Proprioceptive training Dr. Ali Abd El-Monsif Thabet

Proprioceptive trainingProprioceptive training

Dr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet

Proprioceptive system:Proprioceptive system: A general term used to cover all A general term used to cover all

those sensory systems that are those sensory systems that are involved in providing information involved in providing information about position, location, orientation about position, location, orientation and movement of the body and its and movement of the body and its parts (sensing position and motion of parts (sensing position and motion of the body).the body).

Fig. 1 Muscle spindle

Fig. 2 Golgi tendon organ

Ruffini ending

Pacinian corpuscle

Fig. 3 a. Ruffini endings b. Pacinian corpuscle Fig. 3 a. Ruffini endings b. Pacinian corpuscle

Table 1: Summary of articular proprioceptors

Cutaneous Cutaneous mechanoreceptorsmechanoreceptors

Cutaneous mechanoreceptors are located Cutaneous mechanoreceptors are located in the skinin the skin

By morphologyBy morphology Ruffini's end organRuffini's end organ detects sustained pressure. detects sustained pressure. Meissner's corpuscleMeissner's corpuscle detects changes in texture (vibrations detects changes in texture (vibrations

around 50 Hz); around 50 Hz); Pacinian corpusclePacinian corpuscle detects deep pressure and rapid vibrations detects deep pressure and rapid vibrations

(about 200-300 Hz). (about 200-300 Hz). Merkel's discMerkel's disc detects sustained touch and pressure. detects sustained touch and pressure. Free nerve endingsFree nerve endings (touch, pressure, stretch) (touch, pressure, stretch) Hair folliclesHair follicles receptorsreceptors are located in are located in hair follicleshair follicles and sense the and sense the

position position

AFFERENT INPUT

Peripheral afferents

•joint•muscle•skin

Visual receptors

Vestibular receptors

CNS

LEVELS OF MOTOR CONTROL

Spinal reflexes

Cognitive programming

Brain Stem balance

MUSCLE

Purposes of proprioception:Purposes of proprioception: 1- Provide awareness of position 1- Provide awareness of position

sense and kinesthesia.sense and kinesthesia. 2- Produce coordinated reflex 2- Produce coordinated reflex

effects on muscle tone and balance.effects on muscle tone and balance. 3- Provide peripheral feedback so 3- Provide peripheral feedback so

the CNS can design and modify the CNS can design and modify effective motor programseffective motor programs

Measurement MethodsMeasurement Methods

Proprioceptive assessment tests:Proprioceptive assessment tests: 1. 1. Tests of angular reproduction Tests of angular reproduction

(AR)(AR) 2.Threshold to detect passive 2.Threshold to detect passive

movement (TTDPM)movement (TTDPM)

Indications for proprioceptive trainingIndications for proprioceptive training

1-Joint sprain or strain1-Joint sprain or strain

2-Joint instability (shoulder dislocation 2-Joint instability (shoulder dislocation ,ligament laxity or weakness),ligament laxity or weakness)

4-Athletic protection against reinjury4-Athletic protection against reinjury

Proprioceptive Training Proprioceptive Training Proprioceptive exercisesProprioceptive exercises The objective of kinesthetic and proprioceptive The objective of kinesthetic and proprioceptive

training is to restore the neurosensory properties of training is to restore the neurosensory properties of injured capsuloligamentous structures and enhance injured capsuloligamentous structures and enhance the sensitivity of uninvolved peripheral afferents.the sensitivity of uninvolved peripheral afferents.

Rehabilitation programs begin with restoration of Rehabilitation programs begin with restoration of range of motion, muscular endurance, and muscular range of motion, muscular endurance, and muscular strength. These exercises, in a nonspecific fashion, strength. These exercises, in a nonspecific fashion, stimulate joint and muscle proprioceptors in the stimulate joint and muscle proprioceptors in the injured extremityinjured extremity

Joint compression is believed to maximally stimulate Joint compression is believed to maximally stimulate articular receptors and can be accomplished with articular receptors and can be accomplished with closed chain exercises throughout the available ROM. closed chain exercises throughout the available ROM. Early joint repositioning tasks enhance conscious Early joint repositioning tasks enhance conscious proprioceptive and kinesthetic awareness, eventual proprioceptive and kinesthetic awareness, eventual leading to unconscious appreciation of joint motion leading to unconscious appreciation of joint motion and and position. Applying elastic bandage can provide position. Applying elastic bandage can provide additional proprioceptive and kinesthetic formation by additional proprioceptive and kinesthetic formation by stimulating cutaneous receptorsstimulating cutaneous receptors

Proprioceptive TrainingProprioceptive TrainingGeneral principlesGeneral principles 1- Balance is achieved first, then 1- Balance is achieved first, then

coordination, then agility ( the ability to coordination, then agility ( the ability to control the direction of a body or its parts control the direction of a body or its parts during rapid movement, it requires flexibility, during rapid movement, it requires flexibility, strength, power, speed, balance, and strength, power, speed, balance, and coordination and involves rapid change of coordination and involves rapid change of direction and sudden stopping and starting).direction and sudden stopping and starting).

2- Exercises progress from simple to complex 2- Exercises progress from simple to complex ..

3- Initial exercises are performed slowly and 3- Initial exercises are performed slowly and perfomed in controlled situationsperfomed in controlled situations

Proprioceptive TrainingProprioceptive Training 4- Advancement is made only after the 4- Advancement is made only after the

activity is masteredactivity is mastered 5- Progression is to more complex activities 5- Progression is to more complex activities

and evolves to specific performance and evolves to specific performance activities: activities: 

Make activity more complexMake activity more complex Perform simple activity at a faster pacePerform simple activity at a faster pace Require a more powerful outputRequire a more powerful output Have patient perform more than one task Have patient perform more than one task

simultaneouslysimultaneously 6 - Goal: perform the activity accurately:6 - Goal: perform the activity accurately: Do difficult proprioceptive activities early in Do difficult proprioceptive activities early in

exercise session so patient not as fatiguedexercise session so patient not as fatigued RepetitionRepetition

Figure 8 : Left, Eyes open, Fitter balance in push-up position Figure 8 : Left, Eyes open, Fitter balance in push-up position with platform rocking in the frontal plane. Right, Fitter balance with platform rocking in the frontal plane. Right, Fitter balance in push up position with platform rocking in the sagittal plane.in push up position with platform rocking in the sagittal plane.

Figure 9 : Eyes open, Gymnastic ball Figure 9 : Eyes open, Gymnastic ball balance feet-elevated positionbalance feet-elevated position

Figure 11 : Dynamic shoulder stabilization in all four position but Figure 11 : Dynamic shoulder stabilization in all four position but with one hand on a wobble board and the other hand held off the with one hand on a wobble board and the other hand held off the floor. The shoulder girdle is challenged as the patient tries to keep floor. The shoulder girdle is challenged as the patient tries to keep the edge of the wobble board from touching the floor.the edge of the wobble board from touching the floor.

Fig. 12 Dynamic stabilization exercises for the upper extremity. Fig. 12 Dynamic stabilization exercises for the upper extremity. A, Push-ups. B, Horizontal abduction on a slide boardA, Push-ups. B, Horizontal abduction on a slide board

Fig. 14 Active and passive repositioning activities should be Fig. 14 Active and passive repositioning activities should be performed in functional positions specific to individual sports.performed in functional positions specific to individual sports.

Thank you