Re: Proprioceptive training

[Guest guest]

>

> Hi all,

>

> Can anyone recommend a link or a website where I can find

information and some proprioreception exercises for helping someone

recover from a knee injury? I have only read about propriorecption

training being beneficial after an injury to a joint and would like

to learn more. Also, a friend who has recently been released from pt

has asked me to help him with a conditioning program. He recently

had knee surgery. I thought the proprioreception training would be

a nice compliment to the strength and conditioning program. Please

let me know if you need more specifics about the surgery in order to

answer my question.>>>

***

More specific details would be helpful.

Thanks

Carruthers

Wakefield, UK

[Guest guest]

---

Hi !

Although there is a abundance of wobble boards and unstable platforms

that people can balance themselves I find simple activites such as

standing on one leg for time both eyes open and closed works quite

well with a nice progressive free weight program that includes squats

and deadlifts progressing to cleans and snatches along with

plyometric drills.

Best wishes!

Dan Wathen, Youngstown (OH) State University, USA

In Supertraining , " carruthersjam "

wrote:

>

>

> >

> > Hi all,

> >

> > Can anyone recommend a link or a website where I can find

> information and some proprioreception exercises for helping someone

> recover from a knee injury? I have only read about propriorecption

> training being beneficial after an injury to a joint and would like

> to learn more. Also, a friend who has recently been released from

pt

> has asked me to help him with a conditioning program. He recently

> had knee surgery. I thought the proprioreception training would

be

> a nice compliment to the strength and conditioning program. Please

> let me know if you need more specifics about the surgery in order

to

> answer my question.>>>

>

> ***

> More specific details would be helpful.

>

> Thanks

>

> Carruthers

> Wakefield, UK

>

[Guest guest]

Hi,

Here are some more specific details regarding the knee injury.

Surgery # 1 was to trim meniscus. He was on crutches for 2 weeks

Surgery #2 was called micro fracture surgery. His was 2cm by 3cm of the medial

tibial plateau. He said that the cartilage covering the tibial head had a hole

in it down to the bone. The surgery was to stimulate cartilage growth by

drilling into the bone. This time he was on crutches for 7 weeks. He has been

released from pt but he still cannot bear weight evenly on the leg he had

surgery on. He is a former collegiate football player, recreational sprinter

and avid weight lifter. 45 years old 6'4 and I am guessing 225. I can get an

exact weight if necessary. I would very much like to see him get back to the

weight bearing exercises he enjoys if it's possible.

Hopefully this helps you and anyone else attempting to help answer my question.

Thank you

Huntsman

Florida, USA

carruthersjam wrote: ---

In Supertraining , Huntsman

wrote:

>

> Hi all,

>

> Can anyone recommend a link or a website where I can find

information and some proprioreception exercises for helping someone

recover from a knee injury? I have only read about propriorecption

training being beneficial after an injury to a joint and would like

to learn more. Also, a friend who has recently been released from pt

has asked me to help him with a conditioning program. He recently

had knee surgery. I thought the proprioreception training would be

a nice compliment to the strength and conditioning program. Please

let me know if you need more specifics about the surgery in order to

answer my question.>>>

***

More specific details would be helpful.

Thanks

Carruthers

Wakefield, UK

============================================

[Guest guest]

> >

> > >

> > > Hi all,

> > >

> > > Can anyone recommend a link or a website where I can find

> > information and some proprioreception exercises for helping

someone

> > recover from a knee injury? I have only read about

propriorecption

> > training being beneficial after an injury to a joint and would

like

> > to learn more. Also, a friend who has recently been released

from

> pt

> > has asked me to help him with a conditioning program. He

recently

> > had knee surgery. I thought the proprioreception training would

> be

> > a nice compliment to the strength and conditioning program.

Please

> > let me know if you need more specifics about the surgery in order

> to

> > answer my question.>>>

******

Noah Wasielewski, PhD, ATC, CSCS kindly forwarded the below

information to the group:

There is *very* little research in this area. I have a few

references that pertain to ACL reconstructed persons and a couple for

osteoarthritis. See below:

Systematic Reviews

RL, NF, Feller JA A systematic review of the effect of

proprioceptive and balance exercises on people with an injured or

reconstructed anterior cruciate ligament Research in Sports Medicine

2005;13(2):163-178.

---------------------------

Clinical Trials

RL, NF, Feller JA. A randomised controlled trial of

proprioceptive and balance training after surgical reconstruction of

the anterior cruciate ligament. Research in Sports Medicine 2005 Jul-

Sep;13(3):217-230.

Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM. The

effects of proprioceptive or strength training on the neuromuscular

function of the ACL reconstructed knee: a randomized clinical trial.

Scandinavian Journal of Medicine & Science in Sports 2003 Apr;13

(2):115-123.

Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of proprioceptive

functions between computerized proprioception facilitation exercise

and closed kinetic chain exercise in patients with knee

osteoarthritis. Clinical Rheumatology 2007 Apr;26(4):520-528.

Dracoglu D, Aydin R, Baskent A, Celik A. Effects of kinesthesia and

balance exercises in knee osteoarthritis. Journal of Clinical

Rheumatology 2005 Dec;11(6):303-310.

=============================

Carruthers

Wakefield, UK

[Guest guest]

---

Hi !

There is a nice review that might interest you in the latest issue

of the Strength & Conditioning. You can view it on-line at

<www.nsca-lift.org>

Best wishes!

