Proprioceptive Training in Sports
🖊 The use of the word proprioception has increased exponentially in the vocabulary of strength and conditioning coaches.
🖊 Proprioception was first described in the literature in 1906 by the scientist Charles Sherrington (Leporace et al, 2009 ; Ribeiro & Oliveira, 2008 ; Tuthill & Azim, 2018).
🖊 However, between two and three decades ago, this term was restricted to the field of musculoskeletal rehabilitation.
🖊 A question arises: what happened in this period of time for proprioceptive training to get your due attention?
🖊 Many researches were developed and the integrated functional training played a prominent role in the elaboration of the exercises directed to the athletes.
🖊 It is well known that proprioceptive training, when well directed, contributes to the prevention and rehabilitation of muscle, joint and ligament injuries in sports practice.
🖊 Thus, this text aims to discuss about proprioceptive training and its importance in the physical preparation of athletes in different sports.
✅ Neural System
🖊 Basically, the neural system is made up of the central and peripheral nervous system that work together to better meet the demands of movement.
🖊 The central nervous system (CNS) consists of the brain and spinal cord.
🖊 We entitle the central nervous system as an “organ-president” who heads the human motor system through the integration and organization of sensory and motor information (Magill, 2011).
🖊 In neurological terms, the basic cell is the neuron that can receive and send information through it.
🖊 The two most important types of neurons are motor (or efferent) and sensory (or afferent). Proportionally, for each sensory neuron there are ten motor neurons (Magill, 2011; Platonov, 2008).
🖊 The motor, sensory, and regulatory center nerves control the regulation of muscle activity, the respiratory system, and blood circulation.
🖊 While the sensory neurons send information from mechanoreceptors to the central nervous system, motor neurons influence the control of movement (Magill, 2011).
🖊 For McArdle et al (2011) this bi-directional flow of sensory information generates coordinated neuromuscular patterns through central mechanisms of neural control.
🖊 According to Platonov (2008) and Martimbianco et al (2008) the afferent components of sensorimotor origin include muscle-motor sensation, tactile sensation, vision, vestibular perception, hearing, temporal sensation and psycho-semantic components.
🖊 Thinking about movement, there are two neural pathways: the simple movements happen in the form of spinal cord reactions while the most complex movements occur in the cerebral cortex. The control of these same movements occur at different levels: the main one at the cortical level and the secondary ones regulating involuntary movements (Platonov, 2008).
🖊 Lage et al (2015) indicate that learning and practice of motor skills are distinct processes formed in circuits with neurophysiological organizations affecting some brain areas (premotor area, primary motor cortex, dorsolateral prefrontal cortex and posterior parietal cortex).
✅ The Proprioceptors
🖊 Proprioception in Magill’s (2011) view can be considered as sensory receptors that help control the execution of movement.
🖊 Han et al (2015) characterize the proprioception as an ability to integrate different sensory signals into body control.
🖊 Rossato et al (2013) mention that proprioception plays an afferent response to the central nervous system by receptors located at various points (bones, ligaments, tendons, subcutaneous tissue, fascia and muscle interior).
🖊 Safran et al (2001) warn that conscious proprioception is fundamental for joint function in sport. According to the authors, proprioception encompasses specialized sensations of kinesthesia (joint movement) and sense of joint position. On the other hand, unconscious proprioception tends to modulate muscle function and reflex stabilization.
🖊 The proprioception can be understood as a feedback mechanism mediated by the central nervous system that cooperates as somatosensory systems in motor control (Martimbianco et al, 2008).
🖊 In a broader approach, McArdle et al (2011) consider proprioception as specialized sensory receptors with high sensitivity to stretching, tension and pressure that relay real-time information on muscle dynamics and limb movement to the conscious and unconscious regions of the nervous system central.
🖊 Chiappa (2001) names proprioception as proprioceptive re-education or training of joint protection.
🖊 Also, proprioceptors are called mechanoreceptors (muscle, joint and tendon), because they transmit the information via the afferent pathway to the brain and it corrects the task accomplishment via efferent commands (Magill, 2011; Platonov, 2008; McArdle et al, 2011).
