Proper management of sports injuries can be complex and challenging for sports health professionals. Management of sports injuries in athletes includes preventing athletic injuries and programming rehabilitation after joint injuries. Structural and neuromuscular mechanisms will be disrupted if an injury occurs and will cause decreased performance and increase the risk of re-injury.
When performing movements such as walking, running, or jumping, as a rapid response cycle of the lower extremities, and some parts of the upper extremities, the muscles in these parts of the body play an important role in maintaining the desired posture. Afferent information to refine motor control is provided by proprioceptive, visual, vestibular, and somatosensory receptors.
Somatosensory receptors are located in muscles, tendons, joints, and other tissues. Proprioception is concerned with the mechanoreceptive sense of position, which includes the sense of touch and position. Trauma to tissues can cause damage to mechanoreceptors, which can lead to proprioceptive deficits. As a result, the risk of re-injury may occur due to reduced proprioceptive feedback. Ligamentous trauma can result in mechanical instability and proprioceptive deficits that contribute to functional instability, which in turn can lead to further microtrauma and re-injury.
Proprioceptive Training as Ligament Injury Prevention
Exercises should include a series of repetitive movements that are performed slowly and in a directed manner, and accompanied by sudden and external disturbances of joint position to train reflexes.
1. Balance Exercises
One of the main categories of proprioceptive exercises is balance training. These exercises help train the proprioceptive system in activities that are largely static. In the lower extremities, activities may include single-leg balance exercises, use of wobble board progressively, and tandem walking exercises where postural disturbances can be applied to the individual by the therapist.
2. Plyometric Exercises
Plyometric training combines an eccentric preload (rapid eccentric stretching) followed by a powerful concentric contraction. This training technique is thought to enhance reflex stabilization of joints and may increase muscle stiffness. It is gaining popularity as an example of neuromuscular control training that integrates the spinal and brainstem levels and has become an effective adjunct to upper and lower extremity conditioning and rehabilitation programs. Plyometric training may be added to a post-injury rehabilitation program once near-normal strength in all target muscles has been achieved.
3. Isokinetic Exercise
Isokinetic exercises can be performed to improve the sensation of “joint position”. The athlete will be asked to place their extremity in a predetermined position and asked to repeat this position. This is done initially with the eyes open and then with the eyes closed to block out visual input that may aid neuromuscular control. These exercises can be performed with and without eccentric and/or concentric loading.
4. Kinetic-chain exercise
Closed-chain exercises train the dynamic and reflexive aspects of proprioception in the leg and foot. During a closed-chain movement at one joint, a predictable movement is produced at the other joint that usually involves an axial force. The lower extremity functions in a closed-chain manner during sports and activities of daily living, so these exercises will facilitate the re-establishment of proper neuromuscular patterns.
Open-chain manual resistance exercises with rhythmic stabilization (rapid changes in the direction of applied pressure) are also considered proprioceptively useful. In both cases, the resistance can be modified, depending on pain tolerance, as the patient progresses.
5. Reaction-Time Practice
The long reaction time suggests that motor activity cannot be considered a mere response to environmental stimuli. To prevent injury, a programmed set of muscle commands is required. This motor programming allows for activity based on exposure to ongoing events. Repeated practice of reaction time also allows the cerebral cortex to determine the most effective motor pattern for the task and potentially reduces response time.
In general, it is recommended that the training program be carried out for at least 6-10 weeks to improve proprioceptive abilities, especially during the pre-season. It should also be noted that proprioceptive training should be combined with other specific training items such as strength, flexibility, agility, etc. during training.
Also read: Apa Itu Kerobekan Ligamen ? Ketahui Penyebab dan Gejalanya
Reference :
- Mahmut Nedim Doral, Jon Karlsson. 2015. Sports Injuries : Prevention, Diagnosis, Treatment and Rehabilitation. Springer Berlin, Heidelberg. doi : https://doi.org/10.1007/978-3-642-36569-0