Dan Wathen,

Youngstown (OH) State University, USA

In Supertraining , " carruthersjam "

wrote:

>

>

> > >

> > > >

> > > > Hi all,

> > > >

> > > > Can anyone recommend a link or a website where I can find

> > > information and some proprioreception exercises for helping

> someone

> > > recover from a knee injury? I have only read about

> propriorecption

> > > training being beneficial after an injury to a joint and would

> like

> > > to learn more. Also, a friend who has recently been released

> from

> > pt

> > > has asked me to help him with a conditioning program. He

> recently

> > > had knee surgery. I thought the proprioreception training

would

> > be

> > > a nice compliment to the strength and conditioning program.

> Please

> > > let me know if you need more specifics about the surgery in

order

> > to

> > > answer my question.>>>

>

> ******

> Noah Wasielewski, PhD, ATC, CSCS kindly forwarded the below

> information to the group:

>

> There is *very* little research in this area. I have a few

> references that pertain to ACL reconstructed persons and a couple

for

> osteoarthritis. See below:

>

> Systematic Reviews

> RL, NF, Feller JA A systematic review of the effect

of

> proprioceptive and balance exercises on people with an injured or

> reconstructed anterior cruciate ligament Research in Sports

Medicine

> 2005;13(2):163-178.

>

> ---------------------------

>

> Clinical Trials

> RL, NF, Feller JA. A randomised controlled trial of

> proprioceptive and balance training after surgical reconstruction

of

> the anterior cruciate ligament. Research in Sports Medicine 2005

Jul-

> Sep;13(3):217-230.

>

> Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM. The

> effects of proprioceptive or strength training on the

neuromuscular

> function of the ACL reconstructed knee: a randomized clinical

trial.

> Scandinavian Journal of Medicine & Science in Sports 2003 Apr;13

> (2):115-123.

>

> Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of

proprioceptive

> functions between computerized proprioception facilitation

exercise

> and closed kinetic chain exercise in patients with knee

> osteoarthritis. Clinical Rheumatology 2007 Apr;26(4):520-528.

>

> Dracoglu D, Aydin R, Baskent A, Celik A. Effects of kinesthesia

and

> balance exercises in knee osteoarthritis. Journal of Clinical

> Rheumatology 2005 Dec;11(6):303-310.

>

> =============================

> Carruthers

> Wakefield, UK

>

[Guest guest]

Hi Dan,

I looked for your recommendation but am not finding it. What is the name of the

review? Is it in the regular journals or the performance training journal?

Thanks

Huntsman

Florida, USA

=================================

icp328 wrote: ---

Hi !

There is a nice review that might interest you in the latest issue

of the Strength & Conditioning. You can view it on-line at

<www.nsca-lift.org>

Best wishes!

Dan Wathen,

Youngstown (OH) State University, USA

In Supertraining , " carruthersjam "

wrote:

>

>

> > >

> > > >

> > > > Hi all,

> > > >

> > > > Can anyone recommend a link or a website where I can find

> > > information and some proprioreception exercises for helping

> someone

> > > recover from a knee injury? I have only read about

> propriorecption

> > > training being beneficial after an injury to a joint and would

> like

> > > to learn more. Also, a friend who has recently been released

> from

> > pt

> > > has asked me to help him with a conditioning program. He

> recently

> > > had knee surgery. I thought the proprioreception training

would

> > be

> > > a nice compliment to the strength and conditioning program.

> Please

> > > let me know if you need more specifics about the surgery in

order

> > to

> > > answer my question.>>>

>

> ******

> Noah Wasielewski, PhD, ATC, CSCS kindly forwarded the below

> information to the group:

>

> There is *very* little research in this area. I have a few

> references that pertain to ACL reconstructed persons and a couple

for

> osteoarthritis. See below:

>

> Systematic Reviews

> RL, NF, Feller JA A systematic review of the effect

of

> proprioceptive and balance exercises on people with an injured or

> reconstructed anterior cruciate ligament Research in Sports

Medicine

> 2005;13(2):163-178.

>

> ---------------------------

>

> Clinical Trials

> RL, NF, Feller JA. A randomised controlled trial of

> proprioceptive and balance training after surgical reconstruction

of

> the anterior cruciate ligament. Research in Sports Medicine 2005

Jul-

> Sep;13(3):217-230.

>

> Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM. The

> effects of proprioceptive or strength training on the

neuromuscular

> function of the ACL reconstructed knee: a randomized clinical

trial.

> Scandinavian Journal of Medicine & Science in Sports 2003 Apr;13

> (2):115-123.

>

> Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of

proprioceptive

> functions between computerized proprioception facilitation

exercise

> and closed kinetic chain exercise in patients with knee

> osteoarthritis. Clinical Rheumatology 2007 Apr;26(4):520-528.

>

> Dracoglu D, Aydin R, Baskent A, Celik A. Effects of kinesthesia

and

> balance exercises in knee osteoarthritis. Journal of Clinical

> Rheumatology 2005 Dec;11(6):303-310.