🖊 Francisco & Gaberlotti Júnior (2002) highlight that mechanoreceptors transmit to the central nervous system the articular position, angulation, dislocation, velocity of dislocation and also deformations that could result in injuries.
🖊 Sahin et al (2015) report that receptors located on muscles, tendons, ligaments, menisci, and articular capsules assist in the perception of movement and its positioning during motor tasks.
🖊 Muscle proprioceptors are called muscle spindles. They are specialized and differentiated muscle fibers. They are divided into intrafusal (internal) fibers and extrafusal (external) fibers. Magill (2011) argues that muscle spindles detect changes in muscle length and velocity that cause mechanical deformation of the receptors. At any stretch of the muscle, the muscle spindles react by triggering the modulation of the extrafusal fibers length (McArdle et al, 2011).
🖊 In mammalian skeletal muscles the intrafusal fibers are positioned parallel to the extrafusal fibers (Tuthill & Azim, 2018). In addition, Vaughan et al (2017) mention type Ia\II sensory neurons innervate intrafusal fibers, which are sensitive to velocity and extent of muscle contraction.
🖊 Articular proprioceptors are located in the joint capsule and are called corpuscles. There are four types: Ruffini’s corpuscle (located in the proximal joint capsule), Paccini’s corpuscle (located in the distal joint capsule), Golgi-Mazzoni corpuscle (located in the articular ligaments), and the free nervus termini found in the surrounding region of the joints. (Chiappa, 2001; Panics et al, 2008).
🖊 Some of the functions performed by these joint receptors: changes in joint position (Ruffini corpuscle), speed and acceleration of joint movement (Paccini corpuscle), direction of movement and joint position (Golgi-Mazzoni corpuscle), and mechanical deformities (free nerve endings) (Chiappa, 2001).
🖊 Completing this information, Ribeiro & Oliveira (2008) report that of the cutaneous proprioceptors (Meissner, Paccini, Merkel and Ruffini corpuscles), the first two are fast adapting and the other two are slow adapting.
🖊 According to Ribeiro & Oliveira (2008) it is through these joint proprioceptors that mediates the muscular response promoting a dynamic and functional stabilization.
🖊 Lastly, we have the tendon proprioceptors. The best known is the Golgi Tendon Organ (GTO). It is located at the musculoskeletal junction and one of its functions would be to protect against injury by controlling the degree of muscle tension (Magill, 2011).
🖊 Martimbianco et al (2008) point out that GTO together with muscle spindles control muscle tone and activation and deactivation in the neuromotor control of the agonist/antagonist relationship.
🖊 In the conception of Blecher et al (2018) the true proprioception occurs in the short range and can be of tonic or phasic order.
🖊 There are reports that muscle and/or neural fatigue generated in training or competitions negatively affect athletes’ proprioception (Conduta, 2012; Ribeiro & Oliveira, 2008 ; Sterner et al, 1998 ; Sahin et al, 2015 ; Pinsault et al, 2010).
🖊 Sterner et al (1998) suggest that fatigue decreases mechanoreceptor activity, increasing joint capsule stress.
🖊 The relationship between fatigue and proprioception is a complex phenomenon. One of the theories is that the generation of neuromuscular fatigue occurs when the action potential cannot proceed from the motor neuron to the muscle fiber, generating a failure in myoneural transmission, thereby diminishing proprioceptive functionality (McArdle et al, 2011; Romero- Franco et al, 2013).
🖊 Chiappa (2001) argues that athletes with proprioceptive deficit due to fatigue have poor body control, increasing movement oscillation and may cause rotational trauma.
✅ Proprioceptive Training
🖊 When an athlete is injured, his neuromuscular pattern changes affecting proprioceptive activity. If during the process of injury prevention and rehabilitation proprioceptive exercises are not employed, we would have the emergence of sensorimotor deficits that could generate future problems in the control of movement.
🖊 It is well documented that proprioceptive deficits generated by injuries cause motor and muscle damage, loss of sense of joint angulation, and imbalance and instability during motor actions, impairing sports performance (Martimbianco et al, 2008; Sarabon, 2015 ; Safran et al, 2001 ; Leanderson et al, 1996).
