functional performance among individuals with bilateral knee osteoarthritis (KOA). This cross-sectional study included 50 participants (mean age: 67.10 ± 4.36 years) with KOA. Outcome measures: The level of kinesiophobia was assessed using the Tampa Scale of Kinesiophobia, pain intensity using a visual analog scale (VAS), knee JPS using a digital inclinometer, and functional performance using five times sit-to-stand test. Knee JPS was assessed in target angles of 15°, 30°, and 60°. Pearson’s correlation coefficients and simple linear regressions were used to analyze the data. Significant moderate positive correlations were observed between kinesiophobia and pain intensity (r = 0.55, p < 0.001), JPS (r ranged between 0.38 to 0.5, p < 0.05), and functional performance (r = 0.49, p < 0.001). Simple linear regression analysis showed kinesiophobia significantly predicted pain intensity (B = 1.05, p < 0.001), knee JPS (B ranged between 0.96 (0° of knee flexion, right side) to 1.30 (15° of knee flexion, right side)), and functional performance (B = 0.57, p < 0.001). We can conclude that kinesiophobia is significantly correlated and predicted pain intensity, JPS, and functional performance in individuals with KOA. Kinesiophobia is a significant aspect of the recovery process and may be taken into account when planning and implementing rehabilitation programs for KOA individuals.

Test-Retest Reliability of a New Device Versus a Long-Arm Goniometer to Evaluate Knee Proprioception

CONTEXT

Many methods used to evaluate knee proprioception have shortcomings that limit their use in clinical settings. Based on an inexpensive 3D camera, a new portable device was recently used to evaluate the joint position sense (JPS) of the knee joint. However, the test-retest reliability of the new method remains unclear. This study aimed to evaluate the test-retest reliability of the new device and a long-arm goniometer for assessing knee JPS, and to compare the variability of the 2 methods.

DESIGN

Prospective observational study of the test-retest reliability of knee JPS measurements.

METHODS

Twenty-one healthy adults were tested in 2 sessions with a 1-week interval. Three target knee flexion angles (30°, 45°, and 60°) were reproduced in each session. Target and reproduced angles were measured with both methods. Intraclass correlation coefficients, standard error of the measurement, and Bland-Altman plots were used to quantify test-retest reliability. Paired t tests were used to compare knee JPS (absolute error of the target-reproduced angle) between the methods.

RESULTS

The new device (good to excellent intraclass correlation coefficients .74-.80; standard error of the measurement 0.52°-0.61°) demonstrated better test-retest reliability than the goniometer (poor to fair intraclass correlation coefficients .23-.43; standard error of the measurement 0.89°-2.07°) and better test-retest agreement (respective mean differences for the 30°, 45°, and 60° knee angles: 0.11°, 0.13°, and 0.41° for the new system; 0.84°, 1.52°, and 1.18° for the goniometer). The measurements (absolute errors of the target-reproduced angles) with the goniometer were significantly greater than those with the new device (P < .05); the SDs of repeated measurements with the goniometer (1.50°-2.41°) were greater than with the new device (1.08°-1.38°).

CONCLUSIONS

Given that the new device has good reliability and sufficient precision, it is the better alternative for evaluating knee JPS. Goniometers should be used with caution to assess knee JPS.

Valgus Control Feedback and Taping Improves the Effects of Plyometric Exercises in Women With Dynamic Knee Valgus

BACKGROUND

Female athletes are more predisposed to anterior cruciate ligament (ACL) injuries in comparison with their male counterparts. Research on ACL injury prevention strategies has demonstrated beneficial effects of plyometric exercises and feedback (FB) during the exercises. FB has resulted in reductions in vertical ground-reaction force and kinematic risk factors associated with ACL injury. Furthermore, taping (TP) may draw attention to the restriction created by the tape and serve as real-time biofeedback. The additional influence of FB and TP on plyometric exercises has not been determined.

HYPOTHESIS

FB and TP interventions delivered during plyometric exercises would result in positive changes in biomechanics and muscle onset in female athletes displaying dynamic knee valgus.

DESIGN

Controlled trial.

SETTING

University research laboratory.

LEVEL OF EVIDENCE

Level 2.

METHODS

Forty-eight active female athletes were divided into 3 groups: control (n = 16), plyometric training with FB (n = 16), and plyometric training with TP (n = 16). The 2 experimental groups performed a 6-week exercise program with either FB or TP. The control group continued its regular team schedule. Knee joint position sense, landing error scoring system (LESS), and the onset of muscle activation (the point at which muscle activation exceeds 3 standard deviations over baseline and continued above this threshold for at least 25 ms) before landing for the rectus femoris, vastus medialis, vastus lateralis, gluteus medius, semitendinosus, and biceps femoris during pre- and posttests were measured.

RESULTS

The vastus lateralis onset later in the TP group compared with the FB group (d [95% CI] = 0.64 [0.35-0.82], P = 0.01). Joint position sense accuracy improved only in the TP group (d = -0.63, P = 0.001). Both the FB (d = -0.85, P = 0.001), and TP (d = -0.82, P = 0.001) groups improved in LESS scores.

CONCLUSION

The results of the present study showed that plyometric exercises with FB or TP affect LESS and the onset of the vastus lateralis in active uninjured women with dynamic knee valgus, while TP improves joint position sense. Therefore, when more accurate joint position sense is desired, practitioners may use plyometric with TP. If an improved LESS score is desired, plyometrics with either TP or FB are acceptable.

