Ways to improve proprioception

WAYS TO IMPROVE PROPRIOCEPTION

Sinaki M, Lynn SG, Reducing the risk of falls through proprioceptive dynamic posture training in osteoporotic women with kyphotic posturing: a randomized pilot study.  American Journal of Physical Medicine and Rehab.   81: 4, 241-6, Apr, 2002.

OBJECTIVE: To assess the effect of a proprioceptive dynamic posture training program on balance in osteoporotic women with kyphotic posture.

DESIGN: Subjects were randomly assigned to either a proprioceptive dynamic posture training program or exercise only group. Anthropometric measurements, muscle strength, level of physical activity, computerized dynamic posturography, and spine radiography were performed at baseline and 1 mo.

RESULTS: At the 1-mo follow-up, three groups were formed on the basis of the baseline computerized dynamic posturography results. In general, groups 1 and 2 had no significant change at 1 mo, whereas group 3 improved balance significantly at 1 mo.

CONCLUSION: The subjects who had abnormal balance and used the proprioceptive dynamic posture training program had the most significant improvement in balance. Improved balance could reduce the risk of falls.

Freeman, M.D. and Wyke, M.D.  British Journal of Surgery, 1967; 54(12): 990-1001.  Articular mechanoreceptors along with descending projections from the brain stem reticular system help determine the coordination and degree of gamma motoneuron activity in muscles working a joint.  Mechanoreceptors directly influence segmental and intersegmental reflex coordination of muscles.  Indirectly, they exert control through supra-segmental projections to the brain stem, cerebellum and cortex.

Lephart, Ph.D.  et al.  American Journal of Sports Medicine.  1997; 25(1): 130-137.  Dynamic joint stabilization exercise performed with a wobble board to stimulate coactivation of shoulder muscles.  Trauma to tissues that contain mechanoreceptors may result in partial deafferentation, which can lead to proprioceptive deficits.  Susceptibility to reinjury becomes more likely because of the decreased proprioceptive feedback.  Deficits in neuromuscular reflex pathways may have a detrimental effect on the motor control system’s role as a protective mechanism to prevent acute joint injury.

Revel, M.D.  Archives of Physical Medicine.  1994; 75(August): 895-899.  Head repositioning accuracy as a measure of proprioceptive and fine motor function.  Findings indicate that proprioceptive system of the neck has learning abilities and can be improved by rehabilitation techniques.

Rogers, D.C.  Journal of Manipulative and Physiological Therapeutics.  1997; 20(2): 80-85.  Effects of spinal manipulation on cervical kinesthesia in patients with chronic neck pain.  Study of spinal manipulation vs. stretching exercise’s effect on pain and head repositioning in 20 patients with chronic neck pain in a random controlled trial.  One half of the patients received 6 treatments of high velocity, low amplitude cervical spinal manipulation and one half got stretching of upper thoracic muscles 2 sessions daily.  Result:  Spinal manipulation patients had a mean reduction in visual analog scores of 44% and 41% improvement in head repositioning skill.  Stretching patients had a 9% reduction in visual analog scores and 12% improvement in head repositioning scores.  Conclusion:  Results suggest a possible effect of spinal manipulation on proprioception in patients with chronic neck pain.  Limits:  Small sample size, lack of blinding examiner.

Fitz-Ritson, D.C.  Cervicogenic Vertigo.  Journal of Manipulative and Physiological Therapeutics 1991; 14(3): 193-198.  In 112 post-whiplash patients with cervicogenic vertigo.  90% were symptom free by 18 adjustments.  Patients with upper cervical problems improved the fastest.  Goals of care: to normalize motor function and afferent input.  All 11 patients who only improved slightly or not at all had their injury 21-43 months earlier.  Disturbances in cervical soft tissues may be important in producing vertigo due to the potency of their disturbed afferent input.

Balogun, Ph.D., P.T.  Physiotherapy Canada.  1992; 44(4): 23-30.  6 week wobble board training in asymptomatic males.  Eyes open balance increased 201.2%.  Eyes closed balance increased 58.8%.  Findings:  wobble board exercise can improve static balance.

Wolf, Ph.D.  Journal of Geriatric Society, 1996; 44: 489-497.  2 new studies find elderly patients taking Tai Chi improve their balance and reduce their number of falls.  Tai Chi use slow graceful and precise body movements to improve both balance and body awareness.  Study found 15 week program reduced their rate of falls by 47.5%.

McCloskey, (School of Physiotherapy and Pharmacology).  Physiologic Reviews.  1978; 58(4): 763-820.  The greatest level of afferent firing occurs at or near the extremes of flexion and extension with comparatively little activity in between.  Units’ rate of firing is related to rate of displacement.  The nearer the joint approaches maximal extension or flexion the greater the number of units active and the greater their discharge frequencies.

Zimny, (Dept. of Anatomy).  American Journal of Anatomy.  1988; 182: 16-32.  Joint and muscle receptors detect limits of movement of a joint and play a role in synchronizing mechanisms involved with control of movement.  The densities of mechanoreceptors are greater in areas related to extreme movements.  Mechanoreceptors are the first line of defense in sensing the safe limits of range of motion of a joint.  Discharges provide the central nervous system with information about possible joint injury.  This input activates reflex mechanisms that act to prevent joint injury.

Schaible, HG, Gribb, BD.  (Department of Physiology).  Pain.  1993; 55: 5-54.  Reflexes from joint afferents are important in eliciting protective muscular responses.  Afferents help regulate joint stability through discharges in gamma-motoneurons.  Articular mechanoreceptors are activated by innocuous movements and exhibit an immediate increase in their discharges when the joint is being moved to the extreme of the working range.

McLain, M.D.  Spine 1994; 19(5): 495-501.  Articular proprioceptors respond primarily to the extremes rather than to the mid ranges of joint motion.  They may initiate protective muscular reflexes important in preventing joint degeneration and instability.  Altered mechanoreception has a direct effect on reflex activity of muscle crossing the joint.  Joint deafferentation may accelerate degenerative changes.  Disturbance of articular innervation may play a role in the development of degenerative and inflammatory diseases and joint dysfunction.

Michelson, M.D., Huthcins, M.D.  Journal of Bone and Joint Surgery.  1995; 77-B(2) March:  219-224.  Type III mechanoreceptors provide sensation at the extremes of movement and act to alert the central nervous system of imminent danger to the joint.  Ligaments provide more than structural support.  Sensory output from ligaments aid in controlling muscle stiffness and coordination, thereby increasing joint stability.  Mechanoreceptors influence gamma motoneurons output, and thereby, the discharge of alpha motoneurons, enhancing muscle contractility.  At the extremes of motion, mechanoreceptors elicit protective reflexes to prevent injury to the joint.