Balance Control Deficits are Associated With Diminished Ankle Force Sense, Not Position Sense, in Athletes with Chronic Ankle Instability.

OBJECTIVES: To compare balance control and ankle proprioception between athletes with and without chronic ankle instability (CAI). A further objective was to explore the relationship between balance control performance and ankle proprioception in athletes with CAI. DESIGN: Cross-sectional study. SETTINGS: Sports Rehabilitation Laboratory. PARTICIPANTS: Eighty-eight recreational athletes (47 CAI and 41 healthy control) were recruited. INTERVENTIONS: No applicable. MAIN OUTCOME MEASURES: Balance control performance was assessed using the sway velocity of the center of the pressure during the one-leg standing tasks. Ankle proprioception, including joint position sense and force sense, were tested using absolute error (AE) associated with joint position reproduction and force reproduction tasks in 4 directions, that is, plantarflexion, dorsiflexion, inversion, and eversion. RESULTS: Athletes with CAI performed significantly worse than those without CAI in balance control tasks. In addition, CAI athletes showed significantly worse joint position sense and force sense in all 3 movement directions tested (plantarflexion, inversion, and eversion). Correlation analysis showed that the AE of the plantarflexion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open and closed conditions (r=.372-.403, P=.006-.012), and the AE of inversion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open (r=.345, P=.018) in athletes with CAI, but the joint position sense measures were not (all P>0.05). CONCLUSIONS: Athletes with CAI showed significantly impaired balance control performance and diminished ankle proprioception. Deficit in force sense was deemed as a moderate predictor of one-leg standing balance control deficits in athletes with dominant-side injury CAI, whereas ankle position sense may be a small predictor.

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.

Can We Target Close Therapeutic Goals in the Gait Re-Education Algorithm for Stroke Patients at the Beginning of the Rehabilitation Process?

(1) Background: The study aimed to determine the most important activities of the knee joints related to gait re-education in patients in the subacute period after a stroke. We focused on the tests that a physiotherapist could perform in daily clinical practice. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were included in the study. The patients underwent the 5-meter walk test (5mWT) and the Timed Up and Go test (TUG). Tests such as step up, step down, squat, step forward, and joint position sense test (JPS) were also performed, and the subjects were assessed using wireless motion sensors. (3) Results: We observed significant differences in the time needed to complete the 5mWT and TUG tests between groups. The results obtained in the JPS show a significant difference between the paretic and the non-paretic limbs compared to the CG group. A significantly smaller range of knee joint flexion (ROM) was observed in the paretic limb compared to the non-paretic and control limbs in the step down test and between the paretic and non-paretic limbs in the step forward test. (4) Conclusions: The described functional tests are useful in assessing a stroke patient's motor skills and can be performed in daily clinical practice.

The efficacy of taping on elbow proprioception in healthy individuals: A single-blinded randomized placebo-controlled study.

BACKGROUND: Taping stimulates the mechanoreceptors, increases sensory information to the central nervous system, and improves sensorimotor synchronization, resulting in improved motor control. However, the efficacy of taping on elbow proprioception is not clear. PURPOSE: This study aimed to evaluate the immediate effects of taping on elbow proprioception in healthy individuals. STUDY DESIGN: This study was a two-arm, parallel-group, randomized, controlled, single-blinded study with a sham application. METHODS: Fifty six healthy adults were randomized 1:1 to kinesio taping (n = 27) or sham taping (n = 29). Active joint position sense error (JPSE) was used to quantify proprioception using a universal goniometer at three-time points: baseline (BS), immediately after taping (IA), and 30 minutes after taping (30MA), with the tape still in place at 70° and 110° of elbow flexion. Participants were blinded to group assignments. The Friedman analysis assessed differences between evaluations within groups, and the Mann-Whitney U test determined differences between groups. RESULTS: The study was completed with 56 participants and there were no dropouts. No skin reaction or adverse effect was observed in the participants and no test trial was excluded. The baseline scores of the groups were similar (p > 0.05). A significant difference was detected in the study group after kinesio taping at 70° (MD = -1.22; CI = (-2.33: -0.10; p < 0.005; d = 0.653) and 110° of elbow flexion (MD = -1.34; CI = 2,47: -0,21; p < 0.005; d = 0.73). This statistically significant difference was observed even at the 30MA evaluations at 70° (p < 0.05). Also, there was a statistically insignificant tendency to decrease in JPSE of both groups at both degrees following taping. CONCLUSIONS: Elbow proprioception may be enhanced by kinesio taping, and this effect could last up to 30 minutes at 70° of elbow flexion. In contrast, sham taping did not produce such an improvement. Based on the differences in JPSE, kinesio taping proved more effective and had a longer-lasting impact than the sham application. The statistically insignificant tendency to decrease in JPSE may indicate that the 30-minute application period is inadequate to create a statistically significant effect on elbow proprioception. Longer usage periods can better reveal the effects of orthoses on proprioception.