CLINICAL RELEVANCE

Our findings indicate that female athletes may benefit more when completing a plyometric training program with a TP versus an FB. Trainers, coaches, and clinicians should consider utilizing instructions that promote an external focus when implementing plyometric training programs with male athletes.

Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review

Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.

Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair

Background:

Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR).

Purpose:

To investigate scapular dyskinesis, proprioception, and functional level after ABR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living.

Results:

The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group (P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls (P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation (r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score (r = 0.58; P = .03).

Conclusion:

Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.

Where is my hand in space? The internal model of gravity influences proprioception

Knowing where our limbs are in space is crucial for a successful interaction with the external world. Joint position sense (JPS) relies on both cues from muscle spindles and joint mechanoreceptors, as well as the effort required to move. However, JPS may also rely on the perceived external force on the limb, such as the gravitational field. It is well known that the internal model of gravity plays a large role in perception and behaviour. Thus, we have explored whether direct vestibular-gravitational cues could influence JPS. Participants passively estimated the position of their hand while they were upright and therefore aligned with terrestrial gravity, or pitch-tilted 45° backwards from gravity. Overall participants overestimated the position of their hand in both upright and tilted postures; however, the proprioceptive bias was significantly reduced when participants were tilted. Our findings therefore suggest that the internal model of gravity may influence and update JPS in order to allow the organism to interact with the environment.

Test-Retest Reliability of an iPhone® Inclinometer Application to Assess the Lumbar Joint Repositioning Error in Non-Specific Chronic Low Back Pain

Background: The joint position sense (JPS) has been used as an indirect marker of proprioception in subjects with non-specific chronic low back pain (NSCLBP), showing impairment in previous studies. It seems necessary to devise reliable tests to measure proprioceptive deficits in subjects with NSLBP. The objective of this study was to analyse the test-retest reliability and smallest real difference (SRD) of lumbar proprioception through the JPS indicator in a sample of patients with NSCLBP. Methods: Fifty participants with NSCLBP performed three repetitions of 30° lumbar flexion while standing and sitting using the iPhone^® inclinometer application to measure the lumbar joint repositioning error. For the reliability analysis, we performed an intra-session test-retest. Results: The total sample ICC values were excellent for standing (0.96) and sitting (0.93) 30° lumbar flexion. In addition, our results showed that, for the total sample, an SRD < 12% can be considered as a true change in proprioception concerning this procedure. On the other hand, men have better reliability than women in both standing and sitting positions. Additionally, the sitting position has better reliability than the standing position. The standard error of measurement (SEM) percentage was 4.2 for standing and 3.8 for sitting. The SRD percentage was 11.6 for standing and 10.4 for sitting. Conclusions: The iPhone^® inclinometer seems reliable for assessing proprioceptive ability through the lumbar joint repositioning error in subjects with NSCLBP in both standing (ICC = 0.96) and sitting (ICC = 0.93) positions. This technological device showed a lower measurement error for sitting position (SRD < 12%).

Shoulder Joint Position Sense Can Be Reduced by Sensory Reference Frame Transformations

Joint position sense (JPS) is commonly evaluated using an angle replication protocol with vision occluded. However, multiple sources of sensory information are integrated when moving limbs accurately, not just proprioception. The purpose of this study was to examine different availability of vision during an active JPS protocol at the shoulder. Specifically, the effects of four conditions of vision availability were examined for three target shoulder elevation angles (50°, 70° & 90°): vision occluded continuously (P-P); vision available continuously (VP-VP); vision occluded only during target memorization (P-VP); and vision occluded only during target position replication (VP-P). There were 18 participants (M age = 21, SD = 1 years). We used separate repeated ANOVAs to examine the effect of condition and target angle on participants' absolute error (AE, a measure of accuracy) and constant error (CE, a measure of directional bias). We found a significant main effect for condition and angle for both dependent variables (p < 0.01), and follow-up analysis indicated that participants were most accurate in the VP-VP condition and least accurate in the P-VP condition. Further follow-up analysis showed that accuracy improved with higher target elevation angles, consistent with previous research findings. Constant error results were similar, as there was a prominent tendency to overshoot the target. Unsurprisingly, participants performed best at the angle replication protocol with their eyes open. However, while accuracy was reduced when vision was occluded during target memorization, it was restored during target replication. This finding may have indicated an accuracy cost due to introduced noise when transforming sensory information from a proprioceptive reference frame into a visual reference frame.

Preoperative and postoperative shoulder position sense in patients who underwent arthroscopic Bankart repair for traumatic shoulder joint instability

Background

Proprioceptive feedback is a reflex dislocation prevention mechanism that contributes to shoulder joint stability. In patients with Bankart lesions, the anteroinferior glenohumeral ligament complex is damaged and reduces the likelihood of tensile stress. As a result, proprioceptive feedback does not work, which leads to instability. Surgical reconstruction is indicated to restore proprioception, but the details of recovery after arthroscopic surgery are unknown. The purpose of this study is to investigate whether arthroscopic Bankart repair can improve the position sense of the shoulder.

