I often say that “one of the best predictors if future injury is past injury“ – as a previously damaged muscle, ligament or joint is often weaker and the patient may have returned to full activity when there is still residual post injury weakness, swelling or instability.
In the ankle – it has been suggested that between 40% and 70% of all first time ankle sprain patients will sustain a re-sprain of the same joint some time in the 12 months after the initial injury – this is why “Proprioception and Balance” is such an important part of the rehabilitation protocol.
The term “Proprioception” refers to the ability to sense stimuli arising within the body – or the ability to identify your bodys position in space – the actual term “Proprioception” was coined in 1906 by the English neurophysiologist Charles Sherrington who received the Nobel Prize for Physiology or Medicine in 1932 for research on the function of the neuron and study of reflex action.
To demonstrate your own proprioceptive powers simply shut your eyes – now bend your right elbow to a 90 degree angle –without looking at the elbow you should be able to identify that your elbow is actually in the 90 degree position – now keeping your eyes closed straighten your elbow and raise your arm above your head. Again you should be able to identify that your arm is straight and that it is above your head – this non visual body awareness is an example of Proprioception.
Your brain receives direct nervous impulses (messages) from your joints, muscles, ligaments and other sensory receptors that let you identify exactly where your limbs are in space – however when you injury a body part – these nerve endings and pathways are disrupted – leading to reduced segmental transmission to the brain and thus reduced body awareness.
In the case of an ankle sprain – the patient may have reduced sensory input to your brain when they return to walking and running – and if they were to tread on an uneven surface – their ankle may unfortunately sprain again as the brain did not get the “watch out my ankle is about to sprain” message in time and before they know it they are back at the physio clinic.
The inclusion of balance and proprioception exercises in the post acute recovery stages greatly improves post injury balance and allows the body to re-learn its correct position senses – thus reducing re- injury.
Some typical ankle proprioception exercises include:
– attempting to walk as normally as possible when pain allows (to reduce compensatory changes and imbalances)
– standing on the injured leg for a short time with your eyes open
– standing on one leg with your eyes closed – a great right versus left comparison test post inury
– completing 2 leg and one leg calf raises with eyes open and closed
– progressing to hopping activities with eyes open and closed
– using equipment such as balance boards, BOSU, FREE Form Boards and wobble boards to further challenge the injured body part.
Balance and proprioception training is an important part of the injury recovery process and must be given the attention it deserves – if you have had an injury in the past and are not sure about your level of proprioception – or you have been a victim of re-injury of the same body part – then see your health professional for a full assessment.
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