Long-term neuromuscular training and ankle joint position sense

Abstract

Preventive effect of proprioceptive training is proven by decreasing injury incidence, but its proprioceptive mechanism is not. Major hypothesis: the training has a positive long-term effect on ankle joint position sense in athletes of a high-risk sport (handball). Ten elite-level female handball-players represented the intervention group (training-group), 10 healthy athletes of other sports formed the control-group. Proprioceptive training was incorporated into the regular training regimen of the training-group. Ankle joint position sense function was measured with the "slope-box" test, first described by Robbins et al. Testing was performed one day before the intervention and 20 months later. Mean absolute estimate errors were processed for statistical analysis. Proprioceptive sensory function improved regarding all four directions with a high significance (p<0.0001; avg. mean estimate error improvement: 1.77 degrees). This was also highly significant (p< or =0.0002) in each single directions, with avg. mean estimate error improvement between 1.59 degrees (posterior) and 2.03 degrees (anterior). Mean absolute estimate errors at follow-up (2.24 degrees +/-0.88 degrees) were significantly lower than in uninjured controls (3.29 degrees +/-1.15 degrees) (p<0.0001). Long-term neuromuscular training has improved ankle joint position sense function in the investigated athletes. This joint position sense improvement can be one of the explanations for injury rate reduction effect of neuromuscular training.

Which Treatment is More Effective for Functional Ankle Instability: Strengthening or Combined Muscle Strengthening and Proprioceptive Exercises?

“…In this study, Groups B and C showed significant increases compared with Group A, and when Groups B and C were compared with each other, Group C showed significant increases compared with Group B. Based on this, proprioceptive exercises in combination with muscle strengthening exercises helped to improve ankle stability23 ) . Therefore, combined muscle strengthening and proprioceptive exercises are more effective than muscle strengthening exercises only.…”

The effectiveness of proprioceptive training for improving motor function: a systematic review

“…They involved at least one form of active movement such as single or multi-joint position matching, tracking or reaching tasks, or haptic discrimination tests. Typical reported variables were joint position matching errors, psychophysical thresholds, spatial reaching error, and other limb kinematic measures such as movement time, velocity, or range of motion (Bakan and Thompson, 1967 ; Hocherman et al, 1988 ; Hocherman, 1993 ; Jacobson et al, 1997 ; Hilberg et al, 2003 ; Struppler et al, 2003 ; Robin et al, 2004 ; Diracoglu et al, 2005 ; Sekir and Gür, 2005 ; Haas et al, 2006 ; Kynsburg et al, 2006 , 2010 ; Lin et al, 2007 , 2009 ; Jan et al, 2008 ; Panics et al, 2008 ; Casadio et al, 2009a ; Cordo et al, 2009 ; McKenzie et al, 2009 ; Röijezon et al, 2009 ; Ju et al, 2010 ; Conrad et al, 2011 ; Wong et al, 2011 , 2012 ; Beets et al, 2012 ).…”

“…Among the remaining studies, 15 studies did not include a control group, 6 studies included non-equivalent groups and 16 studies did not report sufficient information. Kynsburg et al ( 2010 ) was excluded because the control group only performed the baseline assessment. Yozbatiran et al ( 2006 ) was excluded because the outcome measure were nominal .…”

“…Studies seeking to train balance applied a multitude of activities including walking and stair-stepping exercises, single and double leg balance exercises with and without vision, sit-to-stand exercises, standing, walking, or jumping on stable and unstable surfaces and sport specific exercises (Eils and Rosenbaum, 2001 ; Hilberg et al, 2003 ; Diracoglu et al, 2005 ; Sekir and Gür, 2005 ; Kynsburg et al, 2006 , 2010 ; Risberg et al, 2007 ; Westlake and Culham, 2007 ; Panics et al, 2008 ; Eils et al, 2010 ; Badke et al, 2011 ). Across all studies pre- to post-test improvements ranged between 16 and 97% (mean: 41%).…”

Effect of Attention Instructions of Balance Training in Athletes With Ankle Instability

“…Body awareness should receive information from the surroundings by sensory receptors including visual, atrial, and somatosensory receptors and transmit them to the central nervous system [21]. Proprioception receptors, including joint position sense of recognition and kinesthesia are the most important components effective in gaining body awareness [22,23]. After ankle sprain and subsequently, instability in the joint due to torn external ligaments of ankle, the proprioception of this area will be disturbed [24].…”