Methods

We used the isokinetic dynamometer Biodex System 3 (Biodex, Shirley, NY, USA) to investigate preoperative and postoperative joint position sense in 140 shoulders (137 men, 3 women) undergoing arthroscopic Bankart repair for traumatic shoulder joint instability. The control subjects comprised 40 shoulders of healthy volunteers (all men). Active position sense was measured by setting the shoulder external rotation to 75° based on 90° abduction and neutral internal/external rotation position. Reproductive angle inaccuracy (RAI) was measured thrice, and the mean value was calculated. The RAI was measured preoperatively, 6 months and 1 year postoperatively, and at the final observation (range, 16-96 months; mean, 31.5 months).

Results

Mean RAI was significantly higher (6.4°) preoperatively in the traumatic shoulder instability group than in the control group (5.0°). Mean postoperative RAI changed to 5.0, 4.9, and 4.7° at 6 months, 1 year, and final observation, respectively (mean, 31.5 months). RAI recovered to the same level as the control group at 6 months after the surgery and was maintained the same level until final observation.

Conclusion

Position sense was significantly worse in patients with traumatic shoulder joint instability than in healthy volunteers, and a significant improvement in position sense was observed after reconstruction of the anteroinferior glenohumeral ligament complex by arthroscopic Bankart repair. Therefore, arthroscopic Bankart repair is a favorable procedure that can improve the position sense of the shoulder in patients with traumatic shoulder instability.

Massage enhances recovery following exercise-induced muscle damage in older adults

To examine efficacy of cold water immersion (CWI) and massage as recovery techniques on joint position sense, balance, and fear of falling following exercise-induced muscle damage in older adults. Seventy-eight older men and women performed a single bout of strength training on the calf muscles (3 exercises with 4 sets of 10 reps with 75% of 1RM) to induce muscle damage. After the damaging exercise, participants received either a 15-minute massage on calf muscles, or a CWI of the lower limb in cold water (15 ± 1°C) for 15 minute, or passive rest. Interventions were applied immediately after the exercise protocol and at 24, 48, and 72 hours post-exercise. Muscle pain, calf muscle strength, joint position sense, dynamic balance, postural sway, and fear of falling were measured at each time point. Repeated application of massage after EIMD relieved muscle pain, attenuated the loss of muscle strength and joint position senses, reduce balance impairments, and fear of falling in older adults (P ≤ .05). However, repeated applications of CWI, despite relieving muscle pain (P ≤ .05), did not attenuate the loss of muscle strength, joint position senses, balance impairments, and fear of falling. CWI had only some modest effects on muscle pain, but massage attenuated EIMD symptoms and the related impairments in muscle strength, joint position sense, balance, and postural sway in untrained older individuals. Therefore, older exercisers who plan to participate in strength training can benefit from massage for recovery from muscle damage indices and balance to decrease falling risk during the days following strength training.

Electroacupuncture and Manual Acupuncture Increase Joint Flexibility but Reduce Muscle Strength

The objective of this study was to investigate the immediate effects of electroacupuncture and manual acupuncture on hip flexion range of motion (ROM), knee joint (flexion replication at 15° and 45°) and quadriceps (strength and activation) function. Forty-five neurologically healthy adults participated in this randomized controlled laboratory study. Straight leg raise test, modified Thomas test, and hip abductors strength test were performed to determine acupoints. Afterwards, one of three 15-min treatments (control—no treatment, electroacupuncture, or manual acupuncture) was randomly applied using determined acupoints. Measurements (hip flexion ROM, and knee joint and quadriceps function) were recorded at baseline, and at 0, 20, and 40 min post treatment. Both electroacupuncture (4.0°, ES = 0.41) and manual acupuncture (5.4°, ES = 0.95) treatment immediately increased hip flexion ROM, and the increased values persisted for 40-min (p = 0.01). Knee flexion replication (at 15°: p = 0.17; 45°: p = 0.19) and quadriceps activation (p = 0.71) did not change at any of the time points. Post-treatment, both electroacupuncture and manual acupuncture decreased quadriceps strength at 0-min (electroacupuncture: 9.2%, p < 0.0001, ES = 0.60) and 40-min (electroacupuncture: 7.3%, p = 0.005, ES = 0.55; manual acupuncture: 8.7%, p = 0.01, ES = 0.54). A single session of either electroacupuncture or manual acupuncture treatment (selected acupoints based on physical examination) may immediately improve joint flexibility but reduce muscle strength.

Comparison of Trunk Flexion Proprioception Between Healthy Athletes and Athletes With Patellofemoral Pain

OBJECTIVE

Patellofemoral pain (PFP) is the most commonly reported musculoskeletal overuse injury in active individuals, such as athletes, and is a multifactorial problem with no definite cause identified to date. Some studies have shown a relationship between impaired core and trunk sensorimotor control and knee disorders, especially PFP. The aim of this study was to evaluate trunk flexion proprioception by comparing the repositioning error between healthy athletes and athletes with PFP.

DESIGN

Cross-sectional case-control study.

SETTING

Rehabilitation sciences research center.

PARTICIPANTS

Twenty healthy athletes and 20 athletes with PFP.

MAIN OUTCOME MEASURES

To examine proprioception of trunk flexors, the absolute active and passive repositioning error at 30° and 60° trunk flexion were evaluated with isokinetic dynamometry. The results were compared between the two groups.