>

> =============================

> Carruthers

> Wakefield, UK

>

[Guest guest]

,

Though I know some people may disagree, but

" core/balance training " , or putting people onto

unstable surfaces (i.e. a core balance disc), is not

what I would recommend for someone coming out of knee

surgery. It might do you some good to look at some

previous discussions on here such as " Stability or

Control of Instability " and " What triggers a motor

program--a wrong one? " . I mention these two because

we first need to understand the forces that are put on

the body on an everyday basis and how we teach the

body to do the things we want it to do. Someone who

is coming off of surgery typically has extremely weak

muscles: they are in a somewhat contracted state, or

weak binding state, and this is why they tend to have

a limited range of motion. Because of this the first

concern needs to be getting these muscles back into

strong binding states. This is done by moving them

through the largest ranges of motion possible and

forcing the body to recruit as many motor units as

possible without excessively overloading the muscles

and causing reinjury. Now many will argue that

" balance/core training " does this exact thing. The

problem is that this may be an excessive overload for

many coming out of knee sugery where stabilizing

themselves in space on a hard flat surface is

typically hard enough for them (see " Stability or

control of instability " ). But the main issue with

this is the motor program that is being taught. When

doing " core/balance training " the body will not be

recruiting the motor-units, and thus fibers, of the

appropriate muscles and in the appropriate order at

the appropriate times. In other words an improper

motor program may be being taught which could

eventually lead to reinjury, or even cause reinjury in

the rehab process, or just teach the body to not be as

effective as it could otherwise be.

Lastly, I would like to dispell the usage of the term

" proprioception " when referring to this kind of

training. Proprioception is generally defined as the

ability to determine where a particular body part is

in space. Because part of the proprioceptive sense is

believed to be regulated by the sensory neurons in the

inner ear many people directly associate it with

balance (and for good reason, without the

proprioceptive sense we wouldn't be able to " balance "

at all). However, proprioception is used just as

effectively, or even more effectively during many

stable surfaced exercises, i.e. squats (especially one

legged), bench press, and any of the Olympic Lifts.

Call it " core training " or " balance training " or

whatever else you want, but to suggest that it teaches

someone to better understand where their body is at in

space is completely not accurate (this is not a hit on

's use of the term, it's not her fault that this

is what many people call it, just the fact that the

use of this terminology in reference to this kind of

training ever started).

Chad Scheitel, MA, CSCS

Minneapolis, MN

--- carruthersjam wrote:

>

> > >

> > > >

> > > > Hi all,

> > > >

> > > > Can anyone recommend a link or a website

> where I can find

> > > information and some proprioreception exercises

> for helping

> someone

> > > recover from a knee injury? I have only read

> about

> propriorecption

> > > training being beneficial after an injury to a

> joint and would

> like

> > > to learn more. Also, a friend who has recently

> been released

> from

> > pt

> > > has asked me to help him with a conditioning

> program. He

> recently

> > > had knee surgery. I thought the

> proprioreception training would

> > be

> > > a nice compliment to the strength and

> conditioning program.

> Please

> > > let me know if you need more specifics about the

> surgery in order

> > to

> > > answer my question.>>>

>

> ******

> Noah Wasielewski, PhD, ATC, CSCS kindly forwarded

> the below

> information to the group:

>

> There is *very* little research in this area. I

> have a few

> references that pertain to ACL reconstructed persons

> and a couple for

> osteoarthritis. See below:

>

> Systematic Reviews

> RL, NF, Feller JA A systematic review

> of the effect of

> proprioceptive and balance exercises on people with

> an injured or

> reconstructed anterior cruciate ligament Research in

> Sports Medicine

> 2005;13(2):163-178.

>

> ---------------------------

>

> Clinical Trials

> RL, NF, Feller JA. A randomised

> controlled trial of

> proprioceptive and balance training after surgical

> reconstruction of

> the anterior cruciate ligament. Research in Sports

> Medicine 2005 Jul-

> Sep;13(3):217-230.

>

> Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P,

> Khan KM. The

> effects of proprioceptive or strength training on

> the neuromuscular

> function of the ACL reconstructed knee: a randomized

> clinical trial.

> Scandinavian Journal of Medicine & Science in Sports

> 2003 Apr;13

> (2):115-123.

>

> Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison

> of proprioceptive

> functions between computerized proprioception

> facilitation exercise

> and closed kinetic chain exercise in patients with

> knee

> osteoarthritis. Clinical Rheumatology 2007

> Apr;26(4):520-528.

>

> Dracoglu D, Aydin R, Baskent A, Celik A. Effects of

> kinesthesia and

> balance exercises in knee osteoarthritis. Journal of

> Clinical

> Rheumatology 2005 Dec;11(6):303-310.

>

> =============================

[Guest guest]

---

Hi !

The article is titled " Core Stability Training for Healthy

Athletes: A Different Pardigm for Fitness Professionals, " by Dr.

Jeff Willardson in Strength and Conditioning Journal 29 (6):42-49.

2007.

Best wishes!

Dan Wathen, Youngstown (OH) State University, USA

In Supertraining , Huntsman

wrote:

>

> Hi Dan,

>

> I looked for your recommendation but am not finding it. What is

the name of the review? Is it in the regular journals or the

performance training journal?

>

> Thanks

>

> Huntsman

> Florida, USA

> =================================

> icp328 wrote: ---

> Hi !

>

> There is a nice review that might interest you in the latest

issue

> of the Strength & Conditioning. You can view it on-line at

> <www.nsca-lift.org>

>

> Best wishes!

>

> Dan Wathen,

> Youngstown (OH) State University, USA

>

> In Supertraining , " carruthersjam "

> <Carruthersjam@> wrote:

> >

> >

> > > >

> > > > >

> > > > > Hi all,

> > > > >

> > > > > Can anyone recommend a link or a website where I can

find

> > > > information and some proprioreception exercises for helping

> > someone

> > > > recover from a knee injury? I have only read about

> > propriorecption

> > > > training being beneficial after an injury to a joint and

would

> > like

> > > > to learn more. Also, a friend who has recently been

released

> > from

> > > pt

> > > > has asked me to help him with a conditioning program. He

> > recently

> > > > had knee surgery. I thought the proprioreception training

> would

> > > be

> > > > a nice compliment to the strength and conditioning

program.