🖊 In the sports activity, the maneuvers of sudden stops, quick exits, changes of direction, jumps, landings and others, require an appropriate level of proprioception of athletes. Therefore, preventive programs should pay attention to these movement requirements.
🖊 It is proprioceptive exercises in conjunction with neuromuscular work that prevent and rehabilitate from sports injuries (Lauersen et al, 2014).
🖊 Sahin et al (2015) argue that proprioception training and postural control are considered excellent proposals to prevent injuries.
🖊 The vast majority of these injury prevention exercises work on proprioception through motor tasks involving kinesthetic awareness and neuromuscular control (Rossato et al, 2013).
🖊 These exercises restore and enhance proprioception through activities that involve static, dynamic, and recovered balance by controlling postural movement.
🖊 In the field of rehabilitation, there are various protocols according to the pathological condition, which essentially seek to develop proprioceptive re-education.
🖊 Rossato et al (2013) warn that a rehabilitation program that includes proprioceptive exercises decreases the incidence of joint stiffness and reduces the athlete’s recovery time.
🖊 Regarding exercises, the literature reports that the use of devices that employ instability, with varying support (bipodal and unipodal) as well as, with and without the use of visual information with appropriate progressions, could be relevant strategies to develop proprioception (Rossato et al, 2013; Sarabon, 2015; Rivera et al, 2018 ; Baldaço et al, 2017).
🖊 In a proprioceptive training program, Chiappa (2001) points out that we must respect the progression of the exercises (from simple to complex and from general to specific).
🖊 The teaching materials used to develop proprioception in athletes are very varied and include from simple foams, skateboard, bosu, balance boards, trampoline and other accessories (Baldaço et al, 2017 ; Rossato et al, 2013 ; Leporace et al, 2009).
🖊 In this aspect, the challenge is for the strength and conditioning trainer to carry out a proprioceptive program that respects the athlete’s biological individuality and the respective specificity of his sport (Chiappa, 2001 ; Plummer et al, 2019).
🖊 Different articular segments of athletes have benefited from a proprioceptive training program (Leanderson et al, 1996; Pánics et al, 2008; Sterner et al, 1998; Safran et al, 2001; Myklebust et al, 2003).
🖊 Both passive and active exercise are important mechanisms for stimulating proprioceptive activity. In the matter of active exercises, there must be a variation in speed and range of motion in motor tasks (Chiappa, 2001).
🖊 Leporace et al (2009) argue that in proprioceptive programs various postures should be employed simulating complex situations of restoration of stability so that reactive motor signals and responses are triggered.
🖊 In female handball players, four-month proprioceptive training significantly improved the sense of knee joint positioning (Pánics et al, 2008).
🖊 Romero-Franco et al (2013) evaluated the effect of six weeks of proprioceptive training (3 times week — 30 minutes a day) on sprinters athletes. Significant differences were found in post-training in vertical jump and postural stability.
🖊 In the classical ballet, Leanderson et al (1996) found that the injured ankle presents differences in relation to the uninjured limb in the proprioceptive aspect affecting postural stability.
🖊 In a review on the prevention of ankle injuries, Rivera et al (2017) found that athletes with injury history are benefited by proprioceptive intervention demonstrated a reduction in repeat ankle sprain.
🖊 A longitudinal study (02 seasons) with female handball players showed that a preventive program involving neuromuscular and proprioceptive training reduced anterior cruciate ligament injuries of the knee. The program was used 3 times week over a period (pre-season) and was then employed 1 time week during the season (Myklebust et al, 2003).
🖊 Analyzing collegiate baseball pitchers, Safran et al (2001) found that athletes with shoulder pain have a proprioceptive deficit due to an uncoordinated pattern of muscle firing. Joint instability damages afferent receptors reducing the stimulation of mechanoreceptors.
