The Link Between Knee and Ankle Injuries and Proprioception

November 1, 2016 in STSMPT


Most people take proprioception for granted, even though it is an amazing sense. Proprioception refers to your body’s ability to sense joint movement and position. If your eyes are closed and you start slowly extending your leg, you know if your foot is only a little off the ground, half way up, or at the end of your range of motion. That’s proprioception. The sense is much more finely tuned than most people realize, and even slight deficits or improvements can make a big difference in injury prevention and injury rehabilitation – and maybe even in sports performance.


Combined, two sports training studies from Italy and the United States followed 1,600 semi-professional and amateur football players. Half of the athletes received a supervised proprioceptive training program as part of their warm-up routine while the other half trained as normal. Exercises included bounding, vertical jumps, walking lunges, single-leg stances, the Nordic hamstring, and the static bench. The people who received proprioceptive training programs experienced 85% to 88% fewer ACL injuries (anterior cruciate ligament – the ligament that crisscrosses the knee to provide knee stability and prevent your knee from bending both directions). That’s a very large reduction. Hypothetically, improvements in proprioception improve balance and coordination, which would have athletic performance benefits as well.


Proprioceptive training is not just for athletes at risk of ACL injuries. It can also be used for thorough rehabilitation of many types of leg, foot, and ankle injury. When there is a tear in a ligament or tendon of the leg, foot, or ankle, the nerves involved in proprioception often become damaged. Even when people are feeling better, they may not realize that they now have a proprioceptive deficit setting them up for re-injury. In fact, a meta-analysis published recently in the peer review journal, Physiotherapy, verified that people with ACL injuries have worse proprioception in the injured leg than in their uninjured leg. They combined multiple studies that finely measured proprioceptive acuity in terms of threshold to detect passive motion or joint position sense.


Similarly, a loss of proprioceptive acuity from an ankle injury, hamstring injury, Achilles tendinitis, quadriceps tear, etc. can predispose people to future injuries in the same area and along the kinetic chain. Recovering from such injuries should involve more than strength and range of motion. We must also consider the neurological components of joint and tendon injuries. Studies have shown us that proprioception can be improved through targeted training and that it can create a dramatic improvement in the chance of future injury.

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