Rehabilitation continues to evolve with the increased emphasis on patient management and proprioceptive training. Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position (joint position sense). Numerous investigators have observed that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Examining the effects of ligamentous injury, surgical intervention, and proprioceptively mediated activities in the rehabilitation program provides an understanding of the complexity of this system responsible for motor control. It appears that this neuromuscular feedback mechanism becomes interrupted with injury and abnormalities, and approaches restoration after surgical intervention and rehabilitation. Rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. Such a program is highly recommended to promote dynamic joint and functional stability. Thus far, current knowledge regarding the basic science and clinical application of proprioception has led the profession of sports medicine one step closer to its ultimate goal of restoring function.

The purpose of this study was to determine the relationship between hip and knee strength, and valgus knee motion during a single leg squat. Thirty healthy adults (15 men, 15 women) stood on their preferred foot, squatted to approximately 60 deg of knee flexion, and returned to the standing position. Frontal plane knee motion was evaluated using 3-D motion analysis. During Session 2, isokinetic (60 deg/sec) concentric and eccentric hip (abduction/adduction, flexion/extension, and internal/external rotation) and knee (flexion/extension) strength was evaluated. The results demonstrated that hip abduction (r2=0.13), knee flexion (r2=0.18), and knee extension (r2=0.14) peak torque were significant predictors of frontal plane knee motion. Significant negative correlations showed that individuals with greater hip abduction (r=-0.37), knee flexion (r=-0.43), and knee extension (r=-0.37) peak torque exhibited less motion toward the valgus direction. Men exhibited significantly greater absolute peak torque for all motions, excluding eccentric internal rotation. When normalized to body mass, men demonstrated significantly greater strength than women for concentric hip adduction and flexion, knee flexion and extension, and eccentric hip extension. The major findings demonstrate a significant role of hip muscle strength in the control of frontal plane knee motion.

Proprioception and accompanying neuromuscular feedback mechanisms provide an important component for the establishment and maintenance of functional joint stability. Neuromuscular control and joint stabilisation is mediated primarily by the central nervous system. Multisite sensory input, originating from the somatosensory, visual and vestibular systems, is received and processed by the brain and spinal cord. The culmination of gathered and processed information results in conscious awareness of joint position and motion, unconscious joint stabilisation through protective spinal-mediated reflexes and the maintenance of posture and balance. Clinical research aimed at determining the effects of articular musculoskeletal injury, surgery and rehabilitation, on joint proprioception, neuromuscular control and balance has focused on the knee and ankle joints. Such studies have demonstrated alterations in proprioception subsequent to capsulo-ligamentous injury, partial restoration of proprioceptive acuity following ligamentous reconstruction, and have suggested beneficial proprioceptive changes resulting from comprehensive rehabilitation programmes.

The importance of accurately reproducing isokinetic strength values is critical for the assessment of training induced changes in muscle function. The purpose of this study was to determine the test re-test reliability of the Biodex System 2 Isokinetic Dynamometer for concentric quadricep and hamstring strength and muscular endurance. Twenty-one healthy volunteers underwent isokinetic testing on 2 occasions separated by 7 days. Each subject performed 5 repetitions at 60 degrees/ second followed by a muscular endurance test which consisted of 30 repetitions at 180 degrees/second. The results demonstrated high ICC values ranging from r = 0.88 to r = 0.97 and r = 0.82 to r = 0.96 for variables measured at 60 degrees/second and 180 degrees/second, respectively, SEM values were found to range from low to moderate, 4.8% to 11.6% and 5.6% to 10.8%, at 60 and 180 degrees/second, respectively. ICC coefficients were found to be low, r = 0.52 to r = 0.74, and SEM values were found to be high, 9.8% to 20.8%, for the work fatigue index at 180 degrees/second. The results demonstrate that isokinetic values obtained at 60 and 180 degrees/second are highly reproducible with the Biodex System 2 Dynamometer provided that adequate calibration, gravity correction and patient positioning is recorded and standardized. However, the work fatigue index as a measure of muscular endurance has not been shown to be reliable or precise. Changes in muscular strength over time should be considered valid if these differences lie beyond the SEM values reported in this study.

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The purpose of this study was to examine gender differences in knee extensor and flexor peak torque, work, power, and muscle fatigue during maximal effort isokinetic contractions. Subjects included 19 healthy male and 20 healthy female volunteers. Following a dynamic warm-up period, subjects performed 30 reciprocal, concentric maximal knee extension and flexion contractions at a pre-set angular velocity of 3.14 rad x s(-1) on the Biodex Isokinetic Dynamometer. Values for knee extensor peak torque, work, and power were calculated for each repetition over an angular displacement of 1.05 rad for each repetition. The single highest repetition value for knee extensor and flexor peak torque, work, and power was then calculated relative to body mass (N x m x kg(-1), J x kg(-1), W x kg(-1)) and allometric-scaled (N x m x kg(-) (n), J x kg(-) (n), W x kg(-) (n)) units. The allometric-scaled units were derived from a log-log transformation and linear regression analysis to calculate the exponent to which body mass is raised. The rate of quadriceps femoris muscle fatigue was calculated as the decline in each isokinetic variable by the linear slope from the single highest repetition value through the 30th repetition, and by two different fatigue indexes. The results demonstrate higher knee extension and flexion peak torque, work, and power in absolute, relative, and allometric-scaled units for males compared to females. Males exhibited higher fatigue rates for both muscle groups of each isokinetic variable than females, as described by the slope and the fatigue index, except when adjusted for peak values via analysis of covariance. The findings suggest that during maximal-effort muscle contractions, males exhibit a higher susceptibility to muscle fatigue than females, a phenomenon that may be related to an inherent ability to generate higher knee extensor and flexor torque.

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