🖊 Cervical proprioception was evaluated in rugby players through perform at the cervicocephalic relocation test. The test was performed before and after a training session. In results, when compared to non-rugby players, rugby athletes have changes in joint position sense. According to the authors, this is mainly due to collision activities that occur in matches and training such as tackling (Pinsault et al, 2010).
🖊 In futsal, Baldaço et al, (2017) performed a 4-week intervention (3 times per week) through a proprioceptive ankle program. For analysis was performed using a force platform measuring the amplitude of the pressure center. The results found a decrease in the center of pressure amplitude in the medium-lateral direction, and in the condition with eyes closed.
🖊 Investigating high school basketball players, Rivera et al, (2018) applied a prophylactic proprioceptive program for lateral ankle sprains for twelve weeks. In the results, there were significant improvements in previous reach distance performed in the Y-Balance Test. Also, there was reduction in the number of anterior ankle sprains and recurrence of lesions.
🖊 In professional soccer players, Fousekis et al, (2012) studied proprioceptive deterioration of the ankle in injured and non-injured players.
🖊 It seems that systematic volleyball training improves athletes’ proprioception. In youth female volleyball players, Sahin et al (2015) evaluated knee proprioception compared with a sedentary group. It was found that there were significant differences in both active and passive knee joint proprioception at 60 ° and 20 ° degrees.
🖊 Proprioception tends to decrease in specific phases of the menstrual cycle in female athletes. In this sense, Legerlotz et al, (2017) investigated well-trained ice hockey athletes using hormonal contraception during a period of the menstrual cycle to evaluate upper limb proprioception and dynamic postural control. In contrast to other studies that indicate changes in proprioception due to the menstrual cycle, the authors found no significant differences in this population of athletes studied.
🖊 In young speed skaters, a 12-week program involving proprioception and dynamic ankle balance showed significant improvements in kinesthesia and overrall stability index (Winter et al, 2015).
🖊 Cho et al (2015) studied elite female synchronized swimmers comparing proprioception through upper and lower limbs joint position sense on land and underwater. In the results there were less joint repositioning errors in hip and ankle underwater, as well as in shoulder, wrist, and ankle on land.
🖊 Fatigue causes deleterious effects on athletes’ proprioception. In this sense, Al Attar et al, (2017) found that the implementation of the FIFA 11+ preventive protocol after training sessions of amateur soccer athletes, that is, under fatigue conditions, can reduce the incidence of injuries. The hypothesis would be that the fatigued athlete after training would be induced to learn the execution of movement control, thus creating a preventive mechanism.
✅ Final Considerations
- To prevent and rehabilitate athletes from sports injuries, proprioceptive and neuromuscular training are considered two essential tools;
- The best situation to include proprioceptive exercises is during warm-up of athletes, but also research indicates that using a preventive protocol after training would also be interesting;
- When developing a proprioceptive prophylactic program, the strength and conditioning coach must respect the athlete’s biological individuality and the specificity of the sport;
- Some tests should be employed to evaluate the effectiveness of the medium and long-term proprioceptive program;
-Proprioceptive re-education should be an ongoing process in the training of athletes.
*** This text was originally written in my BLOG. ***
✅ My BLOG: https://adrianovretaros.blogspot.com/
✅ My Instagram: https://www.instagram.com/adrianovretaros/
✅ REFERENCES
🖊 Al Attar et al, (2017). Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial. Journal of Physiotherapy, 63 (04); 235–242.
🖊 Antunha, E. L. G., & Sampaio, P. (2008). Propriocepção: um conceito de vanguarda na área diagnóstica e terapêutica. Boletim Academia Paulista de Psicologia, 28 (02); 278–283.
🖊 Baldaço et al, (2017). Análise do treinamento proprioceptivo no equilíbrio de atletas de futsal feminino. Fisioterapia em Movimento, 23 (02); 183–192.
🖊 Blecher et al, (2018). New functions for the proprioceptive system in skeletal biology. Philosophical Transactions of the Royal Society B: Biological Sciences, 373 (1759); 20170327.
🖊 Bonfim et al, (2009). Efeito de informação sensorial adicional na propriocepção e equilíbrio de indivíduos com lesão do LCA. Acta Ortopédica Brasileira, 17 (05), 291–296.