RESULTS

In the PFP group, the active trunk repositioning error at 30° flexion was significantly greater than in the healthy individuals (P < .001). The mean absolute active repositioning error at 30° flexion was 3.04° (1.37°) in the PFP group and 1.50° (0.70°) in the control group. There was no significant difference between groups in the active trunk repositioning error at 60° flexion (P = .066). The mean absolute active repositioning error at 60° flexion was 2.96° (1.26°) in the PFP group and 2.18° (0.99°) in the control group. The passive trunk repositioning error at 30° and 60° flexion was significantly greater in the PFP group (P = .013 and P = .004, respectively). The mean absolute passive repositioning error at 30° and 60° flexion in the PFP group was 2.94° (0.80°) and 3.13° (1.19°), respectively, and was 2.08° (1.08°) and 1.96° (0.71°), respectively, in the control group. The calculated eta-squared value showed that joint repositioning errors had large effect sizes (0.15-0.32).

CONCLUSION

Trunk proprioception in the flexion direction may be impaired in patients with PFP. This finding suggests that trunk proprioception training may be important in rehabilitation for athletes with PFP.

Contralateral effects of eccentric resistance training on immobilized arm

This study compared the effects of contralateral eccentric-only (ECC) and concentric-/eccentric-coupled resistance training (CON-ECC) of the elbow flexors on immobilized arm. Thirty healthy participants (18-34 y) were randomly allocated to immobilization only (CTRL; n = 10), immobilization and ECC (n = 10), or immobilization and CON-ECC group (n = 10). The non-dominant arms of all participants were immobilized (8 h·day^-1 ) for 4 weeks, during which ECC and CON-ECC were performed by the dominant (non-immobilized) arm 3 times a week (3-6 sets of 10 repetitions per session) with an 80%-120% and 60%-90% of one concentric repetition maximum (1-RM) load, respectively, matching the total training volume. Arm circumference, 1-RM and maximal voluntary isometric contraction (MVIC) strength, biceps brachii surface electromyogram amplitude (sEMG_RMS ), rate of force development (RFD), and joint position sense (JPS) were measured for both arms before and after immobilization. CTRL showed decreases (P < .05) in MVIC (-21.7%), sEMG_RMS (-35.2%), RFD (-26.0%), 1-RM (-14.4%), JPS (-87.4%), and arm circumference (-5.1%) of the immobilized arm. These deficits were attenuated or eliminated by ECC and CON-ECC, with greater effect sizes for ECC than CON-ECC in MVIC (0.29: +12.1%, vs -0.18: -0.1%) and sEMG_RMS (0.31:17.5% vs -0.15: -5.9%). For the trained arm, ECC showed greater effect size for MVIC than CON-ECC (0.47 vs 0.29), and increased arm circumference (+2.9%), sEMG_RMS (+77.9%), and RDF (+31.8%) greater (P < .05) than CON-ECC (+0.6%, +15.1%, and + 15.8%, respectively). The eccentric-only resistance training of the contralateral arm was more effective to counteract the negative immobilization effects than the concentric-eccentric training.

Joint position sense of lower extremities is impaired and correlated with balance function in children with developmental coordination disorder

OBJECTIVE

To determine the joint position sense of the lower extremities and its relationship with motor function in children with developmental coordination disorder (DCD) and typically developing (TD) children.

METHODS

A total of 56 participants were recruited; 28 children with DCD (age 10.86±1.07 years; 13 females, 15 males) and 28 TD children (age 10.96±1.18 years; 12 females, 16 males). Knee and ankle joint position sense were assessed using a Biodex isokinetic dynamometer. Joint position acuity was measured by position error (PE) and position error variability (PEV). Motor function was examined using the 2nd edition of Movement Assessment Battery for children (MABC-2) and quantified via sub-scores from 3 MABC-2 domains.

RESULTS

Both PE and PEV at knee and ankle joints were significantly greater in children with DCD compared with TD children. In addition, both PE and PEV were significantly greater at the ankle joints than the knee joints in children with DCD. For children with DCD only, joint position acuity in the lower extremities significantly and negatively correlated with MABC-2 balance sub-score.

CONCLUSION

This study verifies that lower limb proprioception is impaired in children with DCD. Also, children with DCD displayed greater proprioceptive deficits at the ankle compared with the knee joint. Children with DCD who had poorer joint position acuity, i.e. greater PE and PEV, in the lower extremities tended to perform less well in balance function.

Can a Conservative Rehabilitation Strategy Improve Shoulder Proprioception? A Systematic Review

CONTEXT

Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception.

OBJECTIVES

To summarize the available evidence of conservative rehabilitation (ie, nonsurgical) on proprioception among individuals with shoulder disorders.

EVIDENCE ACQUISITION

PubMed, Web of Science, and EBSCO were systematically searched, from inception until November 24, 2019. Selected articles were systematically assessed, and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were utilized for this review. The conservative treatments were categorized as follows: (1) conventional therapy, (2) proprioceptive training, (3) elastic kinesiology tape, and (4) other passive therapies.