Joint position sense testing at the wrist and its correlations with kinesiophobia and pain intensity in individuals who have sustained a distal radius fracture: A cross-sectional study.

BACKGROUND: Sensorimotor impairment following distal radius fracture (DRF) has been associated with a significant decline in function. Joint position sense (JPS) testing is a meaningful and responsive way to assess sensorimotor impairment for individuals who have sustained a DRF; however, there are factors that may influence the results of JPS testing, including kinesiophobia and pain intensity. PURPOSE: This study aimed to evaluate the influence kinesiophobia may have on wrist JPS testing and if pain intensity impacts kinesiophobia and JPS in individuals with a DRF. STUDY DESIGN: This was a cross-sectional study. METHODS: Participants referred from two medical centers with a diagnosis of DRF treated with at least 3 weeks of immobilization were enrolled in the study. Data were collected at 1 week and 6 weeks postimmobilization period. Demographics were summarized with descriptive statistics, and linear relationships between kinesiophobia, pain intensity, and wrist JPS were examined using Pearson correlation coefficient. RESULTS: Forty-eight participants were included in this study (mean age 42.9 years). Significant positive correlations were found between the Tampa Scale for Kinesiophobia (TSK) and Numeric Rating Scale (NRS; r = 0.951, p < 0.001), TSK and JPS error (r = 0.942, p < 0.001), as well as NRS and JPS error (r = 0.898, p < 0.001). These correlations indicate that higher levels of kinesiophobia are associated with increased pain intensity and greater JPS error. T-tests reveal no significant difference between male and female for the TSK, NRS, or JPS scores. CONCLUSIONS: There is an association for individuals with high levels of kinesiophobia and both greater pain and errors with JPS testing.

Effect of Kinesio taping on wrist proprioception in healthy subjects: A randomized clinical trial.

BACKGROUND: Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception. PURPOSE: The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects. METHODS: Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT). RESULTS: No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p=0.286), nor between pre and post-intervention (p=0.111). For wrist joint position sense, a statistically significant effect (p< 0.05) was found at 30º of extension between the control and experimental group in favor of the control group. CONCLUSIONS: The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered.

Immediate effects of elbow orthoses on elbow proprioception in asymptomatic individuals: A randomized sham-controlled single-blinded study.

BACKGROUND: Improving proprioception can reduce the risk of injuries, while its disruption may lead to injuries and recurrent or persistent symptoms. PURPOSE: This study aimed to evaluate the immediate effects of elbow orthoses on elbow proprioception in asymptomatic individuals. STUDY DESIGN: This was a randomized, controlled, single-blinded study with a sham application. METHODS: Sixty participants were equally distributed into three orthosis groups (counterforce, sleeve, and sham). Proprioception was assessed using active joint position sense error (JPSE) at 70° and 110° of elbow flexion at three time points: baseline (BS), immediately after (IA) wearing the orthosis, and 30 minutes after (30MA) wearing the orthosis. RESULTS: Between groups: No significant difference in JPSE was observed at 70° (p = 0.095); however, there was a significant difference at 110° (p = 0.005). Between time points: At 70°, JPSE did not exhibit a significant difference (p = 0.055), whereas a significant difference was observed at 110° (p = 0.020). Interaction of time points×groups: No significant interaction was observed either at 70° (p = 0.476) or at 110° (p = 0.346). At 70°, within the sleeve group, significant differences were identified between BS-30MA (p = 0.001) and IA-30MA (p = 0.009). At 110°, in the sleeve group, significant differences were observed between BS-30MA (p = 0.007) and IA-30MA (p = 0.007). In the counterforce group, significant differences were identified between BS-30MA time points (p = 0.001). At 70°, no difference was observed within the overall evaluation in the counterforce group (p > 0.05), whereas at 110°, a significant difference was noted (p = 0.026). At both 70° and 110°, no differences were identified within the overall evaluation in the sleeve and sham groups (p > 0.05). CONCLUSIONS: In asymptomatic individuals, sleeve orthosis improved elbow proprioception at 70°, whereas both counterforce and sleeve orthoses were effective at 110°.

Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain.

BACKGROUND: Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood. PURPOSE: This study aimed to investigate the relationship between shoulder pain and proprioception. STUDY DESIGN: This was a cross-sectional comparative study. METHODS: Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations. RESULTS: Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = -0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = -0.31 [-0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]). CONCLUSIONS: Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.

Sacroiliac joint pain increases repositioning error during active straight leg-raising.

PURPOSE: This study aimed to compare the repositioning error (RE) of patients with unilateral sacroiliac joint pain (SIJP) to that of patients with low back pain (LBP) and a healthy control (HC) group. Differences between the symptomatic and asymptomatic sides were also investigated. METHODS: Sixty-six patients with SIJP, LBP, and HC were included in this study. An active straight leg-raising repositioning test (ASLR-Rt) was performed. ASLR was performed three times each on the left and right sides, targeting a set base angle. RE was calculated as the difference between the base angle and the participant's attempt to adjust the target angle. RE was expressed as constant error (CE) and absolute error (AE). RESULTS: The CE of the SIJP group (median [interquartile range]) (6.9 [4.6‒10.4]) was significantly higher than that in the LBP group (3.2 [1.3‒7.1]) and the HC group (2.7 [0.3‒4.6]) (P = 0.009, d = 0.91, P < 0.001, d = 1.30). The AE of the SIJP group (7.3[5.0‒10.4]) was also significantly higher than that in the LBP (3.7[2.8‒7.1]) and HC groups (3.0[1.9‒4.2]) (P = 0.003, d = 1.04; P = 0.001, d = 1.57). Comparing the symptomatic and asymptomatic sides in the SIJP group, the symptomatic side (8.0[6.0‒10.6]) was significantly higher than the asymptomatic side (5.7[3.6‒8.1]) in terms of CE (P = 0.05, d = 0.51). CONCLUSION: Patients with SIJP increased RE during ASLR, which may be related to impaired proprioception and decreased motor control.

Exercise-induced fatigue affects knee proprioceptive acuity and quadriceps neuromuscular function more in patients with ACL reconstruction or meniscus surgery than in healthy individuals.

PURPOSE: To observe how knee proprioceptive acuity and quadriceps neuromuscular function change during and after repeated isokinetic knee-extension exercise in patients with anterior cruciate ligament reconstruction (ACLR) or meniscus surgery. METHODS: Patients with ACLR or meniscus surgery and matched controls (n = 19 in each group) performed knee-flexion replication at 15° and 75°, and quadriceps peak torque (PT), central activation ratio (CAR) and rate of torque development (RTD) at baseline and immediately after every five sets of isokinetic knee-extension exercise (times 1-5). RESULTS: Compared to the baseline, the ACLR and control groups displayed errors in knee-flexion replication at 75° only at time 5 (115.9-155.6%; p ≤ 0.04, d ≥ 0.97), whereas the meniscus surgery group exhibited errors at all time points (142.5-265.6%; p ≤ 0.0003, d ≥ 1.4). Significant percentage reductions in quadriceps CAR were observed between times 4 and 5 in the ACLR group (-5.8%; p = 0.0002, d = 0.96), but not in the meniscus surgery (-1.4%; n.s.) and control (0.1%; n.s.) groups. Significant percentage reductions in quadriceps RTD were observed between times 4 and 5 in the ACLR (-24.2%; p = 0.007, d = 0.99) and meniscus surgery (-23.0%; p = 0.01, d = 0.85) groups, but not in the control group (-0.2%; n.s.). CONCLUSION: Patients with ACLR or meniscus surgery displayed a greater loss in knee proprioceptive acuity and quadriceps neuromuscular function during and after exercise than healthy individuals. Evidence-based interventions to enhance exercise-induced fatigue resistance should be implemented following ACLR or meniscus surgery, aiming to prevent proprioceptive and neuromuscular changes within the knee joint and quadriceps. LEVEL OF EVIDENCE: III.

Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE: Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants. METHODS: Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense. RESULTS: Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05). CONCLUSION: AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

Test-retest reliability of joint position sense in the elbow among healthy adults.

BACKGROUND: Proprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow. PURPOSE: The primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults. STUDY DESIGN: This was a cross-sectional study using a convenience sample of healthy adults. METHODS: Three elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability. RESULTS: Sixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error. CONCLUSIONS: The joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice.

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial.

STUDY DESIGN: Randomized Control Trial. INTRODUCTION: Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. PURPOSE OF THE STUDY: To establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. METHODS: Standard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). RESULTS: Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. DISCUSSION: Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. CONCLUSION: Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.

Targeted sensorimotor retraining in the clinical setting: Improving patient outcomes following distal upper extremity injury.

BACKGROUND: Existing theoretical evidence indicates sensorimotor retraining is beneficial following wrist injury. However, there are no large cohort studies applying the knowledge in a clinical setting. PURPOSE OF THE STUDY: To Determine the clinical benefits of sensorimotor rehabilitation following distal upper extremity injury. STUDY DESIGN: Prospective cohort study. METHODS: A sensorimotor rehabilitation program was evaluated following distal upper extremity injury. A battery of clinical and patient-rated outcome measures (PROM) were taken before and after group completion. RESULTS: Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures. However, improvements in 11 of the clinical measures only had a small effect size (<0.5). Joint position sense had the greatest clinical change with a median improvement of 4° on the left and 3.9° on the right, and these had moderate effect sizes of 0.5 and 0.7, respectively. There were statistically significant improvements in all PROMs. PRWE had a median improvement of 21 (ES = 1.2). UEFI showed median improvements of 19.7 (ES = 1.4) and NRS (pain) median improved 2.5 (ES = 1.2). All PROM improvements had mean change greater than associated MCIDs. DISCUSSION: These results indicate the benefits of sensorimotor group rehabilitation and supports existing literature regarding the importance of sensorimotor control for JPS accuracy and function. Group based sensorimotor programs present an efficient and low-cost opportunity to provide intervention to patients following upper extremity injury. CONCLUSION: A sensorimotor group rehabilitation program may improve patient outcomes following distal upper extremity injury. LEVEL OF EVIDENCE: Level 2b prospective cohort.

A quantitative evaluation of the individual components contributing to the functional ankle instability in patients with modified Broström procedure.

Residual functional ankle instability regardless of the restoration of mechanical stability after the lateral ligament repair or reconstruction can cause recurrent sprain. The purpose of this study was to identify the sequential changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure (MBP) for chronic ankle instability. A total of 46 patients (46 ankles) underwent the MBP for chronic ankle instability were eligible for this study and were followed for 1 year postoperatively. The changes of joint-position sense and peroneal strength were periodically evaluated with an isokinetic dynamometer. Postural control ability was evaluated using a one-leg stance test with eyes closed. The functional performance ability examination comprised a one-leg hop test, a 6-meter hop test, and a cross 3-meter hop test. The error in joint-position sense significantly improved from a mean 4.3º to 2.8º (p < .001). Peak torque for eversion significantly improved from a mean 18.2 Nm to 21.2 Nm (p = .024). Balance retention time significantly improved from a mean 4.7 seconds to 6.4 seconds (p < .001). Among the functional performance tests, only the one-leg hop test showed a significant improvement postoperatively (p = .031). At 1 year postoperatively, the recovery ratios compared to the unaffected ankle were 67.9% in joint-position sense (p < .001), 86.9% in peroneal strength (p = .012), and 74.4% in postural control (p < .001) with significant side-to-side differences. Although joint-position sense, peroneal strength, postural control, and functional performance ability were significantly improved after the MBP, recovery ratios compared to the unaffected ankle were insufficient up to 1 year postoperatively.

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.

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.

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.

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.

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 (sEMGRMS ), 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%), sEMGRMS (-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 sEMGRMS (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%), sEMGRMS (+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.