🖊 Bonfim, T. R., & Barela, J. A. (2017). Efeito da manipulação da informação sensorial na propriocepção e no controle postural. Fisioterapia em Movimento, 20 (02); 107–117.
🖊 Callegari et al, (2010). Atividade eletromiográfica durante exercícios de propriocepção de tornozelo em apoio unipodal. Fisioterapia e Pesquisa, 17(04); 312–316.
🖊 Chiappa, GR (2001). Fisioterapia nas Lesões do Voleibol. Robe Editorial; São Paulo.
🖊 Cho et al, (2017). Proprioception and flexibility profiles of elite synchronized swimmers. Perceptual and Motor Skills, 124 (06); 1151–1163.
🖊 Conduta, F. L. (2012). A importância da propriocepção. Uma revisão bibliográfica. EFDeportes — Revista Digital, Buenos Aires, año16, n.165.
🖊 Corazza et al, (2005). Propriocepção e a familiarização ao meio líquido. Lecturas: Educación Física y Deportes, 82.
🖊 Cug & Wikstrom (2017). P10 4-weeks dynamic balance training fails to improve ankle proprioception. British Journal of Sports Medicine, 51 (01).
🖊 Cug et al, (2016). The effects of sex, limb dominance, and soccer participation on knee proprioception and dynamic postural control. Journal of Sport Rehabilitation, 25 (01), 31–39.
🖊 Francisco & Garbelotti Júnior (2002). Avaliação experimental subjetiva da propriocepção em indivíduos pós-lesão de ligamento cruzado anterior submetidos ou não a procedimento de reconstrução ligamentar. Fisioterapia Brasil, 03 (01); 25–29.
🖊 Fousekis et al, (2012). Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players. The American Journal of Sports Medicine, 40 (08), 1842–1850.
🖊 Han et al (2015). The role of ankle proprioception for balance control in relation to sports performance and injury. BioMed Research International, 01–08.
🖊 Kalantariyan et al (2018). Effects of functional ankle instability on balance recovery strategy in athletes. Physical Treatments, 08 (02); 99–106.
🖊 Leanderson et al, (1996). Proprioception in classical ballet dancers: a prospective study of the influence of an ankle sprain on proprioception in the ankle joint. The American Journal of Sports Medicine, 24 (03); 370–374.
🖊 Martimbianco et al, (2008). Efeitos da propriocepção no processo de reabilitação das fraturas de quadril. Acta Ortopédica Brasileira, 16 (02); 112–116.
🖊 Lage et al, (2015). Repetition and variation in motor practice: a review of neural correlates. Neuroscience & Biobehavioral Reviews, 57; 132–141.
🖊 Lauersen et al, (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48 (11); 871–877.
🖊 Leanderson et al, (1996). Proprioception in classical ballet dancers: a prospective study of the influence of an ankle sprain on proprioception in the ankle joint. The American Journal of Sports Medicine, 24 (03); 370–374.
🖊 Legerlotz et al, (2018). Constant performance in balance and proprioception tests across the menstrual cycle–a pilot study in well trained female ice hockey players on hormonal contraception. Health Science Reports, 01 (01), e18.
🖊 Leporace et al, (2009). Importância do treinamento da propriocepção e do controle motor na reabilitação após lesões músculo-esqueléticas. Acta Fisiátrica, 16 (03), 126–131.
🖊 Maio Nascimento, M. (2016). PET-Biomecânica: educação postural no ensino fundamental, com ênfase no equilíbrio, propriocepção e core. Motrivivência, 28 (49); 207–220.
🖊 Magill, RA (2011). Aprendizagem e Controle Motor. Phorte; São Paulo.
🖊 McArdle et al (2011). Fisiologia do Exercício. 7a. edição. Guanabara Koogan; Rio de Janeiro.
🖊 Myklebust et al, (2003). Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clinical Journal of Sport Medicine, 13 (02); 71–78.
🖊 Panics et al, (2008). Effect of proprioception training on knee joint position sense in female team handball players. British Journal of Sports Medicine, 42 (06); 472–476.