> > Please

> > > > let me know if you need more specifics about the surgery in

> order

> > > to

> > > > answer my question.>>>

> >

> > ******

> > Noah Wasielewski, PhD, ATC, CSCS kindly forwarded the below

> > information to the group:

> >

> > There is *very* little research in this area. I have a few

> > references that pertain to ACL reconstructed persons and a

couple

> for

> > osteoarthritis. See below:

> >

> > Systematic Reviews

> > RL, NF, Feller JA A systematic review of the

effect

> of

> > proprioceptive and balance exercises on people with an injured

or

> > reconstructed anterior cruciate ligament Research in Sports

> Medicine

> > 2005;13(2):163-178.

> >

> > ---------------------------

> >

> > Clinical Trials

> > RL, NF, Feller JA. A randomised controlled trial

of

> > proprioceptive and balance training after surgical

reconstruction

> of

> > the anterior cruciate ligament. Research in Sports Medicine

2005

> Jul-

> > Sep;13(3):217-230.

> >

> > Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P, Khan KM.

The

> > effects of proprioceptive or strength training on the

> neuromuscular

> > function of the ACL reconstructed knee: a randomized clinical

> trial.

> > Scandinavian Journal of Medicine & Science in Sports 2003 Apr;13

> > (2):115-123.

> >

> > Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of

> proprioceptive

> > functions between computerized proprioception facilitation

> exercise

> > and closed kinetic chain exercise in patients with knee

> > osteoarthritis. Clinical Rheumatology 2007 Apr;26(4):520-528.

> >

> > Dracoglu D, Aydin R, Baskent A, Celik A. Effects of kinesthesia

> and

> > balance exercises in knee osteoarthritis. Journal of Clinical

> > Rheumatology 2005 Dec;11(6):303-310.

> >

> > =============================

> > Carruthers

> > Wakefield, UK

> >

>

[Guest guest]

Chad,

Thank you so much for bringing this point to my attention and for doing so in a

very nice way. Training post injuries is a new area for me. I plan to share

your post with my friend as also the other great info I have received since

asking this question. Since reading this post though , I thought to contact

my friend's pt and see if he will review my program and give me guidance as to

when and if the " proprio? " training can be implemented.

My definition of proprioreception training is doing things like standing on one

leg and closing your eyes. I am sure there are other things you can do with

your eyes closed to train this at least I think there is I just don't know what

they are yet. Yes?

My definition of balance training is using things like stability balls, wobble

boards, dura disks etc.. Is that correct? They are 2 separate things? Or can

balance training also mean doing things unilaterally on a flat surface?

When is it appropriate to incorporate these methods of training with a person

recovering from their injury? Just b/c they can weight bear does it mean it's

safe to ask them to do so on one leg or on an unstable surface? Is there some

quantifiable degree of strength they must have to even attempt it? I am most

interested and would love to hear from anyone who can offer insight into this

aspect of working with post pt people.

Thank you again Chad and all for you time

Huntsman

Florida, USA

Chad Scheitel wrote:

,

Though I know some people may disagree, but

" core/balance training " , or putting people onto

unstable surfaces (i.e. a core balance disc), is not

what I would recommend for someone coming out of knee

surgery. It might do you some good to look at some

previous discussions on here such as " Stability or

Control of Instability " and " What triggers a motor

program--a wrong one? " . I mention these two because

we first need to understand the forces that are put on

the body on an everyday basis and how we teach the

body to do the things we want it to do. Someone who

is coming off of surgery typically has extremely weak

muscles: they are in a somewhat contracted state, or

weak binding state, and this is why they tend to have

a limited range of motion. Because of this the first

concern needs to be getting these muscles back into

strong binding states. This is done by moving them

through the largest ranges of motion possible and

forcing the body to recruit as many motor units as

possible without excessively overloading the muscles

and causing reinjury. Now many will argue that

" balance/core training " does this exact thing. The

problem is that this may be an excessive overload for

many coming out of knee sugery where stabilizing

themselves in space on a hard flat surface is

typically hard enough for them (see " Stability or

control of instability " ). But the main issue with

this is the motor program that is being taught. When

doing " core/balance training " the body will not be

recruiting the motor-units, and thus fibers, of the

appropriate muscles and in the appropriate order at

the appropriate times. In other words an improper

motor program may be being taught which could

eventually lead to reinjury, or even cause reinjury in

the rehab process, or just teach the body to not be as

effective as it could otherwise be.

Lastly, I would like to dispell the usage of the term

" proprioception " when referring to this kind of

training. Proprioception is generally defined as the

ability to determine where a particular body part is

in space. Because part of the proprioceptive sense is

believed to be regulated by the sensory neurons in the

inner ear many people directly associate it with

balance (and for good reason, without the

proprioceptive sense we wouldn't be able to " balance "

at all). However, proprioception is used just as

effectively, or even more effectively during many

stable surfaced exercises, i.e. squats (especially one

legged), bench press, and any of the Olympic Lifts.

Call it " core training " or " balance training " or

whatever else you want, but to suggest that it teaches

someone to better understand where their body is at in

space is completely not accurate (this is not a hit on

's use of the term, it's not her fault that this

is what many people call it, just the fact that the

use of this terminology in reference to this kind of

training ever started).

