In sport, movements involving running, jumping, rapid acceleration and deceleration, change of direction and rotation are vital components and require static and dynamic stabilisation and balance. Impairment of balance predisposes both the professional and recreational sporting population to an increased risk of injury (Plisky et al., 2006). Lack of balance and therefore potential injury can occur as a result of muscle, tendon and ligament weakness, improper joint alignment in the lower limb (Bulat et al., 2019), substantial spikes in training volume (Windt et al., 2017), and poor landing techniques (Bird & Markwick, 2016).
Balance impairments not only cost sports clubs and teams, a lack of balance in everyday activity increases the risk of falls and is a leading cause of harm, loss of independence and lower quality of life. The estimated cost to the NHS annually is over £2.3 billion.
The balance system consists of 3 major systems, these are visual, vestibular (inner ear) and proprioception.
What is Proprioception?
The term proprioception is derived from the Latin words “proprius” (one’s own) and “percipere” (to collect information) translating to perceive one’s own self. It has therefore been defined as the “conscious awareness of body and limbs” (Aman et al., 2015). Often referred to as the sixth sense (Hillier et al., 2015; Tuthill & Azim, 2018) proprioception is a neural process in which the body transmits information from the environment and mechanical stimuli within the musculoskeletal framework to the central nervous system to produce a motor response, a reflex response or maintain balance (Stillman, 2002; Rivera et al., 2017). This position sense is served by the proprioceptors. The muscle spindles detect any change in length and velocity of that change with feedback of tension provided by the golgi tendon organs contributing to postural control. Ruffini and Pacinian corpuscles in the ligamentous and capsular tissues act as the static and dynamic receptors (Riemman & Lephart, 2002). Unconsciously, proprioceptive signals initiate a reflex which returns the body to the correct tone, such as the response to the rolling of an ankle and protecting the body against falls.
To summarise, the original description over 100 years ago in 1906, Sherrington describes proprioception as the information from areas of the body used to determine joint position sense, joint stability, movement, and sense of resistance (Riemann & Lephart, 2002).
Proprioceptive Training & Rehabilitation
A task such as kicking a ball demands the utilisation of dynamic postural stability maintaining single leg control whilst performing multi planar movement with the external impact of the ball (Conceição et al., 2016.). Balance therefore requires a sense of joint position and joint stability control enabling the individual to stabilise on one leg and jump and land for optimal functional performance. As a multidirectional sport with short bursts of movement, balance is a fundamental requirement in tennis. With matches often lasting two to three hours the ability to maintain balance whilst performing upper body explosive movements determines the success of the player (Malliou et al., 2010).
An impairment in proprioception can be caused by tissue damage, pain or in the presence of edema which may affect motor control resulting in loss of balance, decreased performance, or injury (Irrang et., 1994). Proprioception function has been shown to be reduced in athletes who complain of a deficit in joint position sense following an ankle sprain measured by delayed peroneal muscle reaction time (Karlsson & Andreasson, 1992; Konradsen & Ravn, 1991; Hertel, 2000). Proprioceptive training helps to regain motor control by reducing this deficit (Lephart et al., 1997). Rehabilitation which fails to address any imbalances and impairments of this system increases the risk of re-injury.
Proprioceptive training is based on the premise that adaptations take place during or prior to movement based on the stimuli these proprioceptors receive modifying the muscular response (Cerulli et al., 2001). Typically, this training is performed on an unstable surface, such as a wobble board or a BOSU® ball or maintaining single leg balance with the aim of enhancing the ability of the sensorimotor system, therefore also described as balance training within the literature. This treatment method aimed to improve the proprioceptive senses is widely used for injury prevention and rehabilitation purposes, especially to improve stability and balance. (Arnold et al., 2009; Mattacola & Dwyer, 2002).
Whether you would like to improve balance in everyday life, rehabilitate a recent injury or prevent injury in the future for help and advice get in touch!
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