🖊 Pinsault et al, (2010). Cervical joint position sense in rugby players versus non-rugby players. Physical Therapy in Sport, 11 (02); 66–70.
🖊 Pozzana, L., & Kastrup, V. (2017). Da propriocepção à apropriação da experiência: uma prática corporal com pessoas com deficiência visual. Periferia, 09 (01), 358–382.
🖊 Platonov, VN (2008). Tratado Geral de Treinamento Desportivo. Phorte; São Paulo.
🖊 Plummer et al, (2019). General versus sports-specific injury prevention programs in athletes: A systematic review on the effects on performance. PloS One, 14 (08); e0221346.
🖊 Ribeiro, F., & Oliveira, J. (2017). Efeito da fadiga muscular local na propriocepção do joelho. Fisioterapia em Movimento, 21 (02); 71–83.
🖊 Rivera et al, (2018). Ankle Proprioception Training Program for Preventing Lateral Ankle Sprains in Adolescent Basketball Players: A Case Validation Study. Clinical Practice in Athletic Training, 01 (01); 03–10.
🖊 Rivera et al, (2017). Proprioceptive training for the prevention of ankle sprains: an evidence-based review. Journal of Athletic Training, 52 (11); 1065–1067.
🖊 Romero-Franco et al, (2013). Effect of the proprioceptive training in sprinters. Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte, 13 (51); 437–451.
🖊 Rossato et al, (2013). Propriocepção no esporte: uma revisão sobre a prevenção e recuperação de lesões desportivas. Saúde (Santa Maria), 39 (02), 57–70.
🖊 Safran et al, (2001). Shoulder proprioception in baseball pitchers. Journal of Shoulder and Elbow Surgery, 10 (05); 438–444.
🖊 Şahin et al, (2015). Evaluation of knee joint proprioception and balance of young female volleyball players: a pilot study. Journal of Physical Therapy Science, 27 (02), 437–440.
🖊 Sarabon (2015). Treinamento de estabilidade e equilíbrio. IN: Hoffman, JR (Org). NSCA — Guia de Condicionamento Físico. Manole; São Paulo.
🖊 Souza et al, (2017). Propriocepção cervical e equilíbrio: uma revisão. Fisioterapia em Movimento, 19 (04); 33–40.
🖊 Sterner et al, (1998). The effects of muscular fatigue on shoulder proprioception. Clinical Journal of Sport Medicine, 08; 96–101.
🖊 Tuthill, J. C., & Azim, E. (2018). Proprioception. Current Biology, 28 (05); R194-R203.
🖊 Vaughan et al, (2017). Impact of aging on proprioceptive sensory neurons and intrafusal muscle fibers in mice. The Journals of Gerontology: Series A, 72 (06); 771–779.
🖊 Voight et al, (1996). The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. Journal of Orthopaedic & Sports Physical Therapy, 23 (06); 348–352.
🖊 Vogt et al, . (2012). Áreas de abrangência da propriocepção: um estudo preliminar. EFDeportes — Revista Digital, Buenos Aires, año15, n.166.
🖊 Warner et al, (1996). Role of proprioception in pathoetiology of shoulder instability. Clinical Orthopaedics and Related Research, 330; 35–39.
🖊 Winter et al, (2015). Influence of a proprioceptive training on functional ankle stability in young speed skaters–a prospective randomised study. Journal of Sports Sciences, 33 (08); 831–840.
#strengthandconditioning #sports #athletes #proprioception #proprioceptivetraining #sportsinjuries #injuryprevention #sportsrehab #sportsmedicine #sportsphysiotherapy #sportsperformance #fitness #sportsscience #sportscience #sportstraining #strengthtraining #functionaltraining #physicalpreparation #exercisescience #movement #humanmovement #exercisephysiology #sportsphysiology #motorcontrol #motorprogram #physicalconditioning #conditioning #neuroanatomy #soccer #handball #basketball #baseball #classicalballet #balonmano #football #speedskaters #icehockey #rugby #futsal #synchronizedswimmers #fatigue #volleyball