Chad Scheitel, MA, CSCS

Minneapolis, MN

--- carruthersjam wrote:

>

> > >

> > > >

> > > > Hi all,

> > > >

> > > > Can anyone recommend a link or a website

> where I can find

> > > information and some proprioreception exercises

> for helping

> someone

> > > recover from a knee injury? I have only read

> about

> propriorecption

> > > training being beneficial after an injury to a

> joint and would

> like

> > > to learn more. Also, a friend who has recently

> been released

> from

> > pt

> > > has asked me to help him with a conditioning

> program. He

> recently

> > > had knee surgery. I thought the

> proprioreception training would

> > be

> > > a nice compliment to the strength and

> conditioning program.

> Please

> > > let me know if you need more specifics about the

> surgery in order

> > to

> > > answer my question.>>>

>

> ******

> Noah Wasielewski, PhD, ATC, CSCS kindly forwarded

> the below

> information to the group:

>

> There is *very* little research in this area. I

> have a few

> references that pertain to ACL reconstructed persons

> and a couple for

> osteoarthritis. See below:

>

> Systematic Reviews

> RL, NF, Feller JA A systematic review

> of the effect of

> proprioceptive and balance exercises on people with

> an injured or

> reconstructed anterior cruciate ligament Research in

> Sports Medicine

> 2005;13(2):163-178.

>

> ---------------------------

>

> Clinical Trials

> RL, NF, Feller JA. A randomised

> controlled trial of

> proprioceptive and balance training after surgical

> reconstruction of

> the anterior cruciate ligament. Research in Sports

> Medicine 2005 Jul-

> Sep;13(3):217-230.

>

> Liu-Ambrose T, Taunton JE, MacIntyre D, McConkey P,

> Khan KM. The

> effects of proprioceptive or strength training on

> the neuromuscular

> function of the ACL reconstructed knee: a randomized

> clinical trial.

> Scandinavian Journal of Medicine & Science in Sports

> 2003 Apr;13

> (2):115-123.

>

> Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison

> of proprioceptive

> functions between computerized proprioception

> facilitation exercise

> and closed kinetic chain exercise in patients with

> knee

> osteoarthritis. Clinical Rheumatology 2007

> Apr;26(4):520-528.

>

> Dracoglu D, Aydin R, Baskent A, Celik A. Effects of

> kinesthesia and

> balance exercises in knee osteoarthritis. Journal of

> Clinical

> Rheumatology 2005 Dec;11(6):303-310.

>

> =============================

[Guest guest]

Hi Todd,

Thank you. I enjoyed reading it and gave a copy of what you said to my friend

as well. I would like him to read what I consider the experts on this forum

have to say so he can be involved in the choice to do something or not. Hope

that is okay and not in violation of any privacy issues. Please do tell me if

that is not acceptable. I respect this forum and think it's a great

learning/sharing tool and do not want to lose the privaledge by being in

violation of something I am not supposed to do.

I was able to share my program with the pt earlier this afternoon. If you

don't mind, the references would be nice. I'd like to share them with the pt as

well and have them for my own knowledge. For now the pt recommended pool

running, forwards, backwards, and sideways in conjunction with any exercise that

does not allow my friend to twist his knee when his foot is in contact with the

ground. Rocking movement from heel strike to toe off was also recommended. In

the Strength and Conditioning Journal Vol 28, #5 of October 2006 I did find an

article talking about females and ACL injury. In this article there are

progressions of unstable exercises on pages 50-51 and his pt had no objections

to the progressions so long as he can weight bear properly so I guess that's the

first goal. He is very unsteady since being on cruthces for so long. Please

keep your suggestions and recommendations coming as my plans are certainly not

written in stone.

Thanks all, I so look forward to everyone's responses.

Huntsman

Florida, USA

===========================================

todd langer wrote:

,

Here's an excerpt from a paper I wrote on the topic. Some of the information

in the previous posts is inaccurate and this might help you out. Please, let

me know if you'd like the references.

" The maintenance of standing balance is a complex task, involving the

hierarchal interaction of three major sensory input systems; with visual and

vestibular (semicircular canals) sub-serving the somatosensory (myofascia,

joints, cutaneous receptors) (3, 4) and the outcome is precisely coordinated

motor output. This process is continually monitored by the 6th sense of

proprioception or the perception of position, posture and movement of the

body in relation to our environment (5). The joints and the surrounding

myofascia have sensory receptors (mechanoreceptors) that are in constant

dialogue with the central nervous system (CNS) (5, 6, 7, 8). This

proprioceptive mechanism is part of the body's feedback-feedforward system

that must routinely compensate for unpredictable postural perturbations and

provide adequate neuromuscular adaptability (2, 5, 8).

The more maneuverable an engineering system or biological structure, the

increased feedback it requires to maintain stability (8). Increasing your

proprioceptive awareness will decrease the amount of time needed by your

body's feedback system by sending more accurate commands to muscles, thus

increasing the efficiency of your anticipatory feedforward system in

predicting the consequences of future movement commands (2, 6, 8, 9,). This

becomes more important in increasingly dynamic settings where movement

occurs too quickly to allow us to rely upon sensory feedback to inform our

responses. For example, electromyographic (EMG) studies have shown that, in

order to permit explosive agonist force, the antagonist is not necessarily

active during highly dynamic movements, but that it automatically contracts

at the end range of motion to prevent joint injury and ensure balanced

tension around the joint (1). The feedforward mechanism is not a

monosynaptic reflex that comes from spinal cord, but rather a more complex

signal that comes from the brain and it plays a crucial role in the

anticipation, preparation, and on-line correction of such movements.