EVIDENCE SYNTHESIS

Twelve articles were included, yielding 58 healthy control shoulders and 362 shoulders affected by impingement syndrome, glenohumeral dislocations, nonspecific shoulder pain, rotator cuff dysfunction, or subluxation poststroke. The level of agreement between the evaluators was excellent (84.9%), and the studies were evaluated to be of fair to excellent quality (risk of bias: 28.5%-100%). This review suggests, with moderate evidence, that proprioceptive training (upper-body wobble board or flexible foil training) can improve proprioception in the midterm. No decisive evidence exists to suggest that conventional therapy is of added value to enhance shoulder proprioception. Conflicting evidence was found for the improvement of proprioception with the application of elastic kinesiology tape, while moderate evidence suggests that passive modalities, such as microcurrent electrical stimulation and bracing, are not effective for proprioceptive rehabilitation of the shoulder.

CONCLUSIONS

Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic kinesiology tape does not appear to affect the sense of shoulder proprioception. This review suggests a possible specificity of training effect with shoulder proprioception.

Influence of Menstrual Cycle Phases on Neural Excitability in the Primary Somatosensory Cortex and Ankle Joint Position Sense

Introduction: Ankle sprain (AS) is one of the most common injuries among women engaged in competitive sports and recreational activities. Many studies have shown that several factors contributing to AS are influenced by the menstrual cycle. Despite the finding that abnormal joint position sense (JPS) is one of the major risk factors of AS, the alteration of the JPS throughout the menstrual cycle and its associated neural mechanisms remain unclear.

Objective: This study aimed to examine whether the menstrual cycle phases affect neural excitability in the primary somatosensory cortex (S1) and JPS.

Methods: Fourteen right-footed women participated in this study. Somatosensory-evoked potential and paired-pulse inhibition (PPI) were measured to assess S1 excitatory and inhibitory functions. Ankle JPS was measured using an active joint position matching method. Menstrual syndrome was evaluated using the menstrual distress questionnaire. All assessments were conducted in the follicular, ovulatory, and luteal phases.

Results: The two main findings of this study were as follows: First, PPI decreased in the ovulatory phase than in the follicular phase. This may have been the reason for estrogen altering the neural inhibition and facilitation balance throughout the menstrual cycle. Second, JPS was not changed during the menstrual cycle.

Conclusion: In conclusion, phases of the menstrual cycle affect the neural excitability in S1 as shown by the decreased PPI in the ovulatory phase, and the ankle JPS was unchanged throughout the menstrual cycle.

Evaluation of proprioception in denervated and healthy wrist joints

We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.

Motoneuron Function Does not Change Following Whole-Body Vibration in Individuals With Chronic Ankle Instability

CONTEXT

Following a lateral ankle sprain, ∼40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and, therefore, possibly prevent reinjury.

OBJECTIVE

To determine if an acute bout of WBV can improve AMI and proprioception in individuals with CAI.

DESIGN AND PARTICIPANTS

The authors examined if an acute bout of WBV can improve AMI and proprioception in individuals with CAI with a repeated-measures design. A total of 10 young adults with CAI and 10 age-matched healthy controls underwent a control, sham, and WBV condition in randomized order.

SETTING

Biomechanics laboratory.

INTERVENTION

WBV.

MAIN OUTCOME MEASURES

Motoneuron pool recruitment was assessed via Hoffmann reflex (H-reflex) in the soleus. Proprioception was evaluated using ankle joint position sense at 15° and 20° of inversion. Both were assessed prior to, immediately following, and 30 minutes after the intervention (pretest, posttest, and 30mPost, respectively).

RESULTS

Soleus maximum H-reflex:M-response (H:M) ratios were 25% lower in the CAI group compared with the control group (P = .03). Joint position sense mean constant error did not differ between groups (P = .45). Error at 15° in the CAI (pretest 0.8 [1.6], posttest 2.0 [2.8], 30mPost 2.0 [1.9]) and control group (pretest 0.8 [2.0], posttest 0.6 [2.9], 30mPost 0.5 [2.1]) did not improve post-WBV. Error at 20° did not change post-WBV in the CAI (pretest 1.3 [1.7], posttest 1.0 [2.4], 30mPost 1.5 [2.2]) or control group (pretest -0.3 [3.0], posttest 0.8 [2.1], 30mPost 0.6 [1.8]).

CONCLUSION

AMI is present in the involved limb of individuals with CAI. The acute response following a single bout of WBV did not ameliorate the presence of AMI nor improve proprioception in those with CAI.

Validity and Reliability of an Inertial Sensor-Based Knee Proprioception Test in Younger vs. Older Adults

Diminishing proprioception caused by aging effects is associated with a higher risk to fall. However, existing measurement systems of proprioception are often expensive, time-consuming, or insufficient regarding reliability evaluation. Inertial sensor-based systems could address these issues. Consequently, this study sought to develop and evaluate an inertial sensor-based joint position sense test. Thereto, intra-session and inter-day test-retest reliability were investigated in a cross-over design. Twenty healthy younger (age: 22 ± 3 years) and 20 healthy older adults (age: 65 ± 5 years) participated in the study. We calculated the mean of the absolute error, the signed error, and the standard deviation of the signed error. Test-retest reliability was quantified by using the intraclass correlation coefficient as well as the bias and limits of agreement. To evaluate the possibility of capturing aging effects, and correspondingly a validation of the system, we calculated Cohen's d. For the intra-session reliability, fair to good agreements were achieved for the absolute and relative error in all target ranges. Compared to younger adults, we registered a declined joint position sense in older adults with high effects observed for the absolute error in a target range of 15–25 and 35–45° as well as for the variable error in the target ranges of 35–45 and 55–65°. We suggest that inertial sensor-based joint position sense tests are reliable and capable to measure aging effects on proprioception, and are therefore a low-cost and mobile alternative to existing methods.

