The Role of Proprioception in the Management and Rehabilitation of Injuries

Rehabilitation continues to evolve with the increased emphasis on patient management and proprioceptive training. Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position Goint position sense). Numerous investigators have observed that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Examining the effects of ligamentous injury, surgical intervention, and proprioceptively mediated activities in the rehabilitation program provides an understanding of the complexity of this system responsible for motor control. It appears that this neuromuscular feedback mechanism becomes interrupted with injury and abnormalities, and approaches restoration after surgical intervention and rehabilitation. Rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. Such a program is highly recommended to promote dynamic joint and functional stability. Thus far, current knowledge regarding ~he basic science and clinical application of proprioception has led the pro:fession of sports medicine one':-$tep closer to its ultimate goal of restoring function. The proper management of athletic-related injuries alnd orthopaedic lesions can be complex in the sports medic:ine setting. One of the most challenging aspects to the clinician is understanding the role of proprioceptively me,diated neuromuscular control after joint injury and its restoration through rehabilitation. Proprioception contributes to the motor programming for neuromuscular control required for precision movements and also contzibutes to muscle reflex, providing d)ffiamic joint stabili,ty. The coupling effect of ligamentous trauma resulting in mechanical instability and proprioceptive deficits contzibutes to functional instability, which could ultimately lead to further microt~auma and reinjury (Fig. 1). AchieV:lng functional and sport-specific activities after musculos~:eletal trauma and rehabilitation can be enhanced significantly if proprioception is addressed and instituted early in the treatment program. In addition to the mechanical restraint provided by articular structures, it has been observed that ligame:nts provide neurologic feedback that directly mediates reflex muscular stabilization about the joint.2o The inclusion of proprioception in the rehabilitation program should be based on the preceding finding and not on anecdotal E!vidence without an understanding of the neuromuscular mechanism. This understanding, coupled with a basEl of knowledge regarding the current research on proprioception, is necessary for sports medicine practitioners to optimize treatment programs for athletes. THE ROLE OF PROPRIOCEPTION Numerous investigators have provided definitions regarding the terminology of joint sensation, or proprioception and kinesthesia.3.26 Most contemporary authorities define proprioception as a specialized variation of the sensory .Address correspondence and reprint requests to Scott M. Lephart. PhD. ATC. Neuromuscular Research Laboratory. 127 Trees Hall. University of Pittsburgh. Pittsburgh. PA 15261. No author or related institution has received financial benefit from research