While the basic elements of anticipatory feedforward postural control are

innate, they can be enhanced by exercise that encourages feedback learning

(9). It should be emphasized that a well-formulated rehabilitation or

exercise regimen must integrate all components of sensorimotor function in

order to maximize neuromuscular adaptability. "

=======================================

[Guest guest]

Todd,

I believe you, and maybe even , need a little

more clarification of what I was saying. First off I

obviously did not give her a thorough explanation of

how the body works in regards to balance and stability

which was why I directed her to some of the other

posts. However, though I haven't had a chance to see

nor read all of your references I believe I can use

some of the points you made to better clarify myself.

" The maintenance of standing balance is a

complex task. "

Yes, it is! So is the balance in a lunge position or

squat position, even when not on an unstable surface.

See the problem is most people, especially those who

have suffered knee injuries, cannot nor never have

been able to do a squat or a lunge in the proper

position and using the proper muscles (relaxing

antagonists and contracting agonists). To force them

to do it on an unstable surface can lead to them to

doing it even more incorrect, but because they have

managed to offset the forces properly with the

opposing limbs, they still manage to balance in a

terrible body position (I have seen this one hundreds

of times over).

" and the outcome is precisely coordinated motor

output "

Unfortunately, most people have developed not so

precisely coordinated motors outputs throughout their

lives and end up getting injuries that result from

them. This is why health professionals such as

orthopedic surgeons, physical therapists,

chiropractors, and rolfers are as busy as they

currently are today.

" For example, electromyographic (EMG)studies have

shown that, in order to permit explosive agonist

force, the antagonist is not necessarily active

during highly dynamic movements, but that it

automatically contracts at the end range of

motion to prevent joint injury and ensure

balanced tension around the joint (1). "

If you have more than one research article that

clearly proves that " instability training " can

actually improve someone's ability to create a highly

explosive agonist force and antagonist relaxation, and

also a more properly timed contraction at the end

range of motion better than actually doing explosive,

highly dynamic movements in the proper body positions

I would very much like to read them. Don't forget

that doing iso-metrics and eccentrics can also be

considered explosive and are great at teaching proper

body position, or proprioception (Verkshoshansky,

Special Strength Training).

Chad Scheitel, MA, CSCS

Minneapolis, MN

--- todd langer wrote:

> ,

>

> Here's an excerpt from a paper I wrote on the topic.

> Some of the information

> in the previous posts is inaccurate and this might

> help you out. Please, let

> me know if you'd like the references.

>

> " The maintenance of standing balance is a complex

> task, involving the

> hierarchal interaction of three major sensory input

> systems; with visual and

> vestibular (semicircular canals) sub-serving the

> somatosensory (myofascia,

> joints, cutaneous receptors) (3, 4) and the outcome

> is precisely coordinated

> motor output. This process is continually monitored

> by the 6th sense of

> proprioception or the perception of position,

> posture and movement of the

> body in relation to our environment (5). The joints

> and the surrounding

> myofascia have sensory receptors (mechanoreceptors)

> that are in constant

> dialogue with the central nervous system (CNS) (5,

> 6, 7, 8). This

> proprioceptive mechanism is part of the body's

> feedback-feedforward system

> that must routinely compensate for unpredictable

> postural perturbations and

> provide adequate neuromuscular adaptability (2, 5,

> 8).

>

> The more maneuverable an engineering system or

> biological structure, the

> increased feedback it requires to maintain stability

> (8). Increasing your

> proprioceptive awareness will decrease the amount of

> time needed by your

> body's feedback system by sending more accurate

> commands to muscles, thus

> increasing the efficiency of your anticipatory

> feedforward system in

> predicting the consequences of future movement

> commands (2, 6, 8, 9,). This

> becomes more important in increasingly dynamic

> settings where movement

> occurs too quickly to allow us to rely upon sensory

> feedback to inform our

> responses. For example, electromyographic (EMG)

> studies have shown that, in

> order to permit explosive agonist force, the

> antagonist is not necessarily

> active during highly dynamic movements, but that it

> automatically contracts

> at the end range of motion to prevent joint injury

> and ensure balanced

> tension around the joint (1). The feedforward

> mechanism is not a

> monosynaptic reflex that comes from spinal cord, but

> rather a more complex

> signal that comes from the brain and it plays a

> crucial role in the

> anticipation, preparation, and on-line correction of

> such movements.

>

> While the basic elements of anticipatory feedforward

> postural control are

> innate, they can be enhanced by exercise that

> encourages feedback learning

> (9). It should be emphasized that a well-formulated

> rehabilitation or

> exercise regimen must integrate all components of

> sensorimotor function in

> order to maximize neuromuscular adaptability. "

>

> Todd Langer, MSc, Rolfer

> Boulder, CO

>

> _____

>

> From: Supertraining

> [mailto:Supertraining ]

> On Behalf Of Huntsman

> Sent: Friday, January 18, 2008 11:33 AM

> To: Supertraining

> Subject: Re: Proprioceptive training

>

>

>

> Chad,

>

> Thank you so much for bringing this point to my

> attention and for doing so

> in a very nice way. Training post injuries is a new

> area for me. I plan to

> share your post with my friend as also the other

> great info I have received

> since asking this question. Since reading this post

> though , I thought to

> contact my friend's pt and see if he will review my

> program and give me

> guidance as to when and if the " proprio? " training

> can be implemented.

>

> My definition of proprioreception training is doing

> things like standing on

> one leg and closing your eyes. I am sure there are

> other things you can do

> with your eyes closed to train this at least I think

> there is I just don't

> know what they are yet. Yes?