The long-term effect of complex regional pain syndrome type 1 on disability and quality of life after foot injury

PURPOSE

To study the long-term evolution of patients with lower-limb Complex Regional Pain Syndrome (CRPS), focusing on functional and proprioceptive aspects and quality of life.

METHODS

In 20 patients suffering from chronic distal lower-limb CRPS diagnosed using Budapest criteria, we assessed joint position sense and strength of the knee muscles at the CRPS and unaffected leg, functional exercise capacity, pain, CRPS severity score, quality of life and kinesiophobia. Similar assessments were performed in 20 age-matched controls.

RESULTS

The joint position performance (at 45°) was significantly lower for the CRPS leg as compared to controls. The knee extensor strength of the CRPS leg was significantly reduced as compared to the unaffected leg (-27%) and controls (-42%). CRPS patients showed significantly reduced performance at the 6 min-walk test as compared to their age group predicted value and controls. Patients suffering from CRPS for 3.8 years in average still exhibit high pain, severity and kinesiophobia scores.

CONCLUSIONS

Long-term deficits in strength and proprioceptive impairments are observed at the knee joint of the CRPS leg. This persistent functional disability has significant repercussions on the quality of life. We highlight the importance of including strength and proprioceptive exercises in the therapeutic approaches for CPRS patients.IMPLICATIONS FOR REHABILITATIONThe long-term evolution of patients suffering from lower-limb Complex Regional Pain Syndrome is associated with persistent disability, pain and impacts the quality of life.Strength, proprioceptive, functional and subjective assessments are necessary to better identify deficits.Rehabilitation should focus on the overall deficit of the affected and contralateral limb.

Age-Related Differences in the Relationships Between Lower-Limb Joint Proprioception and Postural Balance

OBJECTIVE

In the present study we aimed to investigate the relationships between lower-limb joint proprioception and postural balance. Age-related differences in such relationships were also identified.

BACKGROUND

Impaired postural balance is reportedly one of the most common risk factors for fall accidents. Interventions have been proposed to improve postural balance by enhancing proprioceptive feedback. However, there is still no consensus on the optimal design for these interventions; therefore, there is a need to better reveal the contributions of lower-limb joint proprioception to postural balance.

METHOD

Twenty-eight young and 28 older adults participated. Lower-limb joint proprioception was assessed by joint position sense errors measured at the ankle, knee, and hip of the dominant side, respectively. Postural balance was assessed by using center-of-pressure measures during bilateral static stance.

RESULTS

Ankle joint position sense error was positively correlated with root mean squared distance of the center of pressure in the anterior-posterior and medial-lateral directions in both young and older adults. Different from young adults, hip joint position sense error was positively correlated with root mean squared distance of the center of pressure in the anterior-posterior and medial-lateral directions in older adults only.

CONCLUSION

Declined ankle and hip proprioception could be risk factors for falls in older adults. Age-related differences in the effects of hip proprioception suggests that hip proprioception is more important for maintaining balance in older adults. Ankle proprioception contributes the most to balance maintenance. Thus, ankle proprioception enhancement exercises should be considered in fall prevention interventions.

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.

Balance and proprioception responses to FIFA 11+ in amateur futsal players: Short and long-term effects

Background: The FIFA 11+ has shown positive effects on balance and proprioception parameters in football players. As there have been very few research studies involving futsal, we examined the short and long term effects of the FIFA 11+ on static and dynamic balance, as well as proprioception in male amateur futsal players. Methods: Seventy-one male futsal players were randomized to two groups (FIFA 11+: n = 37, age: 27.33 ± 4.33 years; Control: n = 34, age: 25.55 ± 4.65 years). Intervention lasted 10 weeks, 2 sessions per week, succeeded by a 10-week follow-up period. For balance testing, we assessed the single-legged postural sway with a force platform (static balance) and the Y balance test (dynamic balance). Proprioception was assessed with active joint position sense testing. Results: Complete pre-post intervention and follow-up tests were available for 61 players. The FIFA 11+ group showed higher training exposure and lower body mass index and body weight. After adjustment for baseline differences, no significant differences between groups were observed in the pre-post changes for centre of pressure measures, Y-balance and proprioception parameters both at short and long-term. Conclusions: Performing FIFA 11+ for 10 weeks did not improve static and dynamic balance as well as proprioception in amateur futsal players.

Timed Vibration Sense and Joint Position Sense Testing in the Diagnosis of Distal Sensory Polyneuropathy

Introduction:

Distal sensory polyneuropathy (DSP) is one of the most common neurological disorders. Although several studies have studied the role of the neurological examination in DSP, there are only limited studies on the utility of timed vibration sense (VBS) and joint position sense (JPS) testing in the diagnosis of DSP.

Objectives:

The objective is to study the utility of timed VBS testing and JPS testing at the great toe in clinical detection of DSP.

Methods:

This study was prospectively conducted in the neurology department of a tertiary care hospital in India. Patients with DSP referred to the electrophysiology laboratory from August 2017 to December 2017 were screened. Patients with symptomatic DSP which was confirmed by electrophysiological studies were taken as cases and normal participants with no symptoms or electrophysiological findings suggestive of DSP served as controls.

