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What is it, and how does it relate to sports performance injury and rehabilitation?

In simple terms, proprioception is an awareness of a joint’s position in space without looking at it. Nerve impulses, generally from stretch receptors in joints, muscles and tendons feedback to the brain to tell us what is happening. These impulses give the brain information about a joint’s position, the direction of motion, pressure areas and vibrations.

When a joint, such as an ankle, knee or hip suffers an injury these nerve ending and their pathways can also be damaged, either by directly tearing themselves or by pressure from bleeding or swelling into the surrounding tissues. When this happens, nerve conduction and reflexes are affected and often slowed, resulting in decreased joint awareness. Thus the athlete may have decreased balance, decreased timing, decreased strength and decreased coordination.

It is a very important component of any rehabilitation program after an injury to challenge and tune up the joint's proprioception. If it is not done and the athlete returns to sport too soon, they may be at risk of further injuring the joint.

What does treatment look like?

Balance and proprioception are easily measurable and treatment usually involves a progression through various functional tasks. These tasks can generally be started early in the rehabilitation phase even if the athlete is not fully weight-bearing.

An example of a proprioceptive program following an ankle sprain may include

○ Weight bearing on the injured leg

○ Single leg balance – aim for 30 seconds

○ Single leg balance with eyes closed

○ Toe and heel-raising exercises on one leg

○ Rocker board exercises

○ Wobble board exercises

○ Dura disk

These are progressed as each level can be performed well. When all of the above can be done the athlete moves on to functional tasks such as soft sand walking, hopping, landing, mini tramp and cutting and running drills before progressing to sport-specific training.

Chronic lower limb injuries are common and often because the very important proprioceptive rehabilitation has not been completed well. Your physiotherapist can assess and prescribe suitable proprioceptive exercises for your injury.

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