>

> My definition of balance training is using things

> like stability balls,

> wobble boards, dura disks etc.. Is that correct?

> They are 2 separate things?

> Or can balance training also mean doing things

> unilaterally on a flat

> surface?

>

> When is it appropriate to incorporate these methods

> of training with a

> person recovering from their injury? Just b/c they

> can weight bear does it

> mean it's safe to ask them to do so on one leg or on

> an unstable surface? Is

> there some quantifiable degree of strength they must

> have to even attempt

> it? I am most interested and would love to hear from

> anyone who can offer

> insight into this aspect of working with post pt

> people.

>

> Thank you again Chad and all for you time

> Huntsman

> Florida, USA

>

> Chad Scheitel <chadscheitel@

> <mailto:chadscheitel%40yahoo.com> yahoo.com>

> wrote: ,

>

> Though I know some people may disagree, but

> " core/balance training " , or putting people onto

> unstable surfaces (i.e. a core balance disc), is not

> what I would recommend for someone coming out of

> knee

> surgery. It might do you some good to look at some

> previous discussions on here such as " Stability or

> Control of Instability " and " What triggers a motor

> program--a wrong one? " . I mention these two because

> we first need to understand the forces that are put

> on

> the body on an everyday basis and how we teach the

> body to do the things we want it to do. Someone who

> is coming off of surgery typically has extremely

> weak

> muscles: they are in a somewhat contracted state, or

> weak binding state, and this is why they tend to

> have

> a limited range of motion. Because of this the first

> concern needs to be getting these muscles back into

> strong binding states. This is done by moving them

> through the largest ranges of motion possible and

> forcing the body to recruit as many motor units as

> possible without excessively overloading the muscles

> and causing reinjury. Now many will argue that

> " balance/core training " does this exact thing. The

> problem is that this may be an excessive overload

> for

> many coming out of knee sugery where stabilizing

> themselves in space on a hard flat surface is

> typically hard enough for them (see " Stability or

> control of instability " ). But the main issue with

> this is the motor program that is being taught. When

> doing " core/balance training " the body will not be

> recruiting the motor-units, and thus fibers, of the

> appropriate muscles and in the appropriate order at

> the appropriate times. In other words an improper

> motor program may be being taught which could

> eventually lead to reinjury, or even cause reinjury

> in

> the rehab process, or just teach the body to not be

> as

> effective as it could otherwise be.

>

> Lastly, I would like to dispell the usage of the

> term

> " proprioception " when referring to this kind of

> training. Proprioception is generally defined as the

> ability to determine where a particular body part is

> in space. Because part of the proprioceptive sense

> is

> believed to be regulated by the sensory neurons in

> the

> inner ear many people directly associate it with

> balance (and for good reason, without the

> proprioceptive sense we wouldn't be able to

> " balance "

> at all). However, proprioception is used just as

> effectively, or even more effectively during many

>

=== message truncated ===

[Guest guest]

Hi

You might also find an old article of Mel's worth reading to widen perspective

on this issue. " Functional training revisited " Strength and Conditioning Journal

Vol 24 No 5 pgs 42-46

For example he writes:

" the popular use of balance drills on balls, wobble boards, and other relatively

unstable surfaces may not serve as suitable functional activities because they

implicate very different change in support and compensatory strategies compared

to those involved in real sporting situations.... "

We also need to appreciate the relative roles of both proprioceptive and

vestibular systems when moving from static to dynamic balance.

Stebbing

London UK

[Guest guest]

,

Could you provide more information regarding his second surgery?

How long ago?

How long was he Non-weigthbearing on crutches?

HOw long prior to surgery was his injury, resulting in ultimate need

for surgery?

What types of formal Physical Therapy/rehabilitation has he completed?

How is his surgical knee range of motion, both flexion and extension?

Does he have pain with either end range of motion flexion, end range

of motion extension, pain at any point throughout his range of motion?

Does he have pain with symmetric weight-bearing, 50/50 on each leg?

How much weight (percentage of body weight) can he support pain-free

on the surgical leg?

Does he still have any swelling or joint effusion from the surgery?

Does his knee swell after a duration of weight-bearing?

The answers to these questions will go a long way in determining if

the surgical knee is even capable of doing any of the things that

have been proposed thus far. Given the nature of the microfracture

procedure, his weight-bearing joint surface may not be ready to do

anything more than ROM type exercises. This type of suregery is a

multiple month-to year type of rehabilitation process (Amare

Stoudemire, Kidd, Kenyon , Webber, among others)

There is absolutely no need to rush into things that the joint itself

is not ready to handle.

Diny PT, CSCS

Madison WI USA

> >

> > Hi all,

> >

> > Can anyone recommend a link or a website where I can find

> information and some proprioreception exercises for helping

someone

> recover from a knee injury? I have only read about

propriorecption

> training being beneficial after an injury to a joint and would

like

> to learn more. Also, a friend who has recently been released from

pt

> has asked me to help him with a conditioning program. He recently

> had knee surgery. I thought the proprioreception training would

be

> a nice compliment to the strength and conditioning program.

Please

> let me know if you need more specifics about the surgery in order

to

> answer my question.>>>

>

> ***

> More specific details would be helpful.

>

> Thanks

>

> Carruthers

> Wakefield, UK

>

> ============================================

>

[Guest guest]

Hi,

The discussion on proprioceptive training is getting closer to the

question I asked as " What triggers a motor program " . I've been reading

Schmidt's book " Motor Learning and Performance " . It describes a

Conceptual model with various feedback loops with different durations.