Results:

We studied 127 patients and 194 controls. The mean age of the patients was 48.7 (14.5) years in the patient group and 39.7 (14.5) years in the control group. The male: female ratio was 77/50 in the patient group and 112/82 in the control group. Abnormal clinical examination was found in 95% of the patients with DSP. The most common abnormal examination components were impaired ankle reflexes (70%), vibration (85%), and JPS (39.6%) sensation. Using the receiver operating characteristic curve for the diagnosis of DSP, a vibratory response lasting <8 s at the great toe had a sensitivity of 85% and specificity of 42.8%. For JPS testing at the great toe, obtaining two or more incorrect responses had a sensitivity of 33% and specificity of 87.6%.

Conclusion:

VBS testing was more sensitive and JPS testing was more specific in making a clinical diagnosis of DSP. For timed VBS, duration of >8 s at the great toe was a useful test to rule out DSP, and for JPS testing at the great toe, obtaining two or more incorrect responses was a useful test in ruling in the diagnosis of DSP.

Bilateral shoulder proprioception deficit in unilateral anterior shoulder instability

HYPOTHESIS AND BACKGROUND

Proprioception is an important element of shoulder dynamic stability. It has been shown to be affected in cases of capsular or labral injuries of the glenohumeral joint. Therefore, this study was conducted to investigate bilateral shoulder proprioception by active reproduction of joint position both in patients with post-traumatic recurrent unilateral shoulder instability and in normal healthy volunteers.

METHODS

We compared 41 patients, comprising 11 female and 30 male patients with an average age of 25.6 years (range, 18-39 years), with post-traumatic unilateral anterior shoulder instability with a control group of 27 healthy volunteers with no history of shoulder problems and with normal shoulder function during examination. All patients were examined using a high-accuracy computer-controlled electronic goniometer (Propriometer). The error of active reproduction of joint position (EARJP) was measured in abduction, flexion, external rotation, and internal rotation in both shoulders.

RESULTS

We observed a significant deficit in the EARJP in the unstable shoulders within the instability group. Surprisingly, similar results were recorded for the contralateral, unaffected shoulders within this group of patients compared with the control group. Joint acuity increased with higher elevation of the arm position.

CONCLUSION

Unilateral shoulder injuries, resulting in instability, affect proprioception in both shoulders, as demonstrated by an increased EARJP. This is the first report of unilateral shoulder instability coexisting with inferior proprioception in both shoulders.

Preliminary Report

BACKGROUND

Kinesiology Taping is a very popular physiotherapy method. It is used in both healthy people and orthopaedic patients in order to relieve pain, increase range of motion and for other purposes. Many researchers claim that these applications will also improve proprioception and sensorimotor efficiency, which are important for recovery after injuries and orthopaedic surgeries, especially on the knee joint. The aim of this study was to determine the effect of the muscle application of Kinesiology Taping on knee joint position sense in active motion.

MATERIAL AND METHODS

The study involved 50 healthy people (30 men and 20 women). Mean age was 23.2 years (range 18-30 years). The exclusion criteria were past knee injuries and knee surgery that could affect the test results. The participants were divided randomly into two equal groups. The first group (KT group) had a Kinesiology Taping muscle application placed, whereas a placebo application of an adhesive tape was used in the remaining participants (placebo group). Both applications were supposed to support quadriceps muscle activity. Joint position sense (JPS) was evaluated by measuring the error of active reproduction of the joint position (EARJP) of the knee in 45° flexion. The test was performed prior to applying the patch, after the patch was applied, then after 24 hours of wearing it and after removing the tape. The interval between trials before and after application of the patch was not less than 30 minutes. Statistical analysis was performed using Statistica 12.0. Distribution characteristics were calculated and the Wilcoxon test, Friedman's ANOVA and Mann-Whitney U test were performed.

RESULTS

The average test scores of JPS in the KT group and the placebo group before applying the KT patch were 3.48° and 5.16° respectively, compared to 4.84° and 4.88°, respectively, with the patch on, 5.12° and 4.96°, respectively, after 24 hours of wearing the tape, and 3.84° and 5.12°, respectively, after removing the patch. Within-group differences at any two time points were not statistically significant. There were also no significant differences between the groups.

CONCLUSIONS

1. Kinesiology Taping application to the quadriceps muscle had no significant effect on knee joint proprioception. Its use in order to improve sensorimotor skills therefore seems unreasonable. 2. The results are the basis for future prospective, randomised trials of larger experimental groups and involving the use of other Kinesiology Taping applications as well as including individuals with lesions of knee joint structures.

Two 4-Week Balance-Training Programs for Chronic Ankle Instability

CONTEXT

  Traditional single-limb balance (SLB) and progressive dynamic balance-training programs for those with chronic ankle instability (CAI) have been evaluated in the literature. However, which training program may be more beneficial is not known.

OBJECTIVE

  To investigate the effects of a progressive hop-to-stabilization balance (PHSB) program compared with an SLB program on self-reported function, dynamic postural control, and joint position sense (JPS) where angle and direction were self-reported by participants with CAI.

DESIGN

  Randomized controlled clinical trial.

SETTING

  A single testing location in a mid-Atlantic state.

PATIENTS OR OTHER PARTICIPANTS

  A total of 18 participants (age = 18.38 ± 1.81 years; height = 175.26 ± 6.64 cm; mass = 75.79 ± 12.1 kg) with CAI.

