Does Proprioceptive Training During Knee and Ankle Rehabilitation Improve Outcome?

Abstract Although much research has been conducted on the measurement and quantification of knee and ankle proprioception, there are few studies on results of targeted proprioceptive training during rehabilitation in knee and ankle injuries. Proprioceptive training has been hypothesized to increase joint stability through a variety of mechanisms, including muscle strength, kinesthesia, and muscle tone. The purpose of this paper is to comprehensively review and critically appraise the available literature from 1966 to January 2001 in order to examine the evidence concerning the efficacy of proprioceptive training during knee and ankle rehabilitation. Medline was searched using MeSH and textwords for English language articles related to proprioceptive training during knee and ankle rehabilitation published since 1966. Additional references were reviewed from the bibliographies of the retrieved articles. The total number of articles reviewed was 9 and 8 for the knee and ankle, respectively. In reviewing the literature, particular attention was paid to the relative strengths of the different study designs. From these data, the factors associated with effectiveness and the beneficial results of proprioceptive training were examined. For the knee, five of the nine studies evaluated a proprioceptive rehabilitation programme for anterior cruciate ligament (ACL) deficient patients, three studied a training programme in healthy subjects and athletes involved in soccer and gymnastics and one study was on patients suffering from knee pain. The duration of proprioceptive training ranged from 1–52 weeks. Eight studies showed the beneficial effects of proprioceptive training during a knee exercise programme; one study showed that joint position sense in the ACL deficient knees with muscular and proprioceptive training remained unchanged. For the ankle, three studies evaluated patients with functionally instability in the ankle joint. The authors found that improvements in balance performance following a 6-week, 8-week, and 10-week training period appeared to be greater in individuals with previously reported ankle sprains as compared with uninjured participants. Three papers investigated the significance of postural stability in healthy subjects receiving a proprioceptive training programme; one studied joint position sense in gymnasts, and one study looked at postural stability in dancers. Eight studies have been published on the benefits of proprioceptive training during a knee exercise programme and the role of proprioception in the knee joint. Increased joint proprioceptive sense, muscle strength, knee kinesthesia, muscle tone and the decreased risk of ACL injury have suggested that dynamic joint control training may improve stability by improving joint position sense in healthy and injured-knees. The effects of proprioceptive training on muscle reaction times and postural stability have increased during ankle rehabilitation after several weeks. Ankle proprioceptive training has been shown to decrease functional instabilities of the ankle and to decrease the incidence of re-injury. Specific neuromuscular co-ordination training such as dynamic joint control and kinesthetic awareness may be indicated at 3–4 months following rehabilitation.