Something happens even without motor programs and these " reflexes " can

be learned – but it's very difficult.

Eloranta has compared different kinds of jumpers and noticed that

their coordination changes and concluded that this is due to

" proprioceptive training " . This is after years of doing a specific

type of exercises.

Eloranta, V. 2003. Influence of sports background on leg muscle

coordination in vertical jumps. Electromyography and Clinical

Neurophysiology, 43, 141–156.

I think that if you are doing a movement correct way and if your motor

system is working, best way to practice " proprioceptive nerves

system " , is by doing " normal " Physical activity. BUT what if learned

not to stimulate motor units? Or if you are recovering from an

accident? How do we get the proprioceptive feedback working, if it's

not responding as it should?

This has been an issue in discussion about core stability, deep

muscles – and at the moment knee muscles? (If I understood this

correctly.)

I'd like to think that this is one of motor learning's basic

questions. It's easier when you do not have a " malfunction " – but

still it's the same. Our motor control needs to learn to activate and

get feedback from all the feedback loops – and most of the loops are

unconscious. – but can be affected by conscious control. (I mean the

conscious me still runs the show – even though it can mess up a good

performance.)

Hannu Leinonen

Jyväskylä, Finland

[Guest guest]

,

Thank you for your your interest. I will ask him and his pt to help me answer

your questions.

Have a great day

Huntsman

Florida, USA

==============================

garydiny wrote:

,

Could you provide more information regarding his second surgery?

How long ago?

How long was he Non-weigthbearing on crutches?

HOw long prior to surgery was his injury, resulting in ultimate need

for surgery?

What types of formal Physical Therapy/rehabilitation has he completed?

How is his surgical knee range of motion, both flexion and extension?

Does he have pain with either end range of motion flexion, end range

of motion extension, pain at any point throughout his range of motion?

Does he have pain with symmetric weight-bearing, 50/50 on each leg?

How much weight (percentage of body weight) can he support pain-free

on the surgical leg?

Does he still have any swelling or joint effusion from the surgery?

Does his knee swell after a duration of weight-bearing?

The answers to these questions will go a long way in determining if

the surgical knee is even capable of doing any of the things that

have been proposed thus far. Given the nature of the microfracture

procedure, his weight-bearing joint surface may not be ready to do

anything more than ROM type exercises. This type of suregery is a

multiple month-to year type of rehabilitation process (Amare

Stoudemire, Kidd, Kenyon , Webber, among others)

There is absolutely no need to rush into things that the joint itself

is not ready to handle.

Diny PT, CSCS

Madison WI USA

> >

> > Hi all,

> >

> > Can anyone recommend a link or a website where I can find

> information and some proprioreception exercises for helping

someone

> recover from a knee injury? I have only read about

propriorecption

> training being beneficial after an injury to a joint and would

like

> to learn more. Also, a friend who has recently been released from

pt

> has asked me to help him with a conditioning program. He recently

> had knee surgery. I thought the proprioreception training would

be

> a nice compliment to the strength and conditioning program.

Please

> let me know if you need more specifics about the surgery in order

to

> answer my question.>>>

>

> ***

> More specific details would be helpful.

>

> Thanks

>

> Carruthers

> Wakefield, UK

>

> ============================================

>

[Guest guest]

Hi ,

Here are the answers to your questions as best as I could get them.

Second surgery was Nov. 19th 2007

Non weight bearing on crutches for 7 weeks

Original injury was from sliding off a roof while trying to repair it from

hurricane damage 2 years prior.

His formal pt consisted of 8 weeks of riding the stationary bike, light leg

extensions, hamstring curls, multi hip exercises (flexion, ext, abd but no add)

and flexibility

He has full knee flexion and about 2-5 degrees short of full extension without

it being painful and the pain is about a 3 on a 1-10 scale. He has no pain when

symmetric weight bearing. If I had to guess from watching him try to support his

BW on the surgery leg I'd say it's not great. He can't do it without buckling

and side flexing but he says it's not painful to do it. It's standing for long

periods of time that end up giving him pain but he can't avoid it it's part of

his job.

No joint swelling or effusion but can you clarify what you mena by effusion?

According to the definition in Websters he says no.

His knee does not swell after a duration of weight bearing, although in 1981

as a college football player he had his knee drained biweekly.

Hope this helps. Thank you and to all who have posted to help me out with

this.

Sincerely,

Huntsman

Florida, USA

=================================

garydiny wrote:

,

Could you provide more information regarding his second surgery?

How long ago?

How long was he Non-weigthbearing on crutches?

HOw long prior to surgery was his injury, resulting in ultimate need

for surgery?

What types of formal Physical Therapy/rehabilitation has he completed?

How is his surgical knee range of motion, both flexion and extension?

Does he have pain with either end range of motion flexion, end range

of motion extension, pain at any point throughout his range of motion?

Does he have pain with symmetric weight-bearing, 50/50 on each leg?

How much weight (percentage of body weight) can he support pain-free

on the surgical leg?

Does he still have any swelling or joint effusion from the surgery?

Does his knee swell after a duration of weight-bearing?

The answers to these questions will go a long way in determining if

the surgical knee is even capable of doing any of the things that

have been proposed thus far. Given the nature of the microfracture

procedure, his weight-bearing joint surface may not be ready to do

anything more than ROM type exercises. This type of suregery is a

multiple month-to year type of rehabilitation process (Amare

Stoudemire, Kidd, Kenyon , Webber, among others)

There is absolutely no need to rush into things that the joint itself

is not ready to handle.

===============================