The Comparison of the Effect of Deep and Superficial Heat on Healthy Ankle Joint Position Sense

Background: Heat therapy is one of the natural treatments that can affect the information transferred by the proprioceptive receptors. Heat has an effect on the conduction velocity of peripheral nerves, but the exact effect of two kinds of deep and superficial heat on the joint position sense is not known clearly. The present study aimed to compare the effect of deep and superficial heat on ankle joint position sense. Methods: Thirty healthy male students aged between 18 to 30 y/o participated in this study. Deep heat by short-wave diathermy and superficial heat by water of 42 oC were applied for 15 minutes in two sessions for all participants. In all of the tests, active and passive ankle joint position sense in dorsiflexion and plantarflexion were measured by pedal goniometers prior to and after heat application. The Non-Parametric-Paired T-test Wilcoxon and Non-ParametricPaired T-test Mann-Withney were used to analyze the data. Results: The superficial heat does not have any positive or negative effect on the ankle joint position sense. After the deep heat, the absolute angular error of active dorsiflexion was increased, but passive plantarflexion was decreased significantly. Comparing the two types of heat, the results revealed that the deep heat increased the absolute angular error of active dorsiflexion significantly more than superficial heat. Conclusion: According to the results, deep heat therapy improves passive ankle joint position sense in plantar flexion, but it worsens the active joint position sense of dorsiflexion. Therefore, it seems that after applying deep heat therapy on an ankle joint, exercise prescriptions need to be cautious. 2014© The Authors. Published by JRSR. All rights reserved. *Corresponding author: Soraya Pirouzi, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Chamran Avenue, Abiverdi Street, Shiraz, Iran, Tel: +98-71-36271551, Fax: +98-71-36272495, E-mail: [email protected] Introduction Conscious perception of each person from his body and his position from his environment with automatic joint reaction is called articular sense or proprioception [1]. This sense makes a person aware about joint position, type of joint movement, the direction of movements, and finally it causes muscle contraction for joint movement and stability [2]. The central nervous system receives the information related to joint position sense from different receptors, such as muscle receptors (muscle spindle and Golgi tendon organs), joint capsule mechanoreceptors, skin receptors (free nerve endings), visual, auditory, and vestibular receptors [3]. Joint position sense is essential for keeping true joint action in sports, ADL, and occupational tasks [4]. The protective role of joint position sense is more important in distal joints, because these joints are exposed to more Journal of Rehabilitation Sciences and Research Journal Home Page: jrsr.sums.ac.ir Ghaffarinejad F et al. JRSR. 2014;1(3) 64 forces and injuries due to more mobility [5]. In addition, the ankle joint tolerates most of the weight of the body and, because of its different movements, joint position sense is very important in this joint [6]. Joint position sense is influenced by different factors, such as vibration and muscular-nervous conditions around the joint and joint destructive factors like arthritis, which subsequently can decrease joint position sense of the joint and affect other joints [7, 8]. Disability in this sense affects the muscle action and joint stability and its weakness can cause acute and chronic injuries in the joint. Therefore, in their treatment, attention must be paid to joint position sense improvement programs [1]. Nowadays, heat modalities are used in curing and as analgesics for musculoskeletal lesions and also for increasing tendon elasticity and decreasing muscle spasms on a large scale [9]. Studies showed that temperature had a remarkable effect on the peripheral nervous system because some biological and chemical processes controlling the nervous system are sensitive to temperature. These include acetylcolin-esterase, voltage canals, and the skeletal muscle contraction properties [10]. In addition, researchers have indicated that there is a linear relation between the speed of spindle-efferent discharge and muscle temperature. This is important because each change in efferent signal can cause a change in the sensitivity of the muscle spindles and, thus, influence the accuracy level of joint position sense [11]. This may alter the balance and motor response. Therefore, it is important to find out the effects of heat on position sense. Proprioception of the ankle joint plays an important role in balance in different positions like walking, standing, and other ADL’s, and the use of heat for curing problems of the ankle joint has become a common modality in physiotherapy clinics. Also, in respect to superficial heat and deep heat affecting different tissues, in the present study the effect of two kinds of heat modalities in the forms of deep and superficial heat have been investigated on the position sense of the ankle joint. The aim of this research is to determine and compare the effects of superficial and deep heat on ankle joint position sense.