INTERVENTION(S)

  Participants were randomly assigned to the PHSB or SLB program. The PHSB and SLB groups pursued their 4-week programs 3 times a week. The PHSB group performed a battery of single-limb hop-to-stabilization exercises, while the SLB group performed a series of SLB exercises. Exercises were advanced throughout the 4 weeks for both groups.

MAIN OUTCOMES MEASURE(S)

  Pretest and posttest measurements were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living subscale; FAAM-Sports subscale; Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; and weight-bearing JPS blocks (dorsiflexion, plantar flexion, inversion, eversion).

RESULTS

  A significant main effect of time was present for the FAAM-Activities of Daily Living, FAAM-Sports, Star Excursion Balance Test (anterior, posteromedial, and posterolateral directions), and JPS (dorsiflexion, plantar flexion, inversion), as posttest results improved for the PHSB and SLB groups. The main effect of group was significant only for the FAAM-Sports, with the SLB group improving more than the PHSB group.

CONCLUSIONS

  Either a 4-week PHSB or SLB can be used in athletes with CAI, as both programs resulted in similar gains.

Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study

CONTEXT

Scapular proprioception is a key concern in managing shoulder impingement syndrome (SIS). However, no study has examined the effect of elastic taping on scapular proprioception performance.

OBJECTIVE

To investigate the immediate effect of kinesiology taping (KT) on scapular reposition accuracy, kinematics, and muscle activation in individuals with SIS.

DESIGN

Randomized controlled study.

SETTING

Musculoskeletal laboratory, National Yang-Ming University, Taiwan.

PARTICIPANTS

Thirty overhead athletes with SIS.

INTERVENTIONS

KT or placebo taping over the upper and lower trapezius muscles.

MAIN OUTCOME MEASURES

The primary outcome measures were scapular joint position sense, measured as the reposition errors, in the direction of scapular elevation and protraction. The secondary outcomes were scapular kinematics and muscle activity of the upper trapezius, lower trapezius, and serratus anterior during arm elevation in the scapular plane (scaption).

RESULTS

Compared with placebo taping, KT significantly decreased the reposition errors of upward/downward rotation (P = .04) and anterior/posterior tilt (P = .04) during scapular protraction. KT also improved scapular kinematics (significant group by taping effect for posterior tilt, P = .03) during scaption. Kinesiology and placebo tapings had a similar effect on upper trapezius muscle activation (significant taping effect, P = .003) during scaption.

CONCLUSIONS

Our study identified the positive effects of KT on scapular joint position sense and movement control. Future studies with a longer period of follow-up and clinical measurement might help to clarify the clinical effect and mechanisms of elastic taping in individuals with SIS.

The short-term effect of swimming training load on shoulder rotational range of motion, shoulder joint position sense and pectoralis minor length

BACKGROUND

Shoulder pain or injury is the most common issue facing elite competitive swimmers and the most frequent reason for missed or modified training. Literature suggests that highly repetitive upper limb loading leads to inappropriate adaptations within the shoulder complex. The most likely maladaptations to occur are variations in shoulder rotational range of motion, reduction in joint position sense and shortened pectoralis minor length. This has yet to have been confirmed in experimental studies. The aim of this study was to investigate the short-term effects of swimming training load upon internal and external rotation range of motion, joint position sense and pectoralis minor length.

METHOD

Sixteen elite swimmers training in the British Swimming World Class programme participated. Measures of internal and external range of motion, joint position sense error score and pectoralis minor length were taken before and after a typical 2 h swimming session.

RESULTS

Following swimming training shoulder external rotation range of motion and pectoralis minor length reduced significantly (-3.4°, p = <0.001 and -0.7 cm, p = <0.001, respectively), joint position sense error increased significantly (+2.0° error angle, p = <0.001). Internal rotation range of motion demonstrated no significant change (-0.6, p = 0.53).

DISCUSSION

This study determined that elite level swimming training results in short-term maladaptive changes in shoulder performance that could potentially predispose them to injury.

Training proprioception with sound: effects of real-time auditory feedback on intermodal learning

Our study analyzed the effects of real-time auditory feedback on intermodal learning during a bilateral knee repositioning task. Thirty healthy participants were randomly allocated to control and experimental groups. Participants performed an active knee joint repositioning task for the four target angles (20°, 40°, 60°, and 80°) bilaterally, with or without additional real-time auditory feedback. Here, the frequency of auditory feedback was mapped to the knee's angle range (0-90°). Retention measurements were performed on the same four angles, without auditory feedback, after 15 min and 24 hours. A generalized knee proprioception test was performed after the 24-h retention measurement on three untrained knee angles (15°, 35°, and 55°). Statistical analysis revealed a significant enhancement of knee proprioception, shown as a lower knee repositioning error with auditory feedback. This enhancement of proprioception also persisted in tests performed between the 5th and 6th auditory-motor training blocks (without auditory feedback). Enhancement in proprioception also remained stable during retention measurements (after 15 min and 24 h). Similarly, enhancement in the generalized proprioception on untrained knee angles was evident in the experimental group. This study extends our previous findings and demonstrates the beneficial effects of real-time auditory feedback to facilitate intermodal learning by enhancing knee proprioception in a persisting and generalized manner.