How to get it back when it’s gone

As children, we learned about the five basic senses: sight, hearing, taste, smell, and touch. Another, lesser-known sense is proprioception or our intuitive awareness of the position of our joints.

Proprioception keeps us stable and oriented during static (still) and dynamic (moving) activities. Static sense provides us with a conscious orientation of one body part to another. In other words, we know exactly where our foot is in relation to our knee. Dynamic sense gives us a sense of the speed and direction of where our foot is moving in relation to our knee or hip.

Unfortunately, any type of joint injury can interrupt our position sense. Complaints about a knee or ankle feeling ‘loose’ after an injury are common, even after the joint has seemingly recovered from injury. In these cases, proprioception has been interrupted. A reduced sense of joint position puts us at an increased risk of re-injury. It also interferes with our performance in sport.

Research has shown that the longer athletes remain unable to compete, the greater the loss of proprioception. After injuries to joints like the ankle or knee, time must be spent rehabilitating this sense of joint position. Balance exercises that gradually increase in difficulty can help.


The research findings

A Canadian physiotherapy team found that balance board training is a very important tool in rehabilitation. Use of the board improves leg and thigh muscle strength more than a series of gym weight machine exercises.

A landmark study by a Scandinavian research team found that a six-week program of balance training, completed by soccer players with long-term ankle problems, prevented repeat ankle injuries in these players.

Proprioception training has also been shown to ward off various types of joint injuries. A study of over 900 European soccer players found that balance exercises helped prevent future ACL (knee ligament) tears.

Athletes are not the only ones who suffer from a loss of joint position sense. Those with other long-term joint conditions, such as osteoarthritis, also experience problems. Balance training can improve the stability of a joint. With the right program, the pain and inflammation of osteoarthritic joints can be reduced.

Getting started
Doing these exercises is like learning to swim. You do not just jump in the ocean and start swimming. You must begin in the shallow end of a swimming pool and practice in a controlled environment first. When doing a proprioceptive rehabilitation program, be aware of your ankle or knee in relation to the rest of your body. You must always be in control of these joints.

Start on a stable surface. As the joint regains its sense and can be controlled, you can progressively challenge it. Next, try doing the same exercise on an unstable surface. After that, do the exercises with your eyes closed. Finally, add in dynamic activities such as kicking, throwing and catching.

The test

The Rhomberg test is a simple check of your balance. To do it, stand on one leg without allowing your raised foot to touch your standing leg. Begin with your eyes open, and practice once or twice on each side. Then, looking straight ahead, close your eyes and try to keep your balance for 30 seconds. You fail if your raised leg touches the ground or the standing leg, or you fail is you grab something with your arms.

Do the test three times and count the longest time you stayed balanced as your score. A full 30 seconds is a pass. If you didn’t pass, practice the following exercises to improve your score.

The program

A balance rehabilitation program should take between five and 20 minutes, three times per week. All the exercises require concentration and should be done at the beginning of your exercise program. Otherwise, the muscles surrounding the joint will be too tired to maintain control.

Use the program for about six weeks. After this, do the most challenging exercises for 10 minutes every five days to maintain your position sense.


Exercise 1

This exercise forms the base of all of the others. Start by sitting in a chair with your feet flat on the floor. Carefully form or pull up the arch in your foot, trying not to curl your toes. When you can do this sitting, try it standing. Once that is mastered, stand on one leg. Finally, when you are becoming a superstar, do it standing on a towel rolled lengthwise.


Exercise 2

Standing on some foam, pull up your arch and balance on one foot. Next, try to maintain your balance with your eyes closed. Then, standing about two meters from a wall, throw a tennis ball against a spot on the wall. Catch the ball while maintaining your balance on the foam.


Exercise 3

Once you have mastered the first two exercises, progress by using a wobble board for this exercise. These can be found in most gyms, made at home, or purchased through various companies.

Place the board on a carpet, preferably near a wall. Begin by simply trying to maintain your balance. As you gain confidence rock the board back and forth with your feet, slowly and with full control. The next challenge is to rock the board from side to side again, retaining full control of the board. Once this has been mastered, perform small knee bends or stand on the board on one foot. Later, try doing all of the same exercises with your eyes closed, or while throwing and catching a tennis ball against a wall.

After completing the above balance-training program, you can begin adding sport-specific exercises. Your imagination is the only limiting factor. However, continue to focus on maintaining control of the position of your joints while doing the balance exercise. Advanced examples include kicking a soccer ball while standing on foam, hitting a golf ball while kneeling on a stability ball, or shooting a basketball while standing on a wobble board